{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T06:44:21Z","timestamp":1773643461189,"version":"3.50.1"},"reference-count":89,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,1,21]],"date-time":"2025-01-21T00:00:00Z","timestamp":1737417600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Psychology Research Centre (CIPsi\/UM), School of Psychology, University of Minho","award":["UIDB\/01662\/2020"],"award-info":[{"award-number":["UIDB\/01662\/2020"]}]},{"name":"Psychology Research Centre (CIPsi\/UM), School of Psychology, University of Minho","award":["2020.09043.BD"],"award-info":[{"award-number":["2020.09043.BD"]}]},{"DOI":"10.13039\/501100001871","name":"Foundation for Science and Technology [Funda\u00e7\u00e3o para a Ci\u00eancia e a Tecnologia, I.P] (FCT) through the Portuguese State Budget","doi-asserted-by":"publisher","award":["UIDB\/01662\/2020"],"award-info":[{"award-number":["UIDB\/01662\/2020"]}],"id":[{"id":"10.13039\/501100001871","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001871","name":"Foundation for Science and Technology [Funda\u00e7\u00e3o para a Ci\u00eancia e a Tecnologia, I.P] (FCT) through the Portuguese State Budget","doi-asserted-by":"publisher","award":["2020.09043.BD"],"award-info":[{"award-number":["2020.09043.BD"]}],"id":[{"id":"10.13039\/501100001871","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001871","name":"FCT","doi-asserted-by":"publisher","award":["UIDB\/01662\/2020"],"award-info":[{"award-number":["UIDB\/01662\/2020"]}],"id":[{"id":"10.13039\/501100001871","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001871","name":"FCT","doi-asserted-by":"publisher","award":["2020.09043.BD"],"award-info":[{"award-number":["2020.09043.BD"]}],"id":[{"id":"10.13039\/501100001871","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background\/Objectives: Acute lymphoblastic leukemia (ALL) is the most common pediatric cancer, with intense treatments affecting both children and their families. Limited information is available on parental distress and psychological well-being during the first treatment year, with most studies focusing on individuals rather than the family system. This study explores longitudinal changes in parental distress (psychological morbidity and traumatic stress symptoms), coping strategies, family resilience and functioning, and psychological well-being. The study also examines the mediating roles of family resilience, family functioning, and coping strategies in the relationships between parental distress and psychological well-being. Methods: A prospective study was conducted with 46 parents of children newly diagnosed with ALL, assessing parental distress, family functioning and resilience, coping, and psychological well-being across three treatment phases: consolidation (T0), delayed intensification (T1), and maintenance (T2). Results: Parental distress and family resilience significantly decreased from T0 to T2, while parental coping improved over time. Family functioning deteriorated from T0 to T1, stabilizing thereafter. Psychological well-being followed a non-linear trajectory, initially declining from T0 to T1 and improving from T1 to T2. Mediation analyses revealed that family resilience and family functioning partially mediated the relationships between parental distress and psychological well-being. Parental coping did not emerge as a mediator. Conclusions: Parental psychological adjustment in the context of ALL is dynamic and influenced by individual and family factors. Interventions that strengthen family functioning and resilience are crucial for supporting parental psychological well-being during treatment. A family-centered approach in healthcare delivery is essential to address individual and systemic challenges.<\/jats:p>","DOI":"10.3390\/cancers17030338","type":"journal-article","created":{"date-parts":[[2025,1,21]],"date-time":"2025-01-21T04:19:51Z","timestamp":1737433191000},"page":"338","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Parental Psychological Adjustment in Pediatric Acute Lymphoblastic Leukemia: The Mediating Role of Family Functioning and Resilience"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9318-0511","authenticated-orcid":false,"given":"Ana","family":"Ferraz","sequence":"first","affiliation":[{"name":"Psychology Research Centre (CIPsi), School of Psychology, Applied Psychology Department, University of Minho, 4710-057 Braga, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8014-9902","authenticated-orcid":false,"given":"Susana","family":"Faria","sequence":"additional","affiliation":[{"name":"Centre of Mathematics (CMAT), Department of Mathematics, University of Minho, 4800-058 Guimar\u00e3es, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6889-7980","authenticated-orcid":false,"given":"M\u00f3nica","family":"Jer\u00f3nimo","sequence":"additional","affiliation":[{"name":"Pediatric Oncology Department, Hospital Pedi\u00e1trico, Centro Hospitalar e Universit\u00e1rio de Coimbra, 3000-602 Coimbra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7987-2562","authenticated-orcid":false,"given":"M. Gra\u00e7a","family":"Pereira","sequence":"additional","affiliation":[{"name":"Psychology Research Centre (CIPsi), School of Psychology, Applied Psychology Department, University of Minho, 4710-057 Braga, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,21]]},"reference":[{"key":"ref_1","unstructured":"National Cancer Institute (2025, January 13). Acute Lymphoblastic Leukemia Treatment (PDQ\u00ae)\u2013Health Professional Version, Available online: https:\/\/www.cancer.gov\/types\/leukemia\/hp\/adult-all-treatment-pdq."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e143257","DOI":"10.5812\/jjcdc-143257","article-title":"Psychosocial challenges of parents with children with acute lymphoblastic leukemia","volume":"13","author":"Beiranvand","year":"2024","journal-title":"Jundishapur J. Chronic Dis. Care"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e39","DOI":"10.1016\/j.clml.2020.08.025","article-title":"Acute complications and survival analysis of childhood acute lymphoblastic leukemia: A 15-year experience","volume":"21","year":"2021","journal-title":"Clin. Lymphoma Myeloma Leuk."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1541","DOI":"10.1056\/NEJMra1400972","article-title":"Acute lymphoblastic leukemia in children","volume":"373","author":"Hunger","year":"2015","journal-title":"N. Eng. J. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1002\/ijc.35136","article-title":"Intestinal mucositis, systemic inflammation and bloodstream infections following high-dose methotrexate treatment in childhood acute lymphoblastic leukaemia: Comparison between the NOPHO ALL 2008 protocol and the ALLTogether1 protocol","volume":"156","author":"Weischendorff","year":"2024","journal-title":"Int. J. Cancer"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e875","DOI":"10.1097\/HS9.0000000000000875","article-title":"The prognostic effect of IKZF1 deletions in ETV6: RUNX1 and high hyperdiploid childhood acute lymphoblastic leukemia","volume":"7","author":"Enshaei","year":"2023","journal-title":"Hemasphere"},{"key":"ref_7","unstructured":"(2025, January 13). Cancer Research UK. Available online: https:\/\/www.cancerresearchuk.org\/about-cancer\/find-a-clinical-trial\/a-study-looking-at-treatment-children-young-adults-with-newly-diagnosed-acute-lymphoblatic-leukaemia-alltogether1#undefined."},{"key":"ref_8","unstructured":"Heyman, M. (2025, January 13). A Treatment Study Protocol for Participants 0\u201345 Years with Acute Lymphoblastic Leukaemia, Available online: https:\/\/clinicaltrials.gov\/study\/NCT04307576#study-overview."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"616","DOI":"10.1111\/ecc.12361","article-title":"A systematic review on factors and consequences of parental distress as related to childhood cancer","volume":"25","author":"Sultan","year":"2016","journal-title":"Eur. J. Cancer Care"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1097\/MPH.0b013e31828b0947","article-title":"Caregiving demands and well-being in parents of children treated with outpatient or inpatient methotrexate infusion: A report from the Children\u2019s Oncology Group","volume":"36","author":"Kelly","year":"2014","journal-title":"J. Pediatr. Hematol. Oncol."},{"key":"ref_11","unstructured":"(2024, November 06). Acute Lymphoblastic Leukemia (ALL). Available online: https:\/\/www.msdmanuals.com\/en-pt\/professional\/hematology-and-oncology\/leukemias\/acute-lymphoblastic-leukemia-all."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1093\/jpepsy\/jsv074","article-title":"Systematic review: A reevaluation and update of the integrative (trajectory) model of pediatric medical traumatic stress","volume":"41","author":"Price","year":"2016","journal-title":"J. Pediatr. Psychol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"IJH17","DOI":"10.2217\/ijh-2019-0002","article-title":"Pediatric cancer, posttraumatic stress and fear-related neural circuitry","volume":"8","author":"Marusak","year":"2019","journal-title":"Int. J. Hematol. Oncol."