Adolescents of parents with cancer:  A mediation-moderation analysis of the relationship between parental stress and psychological reactions in adolescents

Objective: We examine the relationship between parental cancer burden and adolescent psychopathology. Several reviews of stress and negative and positive changes in adolescents are available. We review a model by Compas and Grant describing this relationship and ask about the influence of individual and family resources. Methods: Sixty-one parents with cancer and their children were interviewed 6-9 months after cancer diagnosis. For the ill parents, the Karnofsky index, distress, and psychological distress were measured. In the adolescents, distress, internalization and externalization, threat of the disease, and as moderators: Self-efficacy, Optimism, Coherence, and Family Adaptability and Cohesion were recorded. Moderation, mediation, and moderated mediation models were tested using Hayes Process Programs. Results: 55.2% of adolescents perceive their parents' illness as threatening. This assessment varies with age, intrusion, and social competence. There is no direct relationship between parental stress and adolescents' psychological responses. The adolescent's threat perception mediates the relationship. Optimism, self-efficacy and coherence, and family resources have no moderating influence. Only optimism and self-efficacy moderate the threat perception-adolescent psychological response relationship, i.e., moderated mediation is present here. Conclusions: Adolescents' threat perception, optimism, and self-efficacy are significant in the model. This can be used to plan interventions to improve resilience in adolescents.