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Erschienen in:

26.03.2020 | Special Issue: Sleep Science

Tolerating Uncertainty in the Dark: Insomnia Symptoms, Distress, and Well-Being Among Parents of Adolescents and Young Adults with Cancer

verfasst von: Aliza A. Panjwani, Brett M. Millar, Tracey A. Revenson

Erschienen in: International Journal of Behavioral Medicine | Ausgabe 1/2021

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Abstract

Background

Given the need to better understand mechanisms linking poor sleep and psychological distress in the context of chronic illness, we explored a novel factor, intolerance of uncertainty (IU), in relation to insomnia among parents of adolescents and young adults (AYAs) with cancer. We hypothesized that parents with higher IU would report greater insomnia symptoms, which would be associated with higher anxiety and depressive symptoms. These greater levels of anxiety and depressive symptoms are hypothesized to mediate the relationship between insomnia symptoms and subjective well-being (SWB).

Method

Surveying 59 parents of AYAs with cancer, we computed a parallel-serial mediational analysis using bootstrapping techniques for ordinary least squares regression to test two pathways (adjusting for whether the AYA currently resided with the parent). The first serial pathway was IU→insomnia symptoms→anxiety symptoms→SWB. The second pathway was IU→insomnia symptoms→depressive symptoms→SWB.

Results

Although the first pathway involving sleep and anxiety as serial mediators was nonsignificant, the second pathway with sleep and depressive symptoms was significant. The relationship between IU and SWB was mediated through insomnia and depressive symptoms. An alternative serial mediation analysis wherein depressive symptoms preceded sleep was not significant, lending support to study findings.

Conclusion

This study provides preliminary evidence that IU’s detrimental influence on depression and SWB may operate through its influence on insomnia symptoms. Given implications for parents’ well-being and, likely, their subsequent capacity to care for the AYA with cancer, interventions addressing IU and disturbed sleep among this underserved population deserve attention.
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Fußnoten
1
A similar parallel-serial mediation analysis with the inclusion of the AYA child’s age as a covariate was conducted; the same pattern of results as presented in the manuscript was found.
 
