Chronically Ill Kids & Depression

Chronically Ill Kids Put Up Defenses To Hide Depression

January 30, 2002

(Center for the Advancement of Health)

Children with cancer and other chronic illnesses often adapt to their conditions by repressing their emotions, covering over feelings of depression and anxiety, a new study finds.

The children "are not just engaging in denial or impression management but genuinely think of themselves as well adjusted, self controlled and content, and they organize their behavior to protect that self image," say the study's authors Sean Phipps, Ph.D., of St. Jude Children's Research Hospital and Ric Steele, Ph.D., of the University of Tennessee College of Medicine. "Such individuals are likely to seem very healthy on all self-report measures of mental health."

Children with cancer and serious chronic illnesses were much less likely to appear depressed or anxious based on common screening questions, according to the study published in the January issue of Psychosomatic Medicine.

However, these children were also much more likely to measure high for defensiveness on another common screening questionnaire. Defensiveness is defined as a tendency to avoid or deny negative thoughts about one's self. It is assessed based on measures of "behaviors and attitudes that are socially desirable but improbable," characterized by statements such as "I am always polite, even to people who are not nice to me."

The study included 130 children who were recently diagnosed with cancer, 121 children who had juvenile diabetes, cystic fibrosis or rheumatoid disease for more than a month, and 368 healthy children.

These results leave the unanswered question as to whether defensiveness is an adaptation that helps or hinders children. By seemingly blocking out depression and anxiety symptoms, defensiveness may help children better deal with the practical demands of their illness. But the repression of their feelings may also result in the children ignoring important signs of disease progression, says Phipps.

"The consistency in adaptive styles across the variety of illnesses sampled in the current study leads us to suggest that a shift toward increased defensiveness and more repressive styles of adaptation may be a general characteristic of children with chronic illness," the authors say.

Even if chronically ill children report no distress, further assessment using additional questions or additional screening may be indicated, they say.

The study was funded with grants from the American Lebanese Syrian Associated Charities and the National Cancer Institute.

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