Journal of Clinical Psychology in Medical Settings

, Volume 21, Issue 3, pp 223–233 | Cite as

The Role of Social and Cognitive Processes in the Relationship Between Fear Network and Psychological Distress Among Parents of Children Undergoing Hematopoietic Stem Cell Transplantation

  • Shannon Myers Virtue
  • Sharon Manne
  • Laura Mee
  • Abraham Bartell
  • Stephen Sands
  • Pamela Ohman-Strickland
  • Tina Marie Gajda


The current study examined whether cognitive and social processing variables mediated the relationship between fear network and depression among parents of children undergoing hematopoietic stem cell transplant (HSCT). Parents whose children were initiating HSCT (N = 179) completed survey measures including fear network, Beck Depression Inventory, cognitive processing variables (positive reappraisal and self-blame) and social processing variables (emotional support and holding back from sharing concerns). Fear network was positively correlated with depression (p < .001). Self-blame and holding back emerged as individual partial mediators in the relationship between fear network and depression. Together they accounted for 34.3 % of the variance in the relationship between fear network and depression. Positive reappraisal and emotional support did not have significant mediating effects. Social and cognitive processes, specifically self-blame and holding back from sharing concerns, play a negative role in parents’ psychological adaptation to fears surrounding a child’s HSCT.


Pediatric hematopoietic stem cell transplant Fear Psychological adaptation Parents 



This research was supported by Grant (R01 CA127488) awarded to (second author) from the National Institute of Health (NIH). The authors wish to thank (research assistants names) for their assistance in collection of study data, and (project managers names) for project management. We would like to extend our appreciation to the transplant teams and the parent caregivers who participated in this study.

Conflict of Interest

Shannon Myers Virtue, Sharon Manne, Laura Mee, Abraham Bartell, Stephen Sands, Pamela Ohman-Strickland, and Tina Marie Gajda declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation of (name of participating institutions) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained for all participants for being included in this study.


