RESUMEN
Victims of child abuse and neglect are more likely to develop emotional and behavioral problems than their non-abused peers. In many cases they do not receive evidence based treatments. Based on pilot studies and clinical experience, a structured and manualized case-management protocol was developed to provide child welfare professionals guidance, direction and support in helping these families find and engage in appropriate treatment. The protocol is described. A survey among child welfare workers indicates a lack of knowledge about mental disorders in victims of child abuse as well as an insufficient cooperation between the child welfare and the mental healthcare system. Child welfare workers who have applied the manual evaluate it positively. This study shows that the structured case-management can be implemented in a child welfare setting.
Asunto(s)
Manejo de Caso , Maltrato a los Niños/psicología , Maltrato a los Niños/terapia , Medicina Basada en la Evidencia , Accesibilidad a los Servicios de Salud , Trastornos Mentales/psicología , Trastornos Mentales/terapia , Adolescente , Niño , Maltrato a los Niños/diagnóstico , Protección a la Infancia , Terapia Combinada , Femenino , Adhesión a Directriz , Humanos , Masculino , Manuales como Asunto , Trastornos Mentales/diagnóstico , Proyectos Piloto , Resultado del TratamientoRESUMEN
Abstract The Internet-based psychotherapeutic intervention Onco-STEP for adolescent and young adult (AYA)-aged survivors of pediatric cancer was developed, implemented, and participants' satisfaction was evaluated by use of questionnaires. The intervention consisted of two modules: "Looking Back," aimed to reduce posttraumatic stress symptoms, and "Looking Ahead," supported coping with cancer-related fears of relapse and progression. The writing program was fully completed by 20 participants (Mage=27.3±4.8 years at study; 70% female). The majority was satisfied and perceived the treatment components as helpful. Results demonstrate that an Internet-based psychotherapeutic intervention for AYA-aged survivors of pediatric cancer is feasible and accepted by the target population.
Asunto(s)
Terapia Cognitivo-Conductual/métodos , Internet , Neoplasias/psicología , Satisfacción del Paciente , Trastornos por Estrés Postraumático/terapia , Sobrevivientes/psicología , Terapia Asistida por Computador , Adaptación Psicológica , Adolescente , Adulto , Niño , Progresión de la Enfermedad , Miedo , Estudios de Factibilidad , Femenino , Humanos , Masculino , Recurrencia Local de Neoplasia/psicología , Trastornos por Estrés Postraumático/psicología , Encuestas y Cuestionarios , Adulto JovenRESUMEN
BACKGROUND: Adolescence involves graduating from school and preparing one's professional career. The accomplishment of these tasks may be hampered by the experience of cancer. This study investigates the educational and professional achievements of German long-term survivors of adolescent cancer. PROCEDURE: Adult survivors of cancer during adolescence (n = 820, age at onset between 15 and 18 years; M = 15.8, SD = 0.9 years; age at follow-up: M = 30.4, SD = 6.0 years) were recruited through the German Childhood Cancer Registry. They completed self-reports with standard items on their educational and vocational level and their current occupational situation. Outcomes were compared to an age-matched sample from the general population (German Socio-Economic Panel, n = 820, age: M = 30.4, SD = 6.7). Risk factors for educational and vocational underachievement were identified by subgroup analyses. RESULTS: Compared to peers from the general population, survivors of cancer during adolescence achieved higher educational and vocational levels. A higher proportion of survivors was employed; however, survivors were significantly older when starting their first occupation. Subgroup analyses revealed that neuropsychological late effects were associated with reduced rates of graduation from university and of employment among the survivors. No such effect of neuro-cognitive late effects occurred for high school graduation. CONCLUSIONS: Most German survivors of cancer during adolescence participate in school and vocational life without major difficulties. Problems particularly arise for survivors with neuropsychological sequelae. Further research should investigate whether these results can be attributed to the German support system for pediatric cancer patients or to sample effects.
Asunto(s)
Escolaridad , Neoplasias/psicología , Neoplasias/rehabilitación , Ocupaciones , Sobrevivientes/psicología , Adaptación Psicológica , Adolescente , Adulto , Empleo , Femenino , Alemania , Humanos , Masculino , Adulto JovenRESUMEN
PURPOSE: To compare the general and health-related life satisfaction (LS) in long-term survivors of adolescent cancer with a community sample and to identify medical and psychosocial factors associated with LS. METHODS: LS of 820 survivors (age M = 30.4 ± 6.0 years; time since diagnosis M = 13.7 ± 6.0 years) was assessed with the Questions on Life Satisfaction (FLZ(M)) and compared to an age- and sex-matched community sample. The effects of medical, psychological, and socio-demographical factors on the survivors' general and health-related LS were investigated by means of multiple regression analyses. RESULTS: Survivors were significantly less satisfied than the comparison group in terms of both their general (P < .001, d = -.35) and health-related (P < .001, d = -.47) life. Somatic late effects, symptoms of depression and anxiety, and less posttraumatic growth were associated with impaired general and health-related LS. Moreover, being married contributed significantly to higher general LS. CONCLUSION: Adult survivors of cancer with onset during adolescence are experiencing less LS than the general population. Long-term routine follow-up visits are recommended to identify persisting effects of cancer survival on LS and to provide support for those with special needs. Physicians need to pay special attention to potential risk factors such as psychological distress, somatic late effects, persistent psychological distress, and a lack of posttraumatic growth, which are negatively correlated with LS.