},{"key":"ref_14","unstructured":"(2024, November 06). American Cancer Society. Available online: https:\/\/www.cancer.org\/cancer\/types\/leukemia-in-children\/treating\/children-with-all.html."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1007\/s10880-016-9459-6","article-title":"Adjustment to acute leukemia: The impact of social support and marital satisfaction on distress and quality of life among newly diagnosed patients and their caregivers","volume":"23","author":"Pailler","year":"2016","journal-title":"J. Clin. Psychol. Med. Settings"},{"key":"ref_16","unstructured":"(2024, November 06). European Standards of Care for Children with Cancer. Available online: https:\/\/siope.eu\/media\/wp-content\/uploads\/2013\/09\/European_Standards_final_2011.pdf."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1016\/j.ridd.2011.11.008","article-title":"Parent inclusion in early intensive behavioral intervention: The influence of parental stress, parent treatment fidelity and parent-mediated generalization of behavior targets on child outcomes","volume":"33","author":"Strauss","year":"2012","journal-title":"Res. Dev. Disabil."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1002\/cncr.31023","article-title":"Parental distress 6 months after a pediatric cancer diagnosis in relation to family psychosocial risk at diagnosis","volume":"124","author":"Schepers","year":"2018","journal-title":"Cancer"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e13042","DOI":"10.1111\/ecc.13042","article-title":"The impact of informal cancer caregiving: A literature review on psychophysiological studies","volume":"28","author":"Teixeira","year":"2019","journal-title":"Eur. J. Cancer Care"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Toledano-Toledano, F., Luna, D., Moral de la Rubia, J., Mart\u00ednez Valverde, S., Berm\u00fadez Mor\u00f3n, C.A., Salazar Garcia, M., and Vasquez Pauca, M.J. (2021). Psychosocial factors predicting resilience in family caregivers of children with cancer: A cross-sectional study. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18020748"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e27677","DOI":"10.1002\/pbc.27677","article-title":"Prevalence of anxiety, depression, and posttraumatic stress disorder in parents of children with cancer: A meta-analysis","volume":"66","author":"Zabih","year":"2019","journal-title":"Pediatr. Blood Cancer"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1590\/S0103-863X2012000100014","article-title":"Psychosocial impact of pediatric cancer on parents: A literature review","volume":"22","author":"Kohlsdorf","year":"2012","journal-title":"Paid\u00e9ia"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Rensen, N., Steur, L., Grootenhuis, M., Twisk, J., van Eijkelenburg, N., van der Sluis, I., Dors, N., van des Bos, C., Tissig, W., and Kaspers, G. (2022). Parental sleep, distress, and quality of life in childhood acute lymphoblastic leukemia: A longitudinal report from diagnosis up to three years later. Cancers, 14.","DOI":"10.3390\/cancers14112779"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e66","DOI":"10.1016\/j.pedn.2018.11.003","article-title":"Unmet family needs concerning healthcare services in the setting of childhood hospitalization for cancer treatment in Mainland China: A qualitative study","volume":"44","author":"Lyu","year":"2019","journal-title":"J. Pediatr. Nurs."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Borrescio-Higa, F., and Vald\u00e9s, N. (2022). The psychosocial burden of families with childhood blood cancer. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19010599"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1207","DOI":"10.1002\/pon.5088","article-title":"The impact of childhood cancer on parents\u2019 socio-economic situation\u2014A systematic review","volume":"28","author":"Roser","year":"2019","journal-title":"Psycho Oncol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"299","DOI":"10.33371\/ijoc.v17i4.1005","article-title":"Factors influencing quality of life of parents with children affected by acute lymphoblastic leukemia: A study at Childhood Cancer International Foundation, Jakarta","volume":"17","author":"Trisya","year":"2023","journal-title":"Indones. J. Cancer"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Toledano-Toledano, F., Moral de la Rubia, J., Nabors, L.A., Dom\u00ednguez-Guedea, M.T., Salinas Escudero, G., Rocha Perez, E., Luna, D., and Leyva Lopez, A. (2020). Predictors of quality of life among parents of children with chronic diseases: A cross-sectional study. Healthcare, 8.","DOI":"10.3390\/healthcare8040456"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"S632","DOI":"10.1002\/pbc.25761","article-title":"Standards of psychosocial care for parents of children with cancer","volume":"62","author":"Kearney","year":"2015","journal-title":"Pediatr. Blood Cancer"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1037\/fam0001113","article-title":"Parental distress in childhood acute lymphoblastic leukemia: A systematic review of the literature","volume":"38","author":"Ferraz","year":"2024","journal-title":"J. Fam. Psychol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"pkab036","DOI":"10.1093\/jncics\/pkab036","article-title":"Hospital contacts for psychiatric disorders in parents of children with cancer in Denmark","volume":"5","author":"Mader","year":"2021","journal-title":"JNCI Cancer Spectr."},{"key":"ref_32","first-page":"11","article-title":"Psychological well-being and caregiver burden of parents having child with leukemia: Psychological well-being & caregiver burden of parents","volume":"4","author":"Ghaffar","year":"2023","journal-title":"Therapist"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1300\/J077v24n03_04","article-title":"Factors related to the psychological well-being of parents of children with leukemia in China","volume":"24","author":"Lou","year":"2006","journal-title":"J. Psychosoc. Oncol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"476","DOI":"10.21608\/ejhc.2019.239100","article-title":"Resilience and psychological wellbeing among parents of leukemic child at 57357 Hospital","volume":"10","author":"Mahmoud","year":"2019","journal-title":"Egypt. J. Health Care"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1037\/hea0000619","article-title":"Trajectories of child and caregiver psychological adjustment in families of children with cancer","volume":"37","author":"Katz","year":"2018","journal-title":"Health Psychol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"818","DOI":"10.1093\/jpepsy\/jsae077","article-title":"Posttraumatic stress symptoms in parents of children with newly diagnosed cancer: 1-year trajectories and relationship variables as predictors","volume":"49","author":"Vogt","year":"2024","journal-title":"J. Pediatr. Psychol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"11611","DOI":"10.2147\/CMAR.S276599","article-title":"Predictors of resilience among parents of children with cancer: Cross-sectional study","volume":"ume 12","author":"Mezgebu","year":"2020","journal-title":"Cancer Manag. Res."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1093\/jpepsy\/jsv047","article-title":"Parents of children with cancer: At-risk or resilient?","volume":"40","author":"Phipps","year":"2015","journal-title":"J. Pediatr. Psychol."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Faccio, F., Renzi, C., Giudice, A.V., and Pravettoni, G. (2018). Family resilience in the oncology setting: Development of an integrative framework. Front. Psychol., 9.","DOI":"10.3389\/fpsyg.2018.00666"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"102078","DOI":"10.1016\/j.ejon.2021.102078","article-title":"Family resilience factors affecting family adaptation of children with cancer: A cross-sectional study","volume":"56","author":"Park","year":"2022","journal-title":"Eur. J. Oncol. Nurs."},{"key":"ref_41","first-page":"6","article-title":"Systematic review: Associations between family functioning and child adjustment after pediatric cancer diagnosis: A meta-analysis","volume":"42","author":"Caes","year":"2017","journal-title":"J. Pediatr. Psychol."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Van Schoors, M., De Paepe, A.L., Norga, K., Cosyns, V., Morren, H., Vercruysse, T., Goubert, L., and Verhofstadt, L.L. (2019). Family members dealing with childhood cancer: A study on the role of family functioning and cancer appraisal. Front. Psychol., 10.","DOI":"10.3389\/fpsyg.2019.01405"},{"key":"ref_43","first-page":"7299","article-title":"The effect of resilience training on the condition of style of coping and parental stress in mothers of children with leukemia","volume":"6","author":"Kaboudi","year":"2018","journal-title":"Int. J. Pediatr."