  1. Baker, K., DePor, T., Burns, L., Ramsay, N., Naglia, J., & Robinson, L. (2003). New malignancies after blood or marrow stem-cell transplantation in children and adults: Incidence and risk factors. Journal of Clinical Oncology, 21, 1353–1358.CrossRefGoogle Scholar
  2. Barrera, M., & Ainlay, S. L. (1983). The structure of social support: A conceptual and empirical analysis. Journal of Community Psychology, 11(2), 133–143.Google Scholar
  3. Barrera, M., Atenafu, E., Doyle, J., Berlin-Romalis, D., & Hancock, K. (2012). Differences in mothers’ and fathers’ psychological distress after pediatric SCT: A longitudinal study. Bone Marrow Transplantation, 47(7), 934–939.PubMedCrossRefGoogle Scholar
  4. Barrera, M., Sandler, I. N., & Ramsay, T. B. (1981). Preliminary development of a scale of social support: Studies on college students. American Journal of Community Psychology, 9(4), 435–447.CrossRefGoogle Scholar
  5. Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the Beck depression inventory-II. San Antonio, TX: Psychological Corporation.Google Scholar
  6. Canning, R. D., Harris, E. S., & Kelleher, K. J. (1995). Factors predicting distress among caregivers of children with chronic medical conditions. Journal of Pediatric Psychology, 21(5), 735–749.CrossRefGoogle Scholar
  7. Carver, C. S. (1997). You want to measure coping but your protocol’s too long: Consider the brief COPE. International Journal of Behavioral Medicine, 4(1), 92–100.PubMedCrossRefGoogle Scholar
  8. Carver, C. S., Scheier, M. F., & Weintraub, J. K. (1989). Assessing coping strategies: A theoretically based approach. Journal of Personality and Social Psychology, 56, 267–283.PubMedCrossRefGoogle Scholar
  9. Cohen, M. Z., Ley, C., & Tarzian, A. J. (2001). Isolation in blood and marrow transplantation. Western Journal of Nursing Research, 23, 592–609.PubMedCrossRefGoogle Scholar
  10. Cohen, S., & Wills, T. A. (1985). Stress, social support, and the buffering hypothesis. Psychology Bulletin, 98, 310–357.CrossRefGoogle Scholar
  11. Creamer, M., Burgess, P., & Pattison, P. (1992). Reaction to trauma: A cognitive processing model. Journal of Abnormal Psychology, 101, 452–459.PubMedCrossRefGoogle Scholar
  12. Dermatis, H., & Leski, L. M. (1990). Psychological distress in parents consenting to child’s bone marrow transplantation. Bone Marrow Transplantation, 6(6), 411–417.PubMedGoogle Scholar
  13. DuHamel, K. N., Manne, S., Nereo, N., Ostroff, J., Martini, R., Parsons, S., … Redd, W. H. (2004). Cognitive processing among mothers of children undergoing bone marrow/stem cell transplantation. Psychosomatic Medicine, 66, 92–103.Google Scholar
  14. DuHamel, K. N., Rini, C., Austin, J., Ostroff, J., Parsons, S., Martini, R., … Manne, S. (2007). Optimism and life events as predictors of fear appraisals in mothers of children undergoing hematopoietic stem cell transplantation. Psychooncology, 16, 821–833.Google Scholar
  15. Dunkel-Schetter, C. (1984). Social support and cancer: Findings based on patient interviews and their implications. Journal of Social Issues, 40(4), 77–98.Google Scholar
  16. Figueiredo, M. I., Fries, E., & Ingram, K. M. (2004). The role of disclosure patterns and unsupportive social interactions in the well-being of breast cancer patients. Psychooncology, 13, 96–105.PubMedCrossRefGoogle Scholar
  17. Finch, J. F., Barrera, M, Jr, Okun, M. A., Bryant, W. H. M., Pool, G. J., & Snow-Turek, L. (1997). The factor structure of received social support: Dimensionality and the prediction of depression and life satisfaction. Journal of Social and Clinical Psychology, 16, 323–342.CrossRefGoogle Scholar
  18. Frazier, P., & Schaugen, L. (1994). Causal attributes and recovery from rape and other stressful life events. Journal of Social and Clinical Psychology, 13(1), 1–14.CrossRefGoogle Scholar
  19. Greening, L., & Stoppelbein, L. (2007). Brief report: Pediatric cancer, parental coping style, and risk for depressive, posttraumatic stress, and anxiety symptoms. Journal of Pediatric Psychology, 32(10), 1272–1277.PubMedCrossRefGoogle Scholar
  20. Hayes, A. F. (2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. New York, NY: Guilford Press.Google Scholar
