Coping and Adjustment in Child Cancer Survivors: An Investigation into Spirituality as a Predictor of Psychosocial Outcomes
Boeving, Charmayne Alexandra
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The state of the literature on the psychosocial adjustment of children and adolescents with cancer is primed for novel contributions to the promotion of quality of life and depletion of negative psychosocial outcomes. Many recent studies indicate that this population may be at increased risk for depressed and anxious symptomatology; however, there is a large degree of individual variation. Coping responses have been demonstrated as significant predictors of adjustment outcomes with these patients. Research focusing upon coping with childhood chronic illness is progressing toward levels of greater specificity of construct and application; therefore, it is timely to target specific coping mechanisms in response to specified stressors. Health psychology has examined the role of spirituality as promoting positive health outcomes in adult populations. However, the pediatric literature has not empirically addressed this potential coping mechanism for child populations. The current study sought to: (a) develop a preliminary child measure of spiritual coping, and (b) to employ this assessment tool in an empirical investigation of the relationship between spiritual coping and psychosocial adjustment in the childhood cancer population. This investigation included 55 child participants recruited from three hospital settings across the southeastern, Midwestern, and western United States. During the measure development phase, 22 children were interviewed regarding their use of coping strategies (specifically spirituality) to target illness-related stress. The spiritual coping measure was based upon the response set obtained during this phase, and incorporated items into two subscales: existential and religious coping. The rest of the sample (N=33) participated in an individual interview that assessed coping (approach, avoidant, and spiritual) as well as depression, anxiety, and quality of life. A pilot factor analysis was employed to examine the structure of the new spiritual coping measure. Additionally, hierarchical regression analyses were employed to examine the contributions of each coping variable to the prediction of child adjustment outcomes. The results indicated that depression is significantly predicted by the full coping model; however, the analyses for anxiety and quality of life were not significant. Furthermore, spiritual coping was not demonstrated to add significantly to the prediction of child adjustment in the full coping model. Post-hoc analyses revealed a mediation effect for social functioning upon the relationship of existential coping and depression. Additionally, religious coping was found to mediate the effect of emergency room utilization upon perceived efficacy of avoidant coping. The factor analysis for the measure, while preliminary in nature, reflected a two-factor solution with strong loadings that closely approximated the theoretical delineation of the subscales.
- Doctoral Dissertations