Résumés
Abstract
Introduction: The cancer diagnosis of a child is an extremely challenging event that necessitates adjustments for parents at individual, family, and couple levels. To our knowledge, the factors that may explain parents’ relationship adjustments in the context of pediatric cancer remain under-documented.
Objectives: This dyadic study (1) described the perceived impact of pediatric cancer on parents’ relationship and (2) explored the relationship between attachment insecurities (both anxiety and avoidance) in both parents and their perception of how pediatric cancer influenced different facets of their relationship.
Method: Fifty-one mixed-sex couples whose child has received treatment for cancer (whether the treatment was ongoing or completed) within the past two years, completed online questionnaires.
Results: Path analyses, based on the Actor-Partner Interdependence Model, showed that higher attachment insecurities in mothers and fathers were associated with their own perception of a more negative impact of cancer on their relationship regarding the quality of partner support (actor effect). Surprisingly, higher attachment insecurities in mothers and fathers were also linked to their partner’s perception of a more positive impact of their child’s illness on their relationship functioning (partner effects).
Discussion and conclusion: These results suggest that attachment insecurities not always have solely negative impacts. In extreme situations, such as pediatric cancer (at least in the early years of post-diagnosis), attachment-related anxiety and avoidance of parents could protect the relationship from certain difficulties.
Keywords:
- attachment insecurities,
- relationship functioning,
- parents,
- pediatric cancer,
- actor-partner interdependence model
Résumé
Introduction : Le diagnostic de cancer d’un enfant est un événement extrêmement difficile qui nécessite des ajustements chez les parents au niveau individuel, familial et conjugal. À notre connaissance, les facteurs associés à l’ajustement conjugal dans ce contexte demeurent sous-documentés.
Objectifs : Cette étude dyadique (1) a décrit l’impact perçu du cancer pédiatrique sur la relation des parents et (2) a exploré la relation entre les insécurités d’attachement (anxiété et évitement) chez les deux parents et leur perception de l’influence du cancer pédiatrique sur les différentes facettes de leur relation.
Méthode : Cinquante et un couples hétérosexuels dont l’enfant a été traité pour un cancer (que le traitement soit en cours ou terminé) au cours des deux dernières années ont répondu à des questionnaires en ligne.
Résultats : Les analyses acheminatoires basées sur le modèle d’interdépendance acteur-partenaire ont indiqué qu’un niveau plus élevé d’insécurités d’attachement chez les mères et les pères était associé à leur propre perception d’un impact plus négatif du cancer sur leur relation en ce qui concerne la qualité du soutien du partenaire (effet acteur). Étonnamment, un niveau plus élevé d’insécurités d’attachement chez les mères et les pères était également lié à la perception de leur partenaire d’un impact plus positif de la maladie de leur enfant sur le fonctionnement de leur relation (effets partenaires).
Discussion et conclusion : Ces résultats suggèrent que les insécurités d’attachement n’ont pas uniquement des effets négatifs. Ainsi, nous proposons que dans des situations extrêmes, comme le cancer pédiatrique (au moins dans les premières années suivant le diagnostic), l’anxiété et l’évitement liés à l’attachement chez les parents pourraient protéger la relation de certaines difficultés.
Mots-clés :
- insécurités d’attachement,
- fonctionnement conjugal,
- parents,
- cancer pédiatrique,
- modèle d’interdépendance acteur-partenaire
Parties annexes
Bibliography
- Arruda-Colli, M. N. F., Bedoya, S. Z., Muriel, A., Pelletier, W., & Wiener, L. (2018). In good times and in bad: what strengthens or challenges a parental relationship during a child's cancer trajectory? Journal of Psychosocial Oncology, 36(5), 635–648. https://doi.org/10.1080/07347332.2018.1485813
- Beaulieu, N., Brassard, A., Bergeron, S., & Péloquin, K. (2022). Why do you have sex and does it make you feel better? Integrating attachment theory, sexual motives, and sexual well-being in long-term couples. Journal of Social and Personal Relationships, 39(12), 3753–3774. https://doi.org/10.1177/02654075221108759
- Berant, E., Mikulincer, M., & Florian, V. (2001). The Association of Mothers' Attachment Style and Their Psychological Reactions to the Diagnosis Of Infant's Congenital Heart Disease. Journal of Social and Clinical Psychology, 20(2), 208–232. https://doi.org/10.1521/jscp.20.2.208.22264
- Berant, E., Mikulincer, M., & Florian, V. (2003). Marital satisfaction among mothers of infants with congenital heart disease: The contribution of illness severity, attachment style, and the coping process. Anxiety, Stress & Coping, 16(4), 397–415. https://doi.org/10.1080/10615580031000090079
- Birnbaum, G. E., Simpson, J. A., Weisberg, Y. J., Barnea, E., & Assulin-Simhon, Z. (2012). Is it my overactive imagination? The effects of contextually activated attachment insecurity on sexual fantasies. Journal of Social and Personal Relationships, 29(8), 1131–1152. https://doi.org/10.1177/0265407512452978
- Brennan, K. A., Clark, C. L., & Shaver, P. R. (1998). Self-report measurement of adult attachment: An integrative overview. In J. A. Simpson & W. S. Rholes (Eds.), Attachment theory and close relationships (pp. 46–76). The Guilford Press.