},{"key":"ref_44","first-page":"79","article-title":"Resilience and its predictors among the parents of children with cancer: A descriptive-correlational study","volume":"25","author":"Habibpour","year":"2019","journal-title":"Indian. J. Palliat. Care"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1108","DOI":"10.1007\/s10803-017-3447-z","article-title":"Associations between resilience and the well-being of mothers of children with autism spectrum disorder and other developmental disabilities","volume":"48","author":"Halstead","year":"2018","journal-title":"J. Autism Dev. Disord."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1017\/S0959259810000420","article-title":"What is resilience? A review and concept analysis","volume":"21","author":"Windle","year":"2011","journal-title":"Rev. Clin. Gerontol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"856","DOI":"10.1093\/jpepsy\/jsv055","article-title":"Systematic review: Family resilience after pediatric cancer diagnosis","volume":"40","author":"Caes","year":"2015","journal-title":"J. Pediatr. Psychol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"102403","DOI":"10.1016\/j.ejon.2023.102403","article-title":"Family resilience in cancer treatment and key influence factors: A systematic review","volume":"66","author":"Shao","year":"2023","journal-title":"Eur. J. Oncol. Nurs."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"356","DOI":"10.30773\/pi.2019.0204","article-title":"The associations of family functioning, general well-being, and exercise with mental health among end-stage renal disease patients","volume":"17","author":"Wang","year":"2020","journal-title":"Psychiatry Investig."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1037\/0893-3200.21.3.407","article-title":"A meta-analytic review of the influence of pediatric cancer on parent and family functioning","volume":"21","author":"Pai","year":"2007","journal-title":"J. Fam. Psychol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1229","DOI":"10.1177\/1049732317753587","article-title":"Parents\u2019 perspectives of changes within the family functioning after a pediatric cancer diagnosis: A multi-family member interview analysis","volume":"28","author":"Morren","year":"2018","journal-title":"Qual. Health Res."},{"key":"ref_52","first-page":"597","article-title":"The experiences of mothers who have a child diagnosed with cancer","volume":"37","author":"McEvoy","year":"2022","journal-title":"Psychol. Health"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1111\/sjop.12653","article-title":"Well-being in parents of children with cancer: The impact of parental personality, coping, and the child\u2019s quality of life","volume":"61","author":"Musek","year":"2020","journal-title":"Scand. J. Psychol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"e002453","DOI":"10.1136\/bmjpo-2023-002453","article-title":"Exploring coping strategies among caregivers of children who have survived pediatric cancer in Jordan","volume":"8","author":"Ismael","year":"2024","journal-title":"BMJ Paediatr. Open"},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Van Schoors, M., De Paepe, A.L., Lemiere, J., Morez, A., Norga, K., Lambrecht, K., Goubert, L., and Verhofstadt, L.L. (2019). Family adjustment when facing pediatric cancer: The role of parental psychological flexibility, dyadic coping, and network support. Front. Psychol., 10.","DOI":"10.3389\/fpsyg.2019.02740"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"2153","DOI":"10.3390\/nursrep14030161","article-title":"Effectiveness of family coping interventions in improving problem-solving skills in the care of children and adolescent cancer survivors during and after treatment: A scoping review","volume":"14","author":"Prates","year":"2024","journal-title":"Nurs. Rep."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"3069","DOI":"10.1007\/s00520-020-05811-4","article-title":"\u201cHome wasn\u2019t really home anymore\u201d: Understanding caregivers\u2019 perspectives of the impact of blood cancer caregiving on the family system","volume":"29","author":"Fisher","year":"2021","journal-title":"Support. Care Cancer"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1177\/003435520104400305","article-title":"Psychosocial adaptation to chronic illness and disability","volume":"44","author":"Livneh","year":"2001","journal-title":"Rehabil. Couns. Bull."