{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T04:56:10Z","timestamp":1791262570285,"version":"4.1.0"},"reference-count":63,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":15,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82303929"],"award-info":[{"award-number":["82303929"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007452","name":"Wu Jieping Medical Foundation","doi-asserted-by":"publisher","award":["320.6750.2021\u201004\u201066"],"award-info":[{"award-number":["320.6750.2021\u201004\u201066"]}],"id":[{"id":"10.13039\/100007452","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100012226","name":"Fundamental Research Funds for the Central Universities","doi-asserted-by":"publisher","award":["CUC25GT23"],"award-info":[{"award-number":["CUC25GT23"]}],"id":[{"id":"10.13039\/501100012226","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2026,9]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n Multidimensional sleep problems are prevalent among children and adolescents with cancer. Although perceived family functioning and family resilience are known to be associated with sleep problems, the contributions of depression and anxiety remain unquantified.<\/jats:p>\n <\/jats:sec>\n \n Aims<\/jats:title>\n To examine associations of perceived family functioning and family resilience with multidimensional sleep problems and quantify indirect associations through depression and anxiety among Chinese children and adolescents undergoing active cancer treatment.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This cross\u2010sectional study used baseline data from 518 patients aged 7 to <\u200918\u2009years in the Chinese Childhood Cancer Survivorship Wellbeing Cohort. Perceived family functioning and family resilience were assessed using the Family APGAR Questionnaire and Family Hardiness Index, respectively. Depression and anxiety were measured using the pediatric PROMIS scales, and multidimensional sleep problems were assessed using the BEARS Sleep Screening Scale. A mutually adjusted, multiple\u2010predictor parallel mediation model used 5000 bootstrap resamples and adjusted for sociodemographic and clinical covariates. A parallel indirect\u2010association sensitivity analysis with the BEARS summed score modeled as a Poisson count outcome was performed.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Perceived family functioning was negatively correlated with anxiety (\n r<\/jats:italic>\n \u2009=\u2009\u22120.341), depression (\n r<\/jats:italic>\n \u2009=\u2009\u22120.355), and sleep problems (\n r<\/jats:italic>\n \u2009=\u2009\u22120.240), and family resilience was negatively correlated with anxiety (\n r<\/jats:italic>\n \u2009=\u2009\u22120.283), depression (\n r<\/jats:italic>\n \u2009=\u2009\u22120.311), and sleep problems (\n r<\/jats:italic>\n \u2009=\u2009\u22120.222; all\n p<\/jats:italic>\n \u2009<\u20090.001). After depression and anxiety were included, perceived family functioning remained directly associated with fewer sleep problems (\n B<\/jats:italic>\n \u2009=\u2009\u22120.061,\n p<\/jats:italic>\n \u2009<\u20090.05), with a significant total indirect association (\n B<\/jats:italic>\n \u2009=\u2009\u22120.048, bias\u2010corrected 95% bootstrap CI: \u22120.071 to \u22120.028). Family resilience showed a nonsignificant direct association but a significant total indirect association (\n B<\/jats:italic>\n \u2009=\u2009\u22120.010, bias\u2010corrected 95% bootstrap CI: \u22120.016 to \u22120.004).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Depression and anxiety showed significant indirect associations between family protective factors and sleep problems. Interventions addressing family dynamics and psychological distress may improve sleep outcomes.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/cam4.72248","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T04:34:41Z","timestamp":1789619681000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Perceived Family Functioning, Family Resilience, and Multidimensional Sleep Problems Among Chinese Children and Adolescents With Cancer: The Indirect Association of Depression and Anxiety"],"prefix":"10.1002","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0139-2862","authenticated-orcid":false,"given":"Zhe","family":"Li","sequence":"first","affiliation":[{"name":"National Center for Pediatric Cancer Surveillance, National Center for Children's Health Beijing Children's Hospital, Capital Medical University Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-4174-3059","authenticated-orcid":false,"given":"Chaoran","family":"Hu","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Media Convergence and Communication Communication University of China Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lijia","family":"Yao","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cancer Surveillance Project Beijing To You PrimeKid Nexus Technologies Co. Ltd. Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-0718-9199","authenticated-orcid":false,"given":"Yifei","family":"Wang","sequence":"additional","affiliation":[{"name":"National Center for Pediatric Cancer Surveillance, National Center for Children's Health Beijing Children's Hospital, Capital Medical University Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhuoyu","family":"Yang","sequence":"additional","affiliation":[{"name":"National Center for Pediatric Cancer Surveillance, National Center for Children's Health Beijing Children's Hospital, Capital Medical University Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4060-5982","authenticated-orcid":false,"given":"Xiaoning","family":"Wang","sequence":"additional","affiliation":[{"name":"School of Data Science and Media Intelligence, Communication University of China Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Ni","sequence":"additional","affiliation":[{"name":"National Center for Pediatric Cancer Surveillance, National Center for Children's Health Beijing Children's Hospital, Capital Medical University Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2014.59.1222"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.3390\/children8121100"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352\u20104642(22)00380\u20107"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2017.76.4696"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.30742"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/1559827616681725"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2025.1535442"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/jncics\/pkae010"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.sleep.2021.09.008"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1080\/07347332.2023.2231412"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0249707"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2021.102101"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470\u20102045(23)00320\u20100"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1080\/07347332.2023.2197433"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1093\/jpepsy\/jsad079"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13052\u2010023\u201001409\u20108"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1023\/A:1005135217449"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.2147\/PRBM.S301765"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10826\u2010005\u20105054\u20104"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1590\/0034\u20107167\u20102016\u20100476"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.4236\/jss.2015.312014"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10567\u2010009\u20100060\u20105"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1177\/1074840707312237"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00520\u2010021\u201006280\u2010z"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejon.2021.102078"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.1002\/pon.5242"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.esmoop.2023.102044"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.1177\/27527530211056001"},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2023.2168"},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.1002\/pon.5884"},{"key":"e_1_2_12_32_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.31202"},{"key":"e_1_2_12_33_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10826\u2010021\u201001928\u20100"},{"key":"e_1_2_12_34_1","unstructured":"National Bureau of Statistics of China \u201cRegulations on the Division of Urban and Rural Areas for Statistics [Internet] \u201d 2008 https:\/\/www.stats.gov.cn\/sj\/pcsj\/rkpc\/5rp\/html\/append7.htm."},{"key":"e_1_2_12_35_1","unstructured":"National Bureau of Statistics of China \u201cNational Economy Witnessed Steady Progress Amidst Stability With Major Development Targets Achieved Successfully in 2024 [Internet] \u201d 2025 https:\/\/www.stats.gov.cn\/english\/PressRelease\/202501\/t20250117_1958330.html."},{"issue":"6","key":"e_1_2_12_36_1","first-page":"1231","article-title":"The Family APGAR: A Proposal for a Family Function Test and Its Use by Physicians","volume":"6","author":"Smilkstein G.","year":"1978","journal-title":"Journal of Family Practice"},{"key":"e_1_2_12_37_1","doi-asserted-by":"publisher","DOI":"10.1111\/scs.12313"},{"key":"e_1_2_12_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.outlook.2014.05.009"},{"key":"e_1_2_12_39_1","unstructured":"HealthMeasures \u201cPromis\u2010Interpret Scores [Internet] \u201dhttps:\/\/www.healthmeasures.net\/score\u2010and\u2010interpret\/interpret\u2010scores\/promis."},{"key":"e_1_2_12_40_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11136\u2010010\u20109619\u20103"},{"key":"e_1_2_12_41_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.sleep.2004.07.015"},{"key":"e_1_2_12_42_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph20032340"},{"key":"e_1_2_12_43_1","unstructured":"A. F.Hayes \u201cPROCESS: A Versatile Computational Tool for Observed Variable Mediation Moderation and Conditional Process Modeling [Internet] \u201d 2012."},{"key":"e_1_2_12_44_1","doi-asserted-by":"publisher","DOI":"10.1037\/0022\u20103514.51.6.1173"},{"key":"e_1_2_12_45_1","doi-asserted-by":"publisher","DOI":"10.1097\/NCC.0000000000000991"},{"key":"e_1_2_12_46_1","doi-asserted-by":"publisher","DOI":"10.1111\/jpc.16297"},{"key":"e_1_2_12_47_1","doi-asserted-by":"publisher","DOI":"10.1037\/a0035695"},{"key":"e_1_2_12_48_1","doi-asserted-by":"publisher","DOI":"10.4094\/chnr.2013.19.3.177"},{"key":"e_1_2_12_49_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2024.1367029"},{"key":"e_1_2_12_50_1","doi-asserted-by":"publisher","DOI":"10.37185\/LnS.1.1.453"},{"key":"e_1_2_12_51_1","doi-asserted-by":"publisher","DOI":"10.1089\/jayao.2021.0179"},{"key":"e_1_2_12_52_1","doi-asserted-by":"publisher","DOI":"10.1111\/jne.13268"},{"key":"e_1_2_12_53_1","doi-asserted-by":"publisher","DOI":"10.1002\/adbi.202101203"},{"key":"e_1_2_12_54_1","doi-asserted-by":"publisher","DOI":"10.1111\/jocn.17485"},{"key":"e_1_2_12_55_1","doi-asserted-by":"publisher","DOI":"10.1111\/fare.12106"},{"key":"e_1_2_12_56_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apnu.2024.10.017"},{"key":"e_1_2_12_57_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2023.08.063"},{"key":"e_1_2_12_58_1","doi-asserted-by":"publisher","DOI":"10.1111\/cdep.12243"},{"key":"e_1_2_12_59_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.sleh.2020.11.010"},{"key":"e_1_2_12_60_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10567\u2010022\u201000378\u20104"},{"key":"e_1_2_12_61_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12888\u2010024\u201005526\u20104"},{"key":"e_1_2_12_62_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00787\u2010020\u201001715\u20100"},{"key":"e_1_2_12_63_1","doi-asserted-by":"publisher","DOI":"10.1089\/jayao.2020.0111"},{"key":"e_1_2_12_64_1","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2022.994934"}],"container-title":["Cancer Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cam4.72248","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/cam4.72248","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cam4.72248","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T04:50:00Z","timestamp":1791262200000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/cam4.72248"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":63,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1002\/cam4.72248"],"URL":"https:\/\/doi.org\/10.1002\/cam4.72248","archive":["Portico"],"relation":{},"ISSN":["2045-7634","2045-7634"],"issn-type":[{"value":"2045-7634","type":"print"},{"value":"2045-7634","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9]]},"assertion":[{"value":"2025-11-04","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-26","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-16","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e72248"}}