  21. Janoff-Bulman, R. (1979). Characterological versus behavioral self-blame: Inquiries into depression and rape. Journal of Personality and Social Psychology, 37, 1798–1809.PubMedCrossRefGoogle Scholar
  22. Kazak, A. E. (1998). Posttraumatic distress in childhood cancer survivors and their parents. Pediatric Blood & Cancer, 30(S1), 60–68.Google Scholar
  23. Kronenberger, W. G., Carter, B. D., Edwards, J., Morrow, C., Stewart, J., & Sender, L. (1998). Psychological adjustment of mothers of children undergoing bone marrow transplantation: The role of stress, coping, and family factors. Children’s Health, 27(2), 77–95.Google Scholar
  24. Lepore, S. J. (2001). A social-cognitive processing model of emotional adjustment to cancer. In A. Baum & B. L. Anderson (Eds.), Psychosocial interventions for cancer (pp. 99–116). Washington, DC: American Psychological Association.CrossRefGoogle Scholar
  25. Llewellyn, C. D., Weinman, J., McGurk, M., & Humphris, G. (2008). Can we predict which head and neck cancer survivors develop fears of recurrence? Journal of Psychosomatic Research, 65(6), 525–532.PubMedCrossRefGoogle Scholar
  26. Lutwak, N., Panish, J., & Ferrari, J. (2003). Shame and guilt: Characterological vs. behavioral self-blame and their relationship to fear of intimacy. Personality and Individual Differences, 35, 909–916.CrossRefGoogle Scholar
  27. Maltezou, H., Kafetzis, D., Abisaid, D., Mantzouranis, E., Chan, K., & Rolston, K. V. (2000). Viral infections of children undergoing hematopoietic stem cell transplant. Pediatric Infectious Disease Journal, 19, 307–312.PubMedCrossRefGoogle Scholar
  28. Manne, S. (1998). Cancer in the marital context: A review of the literature. Cancer Investigation, 16(3), 188–202.PubMedCrossRefGoogle Scholar
  29. Manne, S. L., Badr, H., Zaider, T., Nelson, C., & Kissane, D. (2010). Cancer-related communication, relationship intimacy, and psychological distress among couples coping with localized prostate cancer. Journal of Cancer Survivorship, 4, 74–85.Google Scholar
  30. Manne, S., Dougherty, J., Veach, S., & Kless, R. (1999). Hiding worries from one’s spouse: Protective buffering among cancer patients and their spouses. Cancer Research Therapy and Control, 8, 175–188.Google Scholar
  31. Manne, S., DuHamel, K., Nereo, N., Ostroff, J., Parsons, S., Martini, R. … Redd, W. H. (2002). Predictors of PTSD in mothers of children undergoing bone marrow transplantation: The role of cognitive and social processes. Journal of Pediatric Psychology, 27(7), 607–617.Google Scholar
  32. Manne, S., DuHamel, K., Ostroff, J., Parsons, S., Marini, D. R., Williams, S. E., … Redd, W. H. (2003). Coping and the course of mother’s depressive symptoms during and after pediatric bone marrow transplant. Journal of the American Academy of Child and Adolescent Psychiatry, 42(9), 1055–1068.Google Scholar
  33. Manne, S., DuHamel, K., Ostroff, J., Parsons, S., Marini, D. R., Williams, S. E., … Redd, W. H. (2004). Anxiety, depression, and posttraumatic stress disorders among mothers of pediatric survivors of hematopoietic stem cell transplantation. Pediatrics, 113(6), 1700–1708.Google Scholar
  34. Manne, S., Nereo, N., DuHamel, K., Ostroff, J., Parsons, S., & Martini, D. R. (2001). Anxiety and depression in mothers of children undergoing bone marrow transplant: Symptom prevalence and use of the Beck depression and Beck anxiety inventories as screening instruments. Journal of Consulting and Clinical Psychology, 69(9), 1037–1047.PubMedCrossRefGoogle Scholar
  35. Mosher, C. E., Redd, W. H., Rini, C. M., Burkhalter, J. E., & DuHamel, K. (2009). Physical, psychological, and social sequelae following hematopoietic stem cell transplantation: A review of the literature. Psychooncology, 18, 113–127.PubMedCentralPubMedCrossRefGoogle Scholar
  36. Myers, S., Manne, S. L., Kissane, D. W., Ozga, M., Kashy, D. A., Rubin, S., … Graff, J. J. (2013). Social-cognitive processes associated with fear of recurrence among women newly diagnosed with gynecological cancers. Gynecologic Oncology, 128(1), 120–127.Google Scholar