Literatur
1.
Zurück zum Zitat Revenson TA, Griva K, Luszczynska A, et al. Caregiving in the illness context. Palgrav Macmillan: Basingstoke; 2016.CrossRef Revenson TA, Griva K, Luszczynska A, et al. Caregiving in the illness context. Palgrav Macmillan: Basingstoke; 2016.CrossRef
2.
Zurück zum Zitat Nelson LP, Gold JI. Posttraumatic stress disorder in children and their parents following admission to the pediatric intensive care unit: a review. Pediatr Crit Care Med. 2012;13:338–47.CrossRef Nelson LP, Gold JI. Posttraumatic stress disorder in children and their parents following admission to the pediatric intensive care unit: a review. Pediatr Crit Care Med. 2012;13:338–47.CrossRef
3.
Zurück zum Zitat Klassen A, Raina P, Reineking S, Dix D, Pritchard S, O’Donnell M. Developing a literature base to understand the caregiving experience of parents of children with cancer: a systematic review of factors related to parental health and well-being. Support Care Cancer. 2007;15:807–18.CrossRef Klassen A, Raina P, Reineking S, Dix D, Pritchard S, O’Donnell M. Developing a literature base to understand the caregiving experience of parents of children with cancer: a systematic review of factors related to parental health and well-being. Support Care Cancer. 2007;15:807–18.CrossRef
4.
Zurück zum Zitat Lee KC, Yiin JJ, Lin PC, Lu SH. Sleep disturbances and related factors among family caregivers of patients with advanced cancer. Psychooncology. 2015;24:1632–8.CrossRef Lee KC, Yiin JJ, Lin PC, Lu SH. Sleep disturbances and related factors among family caregivers of patients with advanced cancer. Psychooncology. 2015;24:1632–8.CrossRef
5.
Zurück zum Zitat Daniel LC, Walsh CM, Meltzer LJ, Barakat LP, Kloss JD. The relationship between child and caregiver sleep in acute lymphoblastic leukemia maintenance. Support Care Cancer. 2018;26:1123–32.CrossRef Daniel LC, Walsh CM, Meltzer LJ, Barakat LP, Kloss JD. The relationship between child and caregiver sleep in acute lymphoblastic leukemia maintenance. Support Care Cancer. 2018;26:1123–32.CrossRef
6.
Zurück zum Zitat Grandner MA, Kripke DF, Yoon IY, Youngstedt SD. Criterion validity of the Pittsburgh sleep quality index: investigation in a non-clinical sample. Sleep Biol Rhythms. 2006;4:129–36.CrossRef Grandner MA, Kripke DF, Yoon IY, Youngstedt SD. Criterion validity of the Pittsburgh sleep quality index: investigation in a non-clinical sample. Sleep Biol Rhythms. 2006;4:129–36.CrossRef
7.
Zurück zum Zitat Karlson CW, Gallagher MW, Olson CA, Hamilton NA. Insomnia symptoms and well-being: longitudinal follow-up. Health Psychol. 2013;32:311–9.CrossRef Karlson CW, Gallagher MW, Olson CA, Hamilton NA. Insomnia symptoms and well-being: longitudinal follow-up. Health Psychol. 2013;32:311–9.CrossRef
8.
Zurück zum Zitat Buhr K, Dugas MJ. The role of fear of anxiety and intolerance of uncertainty in worry: an experimental manipulation. Behav Res Ther. 2009;47:215–23.CrossRef Buhr K, Dugas MJ. The role of fear of anxiety and intolerance of uncertainty in worry: an experimental manipulation. Behav Res Ther. 2009;47:215–23.CrossRef
9.
Zurück zum Zitat Gentes EL, Ruscio AM. A meta-analysis of the relation of intolerance of uncertainty to symptoms of generalized anxiety disorder, major depressive disorder, and obsessive–compulsive disorder. Clin Psychol Rev. 2011;31:923–33.CrossRef Gentes EL, Ruscio AM. A meta-analysis of the relation of intolerance of uncertainty to symptoms of generalized anxiety disorder, major depressive disorder, and obsessive–compulsive disorder. Clin Psychol Rev. 2011;31:923–33.CrossRef
10.
Zurück zum Zitat Vander Haegen M, Etienne AM. Intolerance of uncertainty in parents of childhood cancer survivors: a clinical profile analysis. J Psychosoc Oncol. 2018;36:717–33.CrossRef Vander Haegen M, Etienne AM. Intolerance of uncertainty in parents of childhood cancer survivors: a clinical profile analysis. J Psychosoc Oncol. 2018;36:717–33.CrossRef
11.
