(PS2-D81) Illness Uncertainty, Posttraumatic Stress Symptoms, and Sleep Quality in Parents of Children with Cancer

Poor quality sleep is consistently linked to negative emotional, neurocognitive, and physiological functioning across the lifespan. Emerging research suggests that high illness uncertainty (i.e., one’s difficulty understanding an illness and its future impact) may lead to increased negative psychosocial functioning, which thereby contributes to poