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Parental cancer and children’s well-being: understanding the potential role of psychological stress
Institutionen för Medicinsk Epidemiologi och Biostatistik, Karolinska Institutet, Stockholm, Sweden.
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Early life stress has a major influence on one’s health through the life course. During childhood, early experience may not only affect the normal brain development, but also influence the susceptibility to mental and physical disorders. A cancer diagnosis in a parent may cause substantial distress in the children, who may have to confront and adapt to short- and long-term changes in their lives and subsequently experience a higher risk of physical and psychosocial problems. Therefore, the first aim of this thesis was to examine whether parental cancer is associated with physical and mental health problems in the affected children using data from the Swedish national registers. Further, to explore the potential mechanism determining the impact of stress on children’ health, we focused on the brain development in childhood and investigated the association between stress biomarkers and brain morphology, using data from a Dutch population-based cohort.

In Study I, we assessed the association between parental cancer and risk of injury in a large representative sample of Swedish children. We found that parental cancer was associated with a higher risk of hospital contacts for injury, particularly during the first year after the cancer diagnosis and when the parent experienced a psychiatric illness after the cancer diagnosis. The risk increment reduced during the second and third years and became null afterwards.

Given the observed higher risk of adverse physical health in terms of injury, we further investigated the influence of parental cancer on adverse mental health in terms of psychiatric disorders among children. In Study II, we constructed a matched cohort, and separately examined the associations between parental cancer diagnosed during pregnancy or after birth and clinical diagnoses of psychiatric disorders or use of prescribed psychiatric medications. Paternal but not maternal cancer during pregnancy appeared to be associated with a higher risk of psychiatric disorders, primary among girls. Parental cancer after birth conferred a higher risk of clinical diagnoses of psychiatric disorders, particularly stress reaction and adjustment disorders. The affected children also experienced a higher risk of use of prescribed psychiatric medications, particularly anxiolytics. The latter associations were most pronounced for parental cancer with poor expected survival and for parental death after cancer diagnosis.

In Study III, we focused on other domains of mental and physical health affected by parental cancer. We examined the associations of parental cancer with intellectual performance, stress resilience, and physical fitness among boys that underwent the compulsory military conscription examination during early adulthood. We observed positive associations of parental cancer with low stress resilience and low physical fitness, with stronger associations noted for parental cancer with poor expected survival and for a loss of parent through death after cancer diagnosis. No overall association was observed between parental cancer and intellectual performance, but the parental cancer with poor expected survival or resulting in a death of the parent was associated with a higher risk of low intellectual performance.

Place, publisher, year, edition, pages
Stockholm: Karolinska Institutet , 2017. , p. 53
National Category
Psychiatry
Identifiers
URN: urn:nbn:se:oru:diva-67304ISBN: 978-91-7676-652-1 (print)OAI: oai:DiVA.org:oru-67304DiVA, id: diva2:1221060
Public defence
2017-04-28, Hörsal Atrium, Nobels väg 12B, Stockholm, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2018-06-19 Created: 2018-06-19 Last updated: 2018-06-19Bibliographically approved
List of papers
1. Childhood injury after a parental cancer diagnosis
Open this publication in new window or tab >>Childhood injury after a parental cancer diagnosis
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2015 (English)In: eLIFE, E-ISSN 2050-084X, Vol. 4, article id e08500Article in journal (Refereed) Published
Abstract [en]

A parental cancer diagnosis is psychologically straining for the whole family. We investigated whether a parental cancer diagnosis is associated with a higher-than-expected risk of injury among children by using a Swedish nationwide register-based cohort study. Compared to children without parental cancer, children with parental cancer had a higher rate of hospital contact for injury during the first year after parental cancer diagnosis (hazard ratio [HR]=1.27, 95% confidence interval [CI]=1.22-1.33), especially when the parent had a comorbid psychiatric disorder after cancer diagnosis (HR=1.41, 95% CI=1.08-1.85). The rate increment declined during the second and third year after parental cancer diagnosis (HR=1.10, 95% CI=1.07-1.14) and became null afterwards (HR=1.01, 95% CI=0.99-1.03). Children with parental cancer also had a higher rate of repeated injuries than the other children (HR=1.13, 95% CI= 1.12-1.15). Given the high rate of injury among children in the general population, our findings may have important public health implications.