Zurück zum Zitat Barahmand U, Haji A. The impact of intolerance of uncertainty, worry and irritability on quality of life in persons with epilepsy: irritability as a mediator. Epilepsy Res. 2014;108:1335–44.CrossRef Barahmand U, Haji A. The impact of intolerance of uncertainty, worry and irritability on quality of life in persons with epilepsy: irritability as a mediator. Epilepsy Res. 2014;108:1335–44.CrossRef
12.
Zurück zum Zitat Ahadzadeh AS, Sharif SP. Uncertainty and quality of life in women with breast cancer: moderating role of coping styles. Cancer Nurs. 2018;41:484–90.CrossRef Ahadzadeh AS, Sharif SP. Uncertainty and quality of life in women with breast cancer: moderating role of coping styles. Cancer Nurs. 2018;41:484–90.CrossRef
13.
Zurück zum Zitat Lin RM, Xie SS, Yan YW, Yan WJ. Intolerance of uncertainty and adolescent sleep quality: the mediating role of worry. Personal Individ Differ. 2017;108:168–73.CrossRef Lin RM, Xie SS, Yan YW, Yan WJ. Intolerance of uncertainty and adolescent sleep quality: the mediating role of worry. Personal Individ Differ. 2017;108:168–73.CrossRef
14.
Zurück zum Zitat Sabouri S, Gerber M, Lemola S, Becker SP, Shamsi M, Shakouri Z, et al. Examining dark triad traits in relation to sleep disturbances, anxiety sensitivity and intolerance of uncertainty in young adults. Compr Psychiatry. 2016;68:103–10.CrossRef Sabouri S, Gerber M, Lemola S, Becker SP, Shamsi M, Shakouri Z, et al. Examining dark triad traits in relation to sleep disturbances, anxiety sensitivity and intolerance of uncertainty in young adults. Compr Psychiatry. 2016;68:103–10.CrossRef
15.
Zurück zum Zitat Carleton RN, Norton MP, Asmundson GJ. Fearing the unknown: a short version of the intolerance of uncertainty scale. J Anxiety Disord. 2007;21:105–17.CrossRef Carleton RN, Norton MP, Asmundson GJ. Fearing the unknown: a short version of the intolerance of uncertainty scale. J Anxiety Disord. 2007;21:105–17.CrossRef
16.
Zurück zum Zitat Hale W, Richmond M, Bennett J, Berzins T, Fields A, Weber D, et al. Resolving uncertainty about the intolerance of uncertainty scale–12: application of modern psychometric strategies. J Pers Assess. 2016;98:200–8.CrossRef Hale W, Richmond M, Bennett J, Berzins T, Fields A, Weber D, et al. Resolving uncertainty about the intolerance of uncertainty scale–12: application of modern psychometric strategies. J Pers Assess. 2016;98:200–8.CrossRef
17.
Zurück zum Zitat Khawaja NG, Yu LN. A comparison of the 27-item and 12-item intolerance of uncertainty scales. Clin Psychol. 2010;14:97–106.CrossRef Khawaja NG, Yu LN. A comparison of the 27-item and 12-item intolerance of uncertainty scales. Clin Psychol. 2010;14:97–106.CrossRef
18.
Zurück zum Zitat Bastien CH, Vallières A, Morin CM. Validation of the insomnia severity index as an outcome measure for insomnia research. Sleep Med. 2001;2:297–307.CrossRef Bastien CH, Vallières A, Morin CM. Validation of the insomnia severity index as an outcome measure for insomnia research. Sleep Med. 2001;2:297–307.CrossRef
19.
Zurück zum Zitat Morris BA, Thorndike FP, Ritterband LM, Glozier N, Dunn J, Chambers SK. Sleep disturbance in cancer patients and caregivers who contact telephone-based help services. Support Care Cancer. 2015;23:1113–20.CrossRef Morris BA, Thorndike FP, Ritterband LM, Glozier N, Dunn J, Chambers SK. Sleep disturbance in cancer patients and caregivers who contact telephone-based help services. Support Care Cancer. 2015;23:1113–20.CrossRef
20.
Zurück zum Zitat Kroenke K, Spitzer RL, Williams JB. The patient health Questionnaire-2: validity of a two-item depression screener. Med Care. 2003;41:1284–92.CrossRef Kroenke K, Spitzer RL, Williams JB. The patient health Questionnaire-2: validity of a two-item depression screener. Med Care. 2003;41:1284–92.CrossRef
21.
Zurück zum Zitat Wagner LI, Pugh SL, Small W Jr, et al. Screening for depression in cancer patients receiving radiotherapy: feasibility and identification of effective tools in the NRG oncology RTOG 0841 trial. Cancer. 2017;123:485–9.CrossRef Wagner LI, Pugh SL, Small W Jr, et al. Screening for depression in cancer patients receiving radiotherapy: feasibility and identification of effective tools in the NRG oncology RTOG 0841 trial. Cancer. 2017;123:485–9.CrossRef