- Burns, W., Péloquin, K., Rondeau, É., Drouin, S., Bertout, L., Lacoste-Julien, A., Krajinovic, M., Laverdière, C., Sinnett, D., & Sultan, S. (2018). Cancer-related effects on relationships, long-term psychological status and relationship satisfaction in couples whose child was treated for leukemia: A PETALE study. PloS one, 13(9), e0203435. https://doi.org/10.1371/journal.pone.0203435
- Burns, W., Péloquin, K., Sultan, S., Moghrabi, A., Marcoux, S., Krajinovic, M., Sinnett, D., Laverdière, C., & Robaey, P. (2017). A 2-year dyadic longitudinal study of mothers' and fathers' marital adjustment when caring for a child with cancer. Psycho-oncology, 26(10), 1660–1666. https://doi.org/10.1002/pon.4189
- Cassidy, J., & Shaver, P. R. (Eds.). (2016). Handbook of attachment: Theory, research, and clinical applications (3rd ed.). The Guilford Press.
- Cicchetti, D. V. (1994). Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology. Psychological Assessment, 6(4), 284–290. https://doi.org/10.1037/1040-3590.6.4.284
- Collins, N. L., & Read, S. J. (1990). Adult attachment, working models, and relationship quality in dating couples. Journal of Personality and Social Psychology, 58(4), 644–663. https://doi.org/10.1037/0022-3514.58.4.644
- Ellison, L. F., Xie, L., & Sung, L. (2021). Trends in paediatric cancer survival in Canada, 1992 to 2017. Health reports, 32(2), 3–15. https://doi.org/10.25318/82-003-x202100200001-eng
- Geenen, M. M., Cardous-Ubbink, M. C., Kremer, L. C., van den Bos, C., van der Pal, H. J., Heinen, R. C., Jaspers, M. W., Koning, C. C., Oldenburger, F., Langeveld, N. E., Hart, A. A., Bakker, P. J., Caron, H. N., & van Leeuwen, F. E. (2007). Medical assessment of adverse health outcomes in long-term survivors of childhood cancer. JAMA, 297(24), 2705–2715. https://doi.org/10.1001/jama.297.24.2705
- Hooghe, A., Rosenblatt, P. C., Vercruysse, T., Cosyns, V., Lambrecht, K., & Rober, P. (2020). “It’s Hard to Talk When Your Child Has a Life Threatening Illness”: A Qualitative Study of Couples Whose Child Is Diagnosed With Cancer. Journal of Pediatric Oncology Nursing, 37(6), 398–407. https://doi.org/10.1177/1043454220944125
- Impett, E. A., Gordon, A. M., & Strachman, A. (2008). Attachment and daily sexual goals: A study of dating couples. Personal Relationships, 15(3), 375–390. https://doi.org/10.1111/j.1475-6811.2008.00204.x
- Jiménez-Picón, N., Romero-Martín, M., Ramirez-Baena, L., Palomo-Lara, J. C., & Gómez-Salgado, J. (2021). Systematic Review of the Relationship between Couple Dyadic Adjustment and Family Health. Children (Basel, Switzerland), 8(6), 491. https://doi.org/10.3390/children8060491
- Kenny, D. A., Kashy, D. A., & Cook, W. L. (2006). Dyadic data analysis. The Guilford Press.
- Kim, M. A., Yi, J., Sang, J., & Molloy, J. (2018). The Impact of a Child’s Cancer on the Father’s Relationship with His Spouse in Korea. Journal of Child and Family Studies, 27(1), 166–175. https://doi.org/10.1007/s10826-017-0862-x
- Kline, R. (2016). Principles and Practice of Structural Equation Modeling (4th ed.). The Guilford Press.