Asunto(s)
Neoplasias , Calidad de Vida/psicología , Sobrevivientes/psicología , Adaptación Psicológica , Adolescente , Femenino , Alemania , Estado de Salud , Humanos , Masculino , Encuestas y CuestionariosRESUMEN
BACKGROUND: To determine the prevalence of posttraumatic stress, depression and anxiety in adults who have survived cancer (5 years) diagnosed in adolescence, as compared to healthy controls. PATIENTS AND METHODS: Survivors (n=820) of cancer during adolescence (age M=30.4+/-6.0 years; M=13.7+/-6.0 years since diagnosis) and 1027 matched controls without history of cancer (age M=31.5+/-6.9 years) completed standardised questionnaires measuring posttraumatic stress, depression and anxiety. Additionally, sub-groups of 202 survivors and 140 controls with elevated scores received structured interviews to ascertain DSM-IV-diagnoses. RESULTS: A total of 22.4% of the survivors reported clinically relevant symptoms of posttraumatic stress, anxiety and/or depression compared to 14.0% of the controls (odds ratios [ORs] 1.77; 95% confidence interval [CI] 1.39-2.26). The odds of posttraumatic stress symptoms in male (OR 3.92, 95% CI 1.80-8.51) and female (OR 3.83, 95% CI 2.54-5.76) survivors were more than three times those in the controls. However, only female survivors reported symptoms of depression and anxiety significantly more often (respectively: OR 2.12, 95% CI 1.16-3.85; and OR 1.86, 95% CI 1.33-2.59) than the controls. A relevant subgroup of 24.3% of the survivors met DSM-IV criteria for at least one mental disorder compared to 15.3% of the controls. CONCLUSION: Survivors of cancer during adolescence show an elevated risk of presenting symptoms of posttraumatic stress, anxiety and/or depression during adulthood which is also reflected in a greater number of DSM-IV diagnoses when compared to controls. Comprehensive follow-up assessments should include the examination of possible psychological late effects of a cancer diagnosis in adolescence in order to identify survivors needing psychosocial interventions even years after the completion of successful medical treatment.
Asunto(s)
Trastornos de Ansiedad/epidemiología , Trastorno Depresivo/epidemiología , Neoplasias/psicología , Trastornos por Estrés Postraumático/epidemiología , Sobrevivientes/psicología , Adolescente , Adulto , Análisis de Varianza , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Encuestas y Cuestionarios , Sobrevivientes/estadística & datos numéricos , Adulto JovenRESUMEN
OBJECTIVES: The study investigates psychosexual and family outcomes among German long-term survivors of adolescent cancer. METHODS: Survivors of cancer during adolescence (n = 820; age at onset of disease: M = 15.8 years, SD = 0.9, age at follow-up: M = 30.4, SD = 6.0 years) completed questionnaires on their family life and their psychosexual and autonomy development. Outcomes were compared to an age-matched sample (German Socio-Economic Panel, G-SOEP, n = 820, age: M = 30.4, SD = 6.7 years) from the general population and to a control group of adults without cancer (n = 1027, age: M = 31.5, SD = 7.0 years). RESULTS: Compared to controls of the same sex, female survivors had achieved fewer developmental milestones in their psychosexual development such as having their first boyfriend, or reached these milestones later, and reported a significantly stronger desire for children. Male survivors were more likely to live with their parents when compared to same sex controls. Equivalent proportions of survivors and persons in the G-SOEP were living in a long-term relationship; however, survivors were less likely to have ever married or had children. At first marriage and at the birth of their first child, survivors were significantly older compared to the G-SOEP. About 14.5% of survivors reported cancer-related infertility. CONCLUSIONS: Survivors of adolescent cancer experience some social late effects of the disease in adulthood, such as a delayed social development as well as substantial differences in their family life and living conditions compared to healthy peers.
Asunto(s)
Neoplasias/psicología , Desarrollo Psicosexual , Calidad de Vida/psicología , Sobrevivientes/psicología , Sobrevivientes/estadística & datos numéricos , Adolescente , Edad de Inicio , Estudios de Casos y Controles , Niño , Escolaridad , Familia , Femenino , Alemania , Humanos , Relaciones Interpersonales , Masculino , Estado Civil , Neoplasias/terapia , Grupo Paritario , Factores Sexuales , Conducta Social , Encuestas y Cuestionarios , Resultado del TratamientoRESUMEN
OBJECTIVE: Both cancer diagnosis and the consequent treatment are particularly challenging for adolescent patients. Adjuvant psychological interventions to reduce cancer-related distress are therefore a fundamental part of a multidisciplinary treatment. Assuming that psycho-oncology has to consider developmentally specific aspects, this review summarizes empirical studies of the efficacy and effectiveness of psychosocial interventions for adolescent cancer patients. METHODS: Electronic searches were conducted in four databases. Studies were included only if they were exclusively designed for adolescent cancer patients and incorporated a defined outcome measure to evaluate the effects of the implemented intervention. RESULTS: Only four studies fulfilled the inclusion criteria. One of those studies reported a significant improvement compared with a waitlist control group. The relevant gains were found in the overall level of distress, as well as in additional outcome variables such as knowledge of sexual issues, body image and anxiety about psychosexual issues. The remaining studies revealed no significant changes related to psychological distress and psychosocial functioning. CONCLUSION: Taken together, the findings point out that there is a lack of intervention research in psycho-oncology with adolescents. So far, there is only limited evidence for the effectiveness of psychosocial interventions to improve coping with cancer-associated problems in adolescent patients. Future research needs to be done in this population. In order to establish more conclusive results, larger samples and interventions particularly designed for adolescent patients ought to be studied.