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1037\/0022-3514.69.4.719","article-title":"The structure of psychological well-being revisited","volume":"69","author":"Ryff","year":"1995","journal-title":"J. Pers. Soc. Psychol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1032","DOI":"10.1017\/S1138741600002675","article-title":"Preliminary analysis of the psychometric properties of Ryff\u2019s scales of psychological well-being in Portuguese adolescents","volume":"13","author":"Fernandes","year":"2010","journal-title":"Span. J. Psychol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1111\/j.1600-0447.1983.tb09716.x","article-title":"The Hospital and Anxiety and Depression Scale","volume":"7","author":"Zigmond","year":"1983","journal-title":"Acta Psychiatr. Scand."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1080\/13548500500524088","article-title":"Validation study of a Portuguese version of the Hospital Anxiety and Depression Scale","volume":"12","author":"Silva","year":"2007","journal-title":"Psychol. Health Med."},{"key":"ref_63","unstructured":"Wilson, J., and Keane, T.M. (1997). The Impact of Event Scale-Revised. Assessing Psychological Trauma and PTSD, Guilford Press."},{"key":"ref_64","first-page":"11","article-title":"Depress\u00e3o, ansiedade e stress p\u00f3s-traum\u00e1tico em doentes com cancro colo-rectal. Valida\u00e7\u00e3o do Hospital Anxiety and Depression Scale (HADS) e Impact of Events Scale (IES) numa amostra de doentes oncol\u00f3gicos","volume":"5","author":"Pereira","year":"2008","journal-title":"Onco News"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1111\/j.1752-0606.1983.tb01497.x","article-title":"The McMaster family assessment device","volume":"9","author":"Epstein","year":"1983","journal-title":"J. Marital. Fam. Ther."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1037\/fsh0000471","article-title":"Psychometric properties of the Portuguese adaptation of General Functioning of Family Assessment Device: A comparative study","volume":"38","author":"Almeida","year":"2020","journal-title":"Fam. Syst. Health"},{"key":"ref_67","unstructured":"McCubbin, H.I., Thompson, A.I., and McCubbin, M.A. (1986). Family Hardiness Index (FHI). Family Assessment: Resiliency, Coping and Adaptation\u2014Inventories for Research and Practice, University of Wisconsin System."},{"key":"ref_68","unstructured":"Cunha, A.I., Major, S., and Relvas, A.P. (2016). Family Hardiness Index (FHI). Avalia\u00e7\u00e3o Familiar: Vulnerabilidade, Stress e Adapta\u00e7\u00e3o, Imprensa da Universidade de Coimbra."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"359","DOI":"10.2307\/351514","article-title":"CHIP\u2014Coping Health Inventory for Parents: An assessment of parental coping patterns in the care of the chronically ill child","volume":"45","author":"McCubbin","year":"1983","journal-title":"J. Marriage Fam."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1016\/j.pedn.2016.04.009","article-title":"Psychometric properties of the Portuguese version of the Coping Health Inventory for Parents (CHIP) of adolescents with chronic illness","volume":"31","author":"Almeida","year":"2016","journal-title":"J. Pediatr. Nurs."},{"key":"ref_71","unstructured":"R Development Core Team (2023). R: A Language and Environment for Statistical Computing [Computer Software]. R Development Core Team. Available online: https:\/\/www.r-project.org\/."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18637\/jss.v059.i05","article-title":"Mediation: R package for causal mediation analysis","volume":"59","author":"Tingley","year":"2014","journal-title":"J. Stat. Softw."},{"key":"ref_73","unstructured":"Hancock, G.R., and Mueller, R.O. (2013). Conditional process modeling: Using structural equation modeling to examine contingent causal processes. Structural Equation Modeling: A Second Course, IAP Information Age Publishing. [2nd ed.]."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"887","DOI":"10.1007\/s00520-016-3478-6","article-title":"Distress and psychological morbidity do not reduce over time in carers of patients with high-grade glioma","volume":"25","author":"Halkett","year":"2017","journal-title":"Support. Care Cancer"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1093\/jpepsy\/jsj054","article-title":"An integrative model of pediatric medical traumatic stress","volume":"31","author":"Kazak","year":"2006","journal-title":"J. Pediatr. Psychol."