  37. Nelson, A. E., Gleaves, L., & Nuss, S. (2003). Mothers’ responses during the child’s stem cell transplantation: Pilot study. Pediatric Nursing, 29(3), 219–223.PubMedGoogle Scholar
  38. Nelson, A. E., Miles, M. S., & Belyea, M. J. (1997). Coping and support effects on mothers’ stress responses to their child’s hematopoietic stem cell transplantation. Journal of Pediatric Oncology Nursing, 14(4), 202–212.PubMedGoogle Scholar
  39. Phipps, S., Dunavant, M., Lensing, S., & Rai, S. N. (2004). Patterns of distress in parents of children undergoing stem cell or bone marrow transplantation. Pediatric Blood & Cancer, 43(3), 267–274.CrossRefGoogle Scholar
  40. Phipps, S., Dunavant, M., Lensing, S., & Rai, S. N. (2005). Psychosocial predictors of distress in parents of children undergoing stem or bone marrow transplantation. Journal of Pediatric Psychology, 30(2), 139–153.PubMedCrossRefGoogle Scholar
  41. Phipps, S., & Mulhern, R. K. (1995). Family cohesion and expressiveness promote resilience to the stress of pediatric bone marrow transplant: A preliminary report. Journal of Developmental and Behavioral Pediatric, 16(4), 257–263.Google Scholar
  42. Pistrang, N., & Barker, C. (1995). The partner relationship in psychological response to breast cancer. Social Science and Medicine, 40(6), 789–797.Google Scholar
  43. Porter, L. S., Keefe, F. J., Hurwitz, H., & Faber, M. (2005). Disclosure between patients with gastrointestinal cancer and their spouses. Psychooncology, 14, 1030–1042.PubMedCrossRefGoogle Scholar
  44. Porter, L. S., Keefe, F. J., Wellington, C., & de Williams, A. (2008). Pain communication in the context of osteoarthritis: Patient and partner self-efficacy for pain communication and holding back from discussion of pain and arthritis-related concerns. Clinical Journal of Pain, 24(8), 662–668.PubMedCrossRefGoogle Scholar
  45. Preacher, K. J., & Hayes, A. H. (2004). SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behavior Research Methods, Instruments, and Computers, 36(4), 717–731.PubMedCrossRefGoogle Scholar
  46. Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavioral Research Methods, 40(3), 879–891.CrossRefGoogle Scholar
  47. Rini, C., Manne, S., DuHamel, K. N., Austin, J., Ostroff, J., Boulad, F., … Redd, W. H. (2008). Social support from family and friends as a buffer of low spousal support among mothers of critically ill children: A multilevel modeling approach. Health Psychology, 27(5), 593–603.Google Scholar
  48. Santavirta, N., Kettunen, S., & Solovieva, S. (2001). Coping in spouses of patients with acute myocardial infarction in the early phase of recovery. Journal of Cardiovascular Nursing, 16(1), 34–46.PubMedCrossRefGoogle Scholar
  49. Titman, P., Pink, E., Skucek, E., O’Hanlon, K., Cole, T. J., Gaspar, J., … Gaspar, H. B. (2008). Cognitive and behavioral abnormalities in children after hematopoietic stem cell transplantation for severe congenital immunodeficiencies. Blood, 112(9), 3907–3913.Google Scholar
  50. Wong, M. G., & Heriot, S. A. (2008). Parents of children with cystic fibrosis: How they hope, cope, and despair. Child: Care, Health, and Development, 34, 344–354.Google Scholar
  51. Zhou, E. S., Penedo, F. J., Bustillo, N. E., Benedict, C., Rasheed, M., Lechner, S., … Antoni, M. H. (2010). Longitudinal effects of social support and adaptive coping on the emotional well-being of survivors of localized prostate cancer. The Journal of Supportive Oncology, 8(5), 196–201.Google Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Shannon Myers Virtue
    • 1
  • Sharon Manne
    • 1
  • Laura Mee
    • 2
  • Abraham Bartell
    • 3
  • Stephen Sands
    • 4
  • Pamela Ohman-Strickland
    • 5
  • Tina Marie Gajda
    • 1
  1. 1.Department of Population ScienceRutgers Cancer Institute of New JerseyNew BrunswickUSA
  2. 2.Department of Psychiatry and Behavioral SciencesEmory University School of MedicineAtlantaUSA
  3. 3.Department of Psychiatry and Behavioral SciencesMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  4. 4.Department of Pediatrics and PsychiatryColumbia University Medical CenterNew YorkUSA
  5. 5.Department of Biostatistics, School of Public HealthRutgers UniversityNew BrunswickUSA

Personalised recommendations