- Knez, R., Francisković, T., Samarin, R. M., & Niksić, M. (2011). Attachment style in parents of children with chronic gastrointestinal disease. Collegium antropologicum, 35 Suppl 2, 125–130.
- Koopman, C., Gore-Felton, C., Marouf, F., Butler, L. D., Field, N., Gill, M., Chen, X.-H., Israelski, D., & Spiegel, D. (2000). Relationships of perceived stress to coping, attachment and social support among HIV-positive persons. AIDS Care, 12(5), 663–672. https://doi.org/10.1080/095401200750003833
- Lafontaine, M.-F., Brassard, A., Lussier, Y., Valois, P., Shaver, P. R., & Johnson, S. M. (2016). Selecting the best items for a short-form of the Experiences in Close Relationships questionnaire. European Journal of Psychological Assessment, 32(2), 140–154. https://doi.org/10.1027/1015-5759/a000243
- Lavee, Y. (2005). Correlates of Change in Marital Relationships under Stress: The Case of Childhood Cancer. Families in Society, 86(1), 112–120. https://doi.org/10.1606/1044-3894.1883
- Lavee, Y., & Mey-Dan, M. (2003). Patterns of Change in Marital Relationships among Parents of Children with Cancer. Health & Social Work, 28(4), 255–263. https://doi.org/10.1093/hsw/28.4.255
- Ljungman, L., Cernvall, M., Grönqvist, H., Ljótsson, B., Ljungman, G., & von Essen, L. (2014). Long-term positive and negative psychological late effects for parents of childhood cancer survivors: a systematic review. PLoS One, 9(7), e103340. https://doi.org/10.1371/journal.pone.0103340
- Long, K. A., & Marsland, A. L. (2011). Family adjustment to childhood cancer: a systematic review. Clinical child and family psychology review, 14(1), 57–88. https://doi.org/10.1007/s10567-010-0082-z
- Mader, L., Roser, K., Baenziger, J., Vetsch, J., Winther, J. F., Scheinemann, K., & Michel, G. (2019). Relationship status and quality of the partner relationship in parents of long-term childhood cancer survivors: The Swiss Childhood Cancer Survivor Study-Parents. Psycho-Oncology, 28(2), 309–316. https://doi.org/https://doi.org/10.1002/pon.4941
- Marganska, A., Gallagher, M., & Miranda, R. (2013). Adult attachment, emotion dysregulation, and symptoms of depression and generalized anxiety disorder. American Journal of Orthopsychiatry, 83(1), 131–141. https://doi.org/10.1111/ajop.12001
- Martin, J., Péloquin, K., Vachon, M. F., Duval, M., & Sultan, S. (2016). Systemic aspects of conjugal resilience in couples with a child facing cancer and marrow transplantation. International journal of qualitative studies on health and well-being, 11, 32423. https://doi.org/10.3402/qhw.v11.32423
- Mikulincer, M., & Florian, V. (1998). The relationship between adult attachment styles and emotional and cognitive reactions to stressful events. In J. A. Simpson & W. S. Rholes (Eds.), Attachment theory and close relationships (pp. 143–165). The Guilford Press.
- Mikulincer, M., & Shaver, P. (2016). Attachment in Adulthood: Structure, Dynamics, and Change (2nd ed.). The Guilford Press.