Place, publisher, year, edition, pages
eLife Sciences Publications Ltd, 2015
National Category
Other Medical Sciences Pediatrics
Research subject
Biology
Identifiers
urn:nbn:se:oru:diva-47206 (URN)10.7554/eLife.08500 (DOI)000373886800001 ()26519735 (PubMedID)2-s2.0-84955264959 (Scopus ID)
Funder
Swedish Research Council, SIMSAM 340-2013-5867 SIMSAM 80748301Forte, Swedish Research Council for Health, Working Life and Welfare, 2012-0498Swedish Society for Medical Research (SSMF)
Note

Funding Agencies:

China Scholarship Council 20126100002

Karolinska Institutet

Available from: 2015-12-22 Created: 2015-12-22 Last updated: 2018-07-23Bibliographically approved
2. Psychiatric disorders among children of parents with cancer: A Swedish register-based matched cohort study
Open this publication in new window or tab >>Psychiatric disorders among children of parents with cancer: A Swedish register-based matched cohort study
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(English)Manuscript (preprint) (Other academic)
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-67312 (URN)
Available from: 2018-06-19 Created: 2018-06-19 Last updated: 2018-06-19Bibliographically approved
3. Is parental cancer associated with intellectual, psychological and physical performance in early adulthood?
Open this publication in new window or tab >>Is parental cancer associated with intellectual, psychological and physical performance in early adulthood?
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(English)Manuscript (preprint) (Other academic)
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-67308 (URN)
Available from: 2018-06-19 Created: 2018-06-19 Last updated: 2018-06-19Bibliographically approved
4. No association between hair cortisol or cortisone and brain morphology in children
Open this publication in new window or tab >>No association between hair cortisol or cortisone and brain morphology in children
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2016 (English)In: Psychoneuroendocrinology, ISSN 0306-4530, E-ISSN 1873-3360, Vol. 74, no 101, p. 101-110Article in journal (Refereed) Published
Abstract [en]

Little is known about the relationship between the long-term hypothalamic-pituitary-adrenal (HPA) axis functioning and brain structure in children. Glucocorticoid in hair has emerged as an important biomarker of HPA activity. In this study, we investigated the associations of hair cortisol and cortisone concentrations with brain morphology in young children. We included 219 children aged 6-10 years from the Generation R Study in Rotterdam, the Netherlands. We examined cortisol and cortisone concentrations by hair analysis using liquid chromatography-tandem mass spectrometry, and assessed brain morphometric measures with structural magnetic resonance imaging. The relationships of hair cortisol and cortisone concentrations with brain volumetrics, cortical thickness, cortical surface area and gyrification were analyzed separately after adjustment for several potential confounding factors. We observed a positive association between cortisol concentrations and cortical surface area in the parietal lobe, positive associations of cortisone concentrations with thalamus volume, occipital lobe volume and cortical surface area in the parietal lobe, and a negative association between cortisone concentrations and cortical surface area in the temporal lobe in the regions of interest analyses. A negative association between cortisol or cortisone concentrations and hippocampal volume was observed in children with behavioral problems. The whole brain vertex-wise analyses did however not show any association between cortisol or cortisone concentration and brain morphometric measures after correction for multiple testing. Although some associations are noted in region of interest analyses, we do not observe clear association of hair cortisol or cortisone with brain morphometric measures in typically developing young children.

Place, publisher, year, edition, pages
Pergamon Press, 2016
Keywords
Child, hair, cortisol, cortisone, brain morphology
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-67309 (URN)10.1016/j.psyneuen.2016.08.023 (DOI)000387524700012 ()27598456 (PubMedID)2-s2.0-84984984875 (Scopus ID)
Available from: 2018-06-19 Created: 2018-06-19 Last updated: 2018-06-19Bibliographically approved

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