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"e54715","DOI":"10.2196\/54715","article-title":"Association of family-centered care with psychological distress among caregivers of children with cancer at a tertiary-level hospital in Ethiopia: Cross-sectional study","volume":"10","author":"Deribe","year":"2024","journal-title":"JMIR Cancer"},{"key":"ref_77","doi-asserted-by":"crossref","unstructured":"Huang, Y., Chen, M., Wang, Y., Qi, Y., Zhang, L., and Dong, C. (2024). Resiliency process in the family after childhood leukaemia diagnosis: A longitudinal qualitative study. J. Clin. Nurs.","DOI":"10.1111\/jocn.17224"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1080\/07347332.2018.1555197","article-title":"Emotions and coping methods of Turkish parents of children with cancer","volume":"37","year":"2019","journal-title":"J. Psychosoc. Oncol."},{"key":"ref_79","unstructured":"McCubbin, H.I., Thompson, A.I., and McCubbin, M.A. (2001). Family Measures: Stress, Coping, and Resiliency: Inventories for Research and Practice, Kamehameha Schools."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1016\/0277-9536(88)90395-4","article-title":"The relationship between coping and emotion: Implications for theory and research","volume":"26","author":"Folkman","year":"1988","journal-title":"Soc. Sci. Med."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"1069","DOI":"10.1037\/0022-3514.57.6.1069","article-title":"Happiness is everything, or is it? Explorations on the meaning of psychological well-being","volume":"57","author":"Ryff","year":"1989","journal-title":"J. Pers. Soc. Psychol."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"1553","DOI":"10.1111\/j.1365-2702.2007.02235.x","article-title":"Being there: Parenting the child with acute lymphoblastic leukaemia","volume":"17","author":"Kars","year":"2008","journal-title":"J. Clin. Nurs."},{"key":"ref_83","first-page":"125","article-title":"A Study to Assess the Quality of Life (QOL) Among Parents of Children with Acute Lymphoblastic Leukemia (ALL) Attending Oncology Out Patient Department (OPD) in Selected Hospital of Kolkata, West Bengal, India","volume":"16","author":"Mondal","year":"2020","journal-title":"Mal. J. Med. Health Sci."},{"key":"ref_84","first-page":"18","article-title":"The impact of childhood cancer on family functioning: A review","volume":"15","author":"Hosoda","year":"2014","journal-title":"Grad. Stud. J. Psychol."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"1080","DOI":"10.1002\/pon.5057","article-title":"Parents\u2019 psychological well-being when a child has cancer: Contribution of individual and family factors","volume":"28","author":"Salvador","year":"2019","journal-title":"Psycho Oncol."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1080\/07347332.2017.1283654","article-title":"Facilitating and hindering factors for coping with the experience of having a child with cancer: A Lebanese perspective","volume":"35","author":"Doumit","year":"2017","journal-title":"J. Psychosoc. Oncol."},{"key":"ref_87","unstructured":"(2024, December 11). European Academy of Paediatrics. Available online: https:\/\/www.eapaediatrics.eu\/wp-content\/uploads\/2020\/07\/DFTB-4990-EAPS-leaflet-02b.pdf."},{"key":"ref_88","unstructured":"(2024, December 12). Registo Oncol\u00f3gico Nacional. Available online: https:\/\/ron.min-saude.pt\/media\/2223\/ron-2020.pdf."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"e26840","DOI":"10.1002\/pbc.26840","article-title":"Could we use parent report as a valid proxy of child report on anxiety, depression, and distress? A systematic investigation of father-mother-child triads in children successfully treated for leukemia","volume":"65","author":"Abate","year":"2018","journal-title":"Pediatr. Blood Cancer"}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/3\/338\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T10:32:36Z","timestamp":1759919556000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/3\/338"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,21]]},"references-count":89,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,2]]}},"alternative-id":["cancers17030338"],"URL":"https:\/\/doi.org\/10.3390\/cancers17030338","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,21]]}}}