22.
Zurück zum Zitat Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166:1092–7.CrossRef Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166:1092–7.CrossRef
23.
Zurück zum Zitat Hayes AF. Introduction to mediation, moderation, and conditional process analysis, second edition: a regression-based approach. 2nd ed. New York: Guilford Publications; 2018. Hayes AF. Introduction to mediation, moderation, and conditional process analysis, second edition: a regression-based approach. 2nd ed. New York: Guilford Publications; 2018.
24.
Zurück zum Zitat Edwards JR, Lambert LS. Methods for integrating moderation and mediation: a general analytical framework using moderated path analysis. Psychol Methods. 2007;1:1–22.CrossRef Edwards JR, Lambert LS. Methods for integrating moderation and mediation: a general analytical framework using moderated path analysis. Psychol Methods. 2007;1:1–22.CrossRef
25.
Zurück zum Zitat Cougle JR, Fitch KE, Fincham FD, Riccardi CJ, Keough ME, Timpano KR. Excessive reassurance seeking and anxiety pathology: tests of incremental associations and directionality. J Anxiety Disord. 2012;26:117–25.CrossRef Cougle JR, Fitch KE, Fincham FD, Riccardi CJ, Keough ME, Timpano KR. Excessive reassurance seeking and anxiety pathology: tests of incremental associations and directionality. J Anxiety Disord. 2012;26:117–25.CrossRef
26.
Zurück zum Zitat Rosen NO, Knäuper B. A little uncertainty goes a long way: state and trait differences in uncertainty interact to increase information seeking but also increase worry. Health Commun. 2009;24(3):228–38.CrossRef Rosen NO, Knäuper B. A little uncertainty goes a long way: state and trait differences in uncertainty interact to increase information seeking but also increase worry. Health Commun. 2009;24(3):228–38.CrossRef
27.
Zurück zum Zitat Rosser BA. Intolerance of uncertainty as a transdiagnostic mechanism of psychological difficulties: a systematic review of evidence pertaining to causality and temporal precedence. Cog Ther Res. 2019;43:438–63.CrossRef Rosser BA. Intolerance of uncertainty as a transdiagnostic mechanism of psychological difficulties: a systematic review of evidence pertaining to causality and temporal precedence. Cog Ther Res. 2019;43:438–63.CrossRef
28.
Zurück zum Zitat van der Heiden C, Muris P, van der Molen HT. Randomized controlled trial on the effectiveness of metacognitive therapy and intolerance-of-uncertainty therapy for generalized anxiety disorder. Behav Res Ther. 2012;50:100–9.CrossRef van der Heiden C, Muris P, van der Molen HT. Randomized controlled trial on the effectiveness of metacognitive therapy and intolerance-of-uncertainty therapy for generalized anxiety disorder. Behav Res Ther. 2012;50:100–9.CrossRef
29.
Zurück zum Zitat Robichaud M, Dugas MJ. A cognitive-behavioral treatment targeting intolerance of uncertainty. In: Davey GCL, Wells A, editors. Worry and its psychological disorders: Theory, assessment and treatment. Hoboken: Wiley; 2006. p. 289.CrossRef Robichaud M, Dugas MJ. A cognitive-behavioral treatment targeting intolerance of uncertainty. In: Davey GCL, Wells A, editors. Worry and its psychological disorders: Theory, assessment and treatment. Hoboken: Wiley; 2006. p. 289.CrossRef
30.
31.
Zurück zum Zitat Shaffer KM, Garland SN, Mao JJ, Applebaum AJ. Insomnia among cancer caregivers: a proposal for tailored cognitive behavioral therapy. J Psychother Integr. 2018;28:275–91.CrossRef Shaffer KM, Garland SN, Mao JJ, Applebaum AJ. Insomnia among cancer caregivers: a proposal for tailored cognitive behavioral therapy. J Psychother Integr. 2018;28:275–91.CrossRef
32.