- Moreira, H., & Canavarro, M. C. (2016). Parental attachment insecurity and parenting stress: The mediating role of parents’ perceived impact of children’s diabetes on the family. Families, systems & health: the journal of collaborative family healthcare, 34(3), 240–249. https://doi.org/10.1037/fsh0000211
- National Cancer Institute. (2019, January). Childhood cancers. https://www.cancer.gov/types/childhood-cancers
- Nolte, T., Guiney, J., Fonagy, P., Mayes, L. C., & Luyten, P. (2011). Interpersonal stress regulation and the development of anxiety disorders: An attachment-based developmental framework. Frontiers in Behavioral Neuroscience, 5, 55. https://doi.org/10.3389/fnbeh.2011.00055
- Othman, A., Mohamad, N., Hussin, Z., & Blunden, S. (2011, 26-27 February). Factors Related to Parental Well Being in Children with Cancer. CQUniversity. Conference contribution. Conference on Social Science and Humanity, Singappore. https://hdl.handle.net/10018/1016477
- Pai, A. L., Greenley, R. N., Lewandowski, A., Drotar, D., Youngstrom, E., & Peterson, C. C. (2007). A meta-analytic review of the influence of pediatric cancer on parent and family functioning. Journal of family psychology: JFP: journal of the Division of Family Psychology of the American Psychological Association (Division 43), 21(3), 407–415. https://doi.org/10.1037/0893-3200.21.3.407
- Sabourin, S., Valois, P., & Lussier, Y. (2005). Development and validation of a brief version of the dyadic adjustment scale with a nonparametric item analysis model. Psychological Assessment, 17(1), 15–27. https://doi.org/10.1037/1040-3590.17.1.15
- Santos, S., Crespo, C., Canavarro, M. C., Kazak, A. E., & Guest Editors: Cynthia A. Gerhardt, Cynthia A. Berg, Deborah J. Wiebe and Grayson N. Holmbeck (2017). Parents' Romantic Attachment Predicts Family Ritual Meaning and Family Cohesion Among Parents and Their Children With Cancer. Journal of Pediatric Psychology, 42(1), 114–124. https://doi.org/10.1093/jpepsy/jsw043
- Silva-Rodrigues, F. M., Pan, R., Pacciulio Sposito, A. M., de Andrade Alvarenga, W., & Nascimento, L. C. (2016). Childhood cancer: Impact on parents’ marital dynamics. European journal of oncology nursing: the official journal of European Oncology Nursing Society, 23, 34–42. https://doi.org/10.1016/j.ejon.2016.03.002
- Simpson, J. A., & Maryhope, H. (2012). Bringing the Partner Into Attachment Theory and Research. Journal of Family Theory & Review, 4(4), 282–289. https://doi.org/10.1111/j.1756-2589.2012.00134.x
- Simpson, J. A., & Rholes, W. S. (2012). Adult attachment orientations, stress, and romantic relationships. In P. Devine & A. Plant (Eds.), Advances in Experimental Social Psychology (Vol. 45, pp. 279–328). Academic Press.
- Simpson, J. A., & Rholes, W. S. (2017). Adult Attachment, Stress, and Romantic Relationships. Current Opinion in Psychology, 13, 19–24. https://doi.org/10.1016/j.copsyc.2016.04.006
- Spanier, G. B. (1976). Measuring Dyadic Adjustment: New Scales for Assessing the Quality of Marriage and Similar Dyads. Journal of Marriage and Family, 38(1), 15–28. https://doi.org/10.2307/350547
- Sultan, S., Leclair, T., Rondeau, É., Burns, W., & Abate, C. (2016). A systematic review on factors and consequences of parental distress as related to childhood cancer. European Journal of Cancer Care, 25(4), 616–637. https://doi.org/10.1111/ecc.12361
- Van Schoors, M., Caes, L., Alderfer, M. A., Goubert, L., & Verhofstadt, L. (2017). Couple functioning after pediatric cancer diagnosis: a systematic review. Psycho-oncology, 26(5), 608–616. https://doi.org/10.1002/pon.4204
- Van Schoors, M., Loeys, T., Goubert, L., Berghmans, G., Ooms, B., Lemiere, J., Norga, K., & Verhofstadt, L. L. (2019). Couples Dealing With Pediatric Blood Cancer: A Study on the Role of Dyadic Coping. Frontiers in Psychology, 10, 402. https://doi.org/10.3389/fpsyg.2019.00402
- Vrijmoet-Wiersma, C. M., van Klink, J. M., Kolk, A. M., Koopman, H. M., Ball, L. M., & Egeler, R. M. (2008). Assessment of parental psychological stress in pediatric cancer: a review. Journal of Pediatric Psychology, 33(7), 694–706. https://doi.org/10.1093/jpepsy/jsn007
- Wang, Y., Huang, J., Rong, L., Wu, P., Kang, M., Zhang, X., Lu, Q., & Fang, Y. (2016). Impact of age on the survival of pediatric leukemia: An analysis of 15083 children in the SEER database. Oncotarget, 7(50), 83767–83774. https://doi.org/10.18632/oncotarget.11765
- Wiener, L., Battles, H., Zadeh, S., Pelletier, W., Arruda-Colli, M. N. F., & Muriel, A. C. (2017). The perceived influence of childhood cancer on the parents' relationship. Psycho-oncology, 26(12), 2109–2117. https://doi.org/10.1002/pon.4313
- Yi, J., Kim, M. A., Byrne, K. A., & Kim, S. H. (2021). Marital Conflicts as Perceived by Mothers of a Child with Cancer in Korea. Journal of Social Service Research, 47(6), 763–775. https://doi.org/10.1080/01488376.2021.1917474