Zurück zum Zitat Dugas MJ, Brillon P, Savard P, Turcotte J, Gaudet A, Ladouceur R, et al. A randomized clinical trial of cognitive-behavioral therapy and applied relaxation for adults with generalized anxiety disorder. Behav Ther. 2010;41:46–58.CrossRef Dugas MJ, Brillon P, Savard P, Turcotte J, Gaudet A, Ladouceur R, et al. A randomized clinical trial of cognitive-behavioral therapy and applied relaxation for adults with generalized anxiety disorder. Behav Ther. 2010;41:46–58.CrossRef
33.
Zurück zum Zitat Steiner EM, Dahlquist LM, Power TG, Bollinger ME. Intolerance of uncertainty and protective parenting in mothers of children with food allergy. Child Health Care. 2019;25:1–8. Steiner EM, Dahlquist LM, Power TG, Bollinger ME. Intolerance of uncertainty and protective parenting in mothers of children with food allergy. Child Health Care. 2019;25:1–8.
34.
Zurück zum Zitat Grinyer A, Thomas C. Young adults with cancer: the effect of the illness on parents and families. Int J Palliat Nurs. 2001;7:162–70.CrossRef Grinyer A, Thomas C. Young adults with cancer: the effect of the illness on parents and families. Int J Palliat Nurs. 2001;7:162–70.CrossRef
35.
Zurück zum Zitat Grinyer A. Young adults with cancer: parents’ interactions with health care professionals. Eur J Cancer Care. 2004;13:88–95.CrossRef Grinyer A. Young adults with cancer: parents’ interactions with health care professionals. Eur J Cancer Care. 2004;13:88–95.CrossRef
36.
Zurück zum Zitat Hamilton AS, Zhuang X, Modjeski D, Slaughter R, Ritt-Olson A, Milam J. Population-based survey methods for reaching adolescent and young adult survivors of pediatric cancer and their parents. J Adolesc Young Adul Oncol. 2019;8:40–8.CrossRef Hamilton AS, Zhuang X, Modjeski D, Slaughter R, Ritt-Olson A, Milam J. Population-based survey methods for reaching adolescent and young adult survivors of pediatric cancer and their parents. J Adolesc Young Adul Oncol. 2019;8:40–8.CrossRef
37.
Zurück zum Zitat Millar B, Patterson P, Desille N. Emerging adulthood and cancer: how unmet needs vary with time-since-treatment. Palliat Support Care. 2010;8:151–8.CrossRef Millar B, Patterson P, Desille N. Emerging adulthood and cancer: how unmet needs vary with time-since-treatment. Palliat Support Care. 2010;8:151–8.CrossRef
38.
Zurück zum Zitat Horrell B, Stephens C, Breheny M. Online research with informal caregivers: opportunities and challenges. Qual Res Psychol. 2015;12:258–71.CrossRef Horrell B, Stephens C, Breheny M. Online research with informal caregivers: opportunities and challenges. Qual Res Psychol. 2015;12:258–71.CrossRef
39.
Zurück zum Zitat Murphy LM, Flowers S, McNamara KA, Young-Saleme T. Fathers of children with cancer: involvement, coping, and adjustment. J Pediatr Health Care. 2008;22:182–9.CrossRef Murphy LM, Flowers S, McNamara KA, Young-Saleme T. Fathers of children with cancer: involvement, coping, and adjustment. J Pediatr Health Care. 2008;22:182–9.CrossRef
40.
Zurück zum Zitat Dahlquist LM, Czyzewski DI, Jones CL. Parents of children with cancer: a longitudinal study of emotional distress, coping style, and marital adjustment two and twenty months after diagnosis. J Pediatr Psychol. 1996;21:541–54.CrossRef Dahlquist LM, Czyzewski DI, Jones CL. Parents of children with cancer: a longitudinal study of emotional distress, coping style, and marital adjustment two and twenty months after diagnosis. J Pediatr Psychol. 1996;21:541–54.CrossRef
41.
Zurück zum Zitat Babson K, Feldner M. Sleep and affect: assessment, theory, and clinical implications. San Diego: Academic Press; 2015.CrossRef Babson K, Feldner M. Sleep and affect: assessment, theory, and clinical implications. San Diego: Academic Press; 2015.CrossRef
Metadaten
Titel
Tolerating Uncertainty in the Dark: Insomnia Symptoms, Distress, and Well-Being Among Parents of Adolescents and Young Adults with Cancer
verfasst von
Aliza A. Panjwani
Brett M. Millar
Tracey A. Revenson
Publikationsdatum
26.03.2020
Verlag
Springer US
Erschienen in
International Journal of Behavioral Medicine / Ausgabe 1/2021
Print ISSN: 1070-5503
Elektronische ISSN: 1532-7558
DOI
https://doi.org/10.1007/s12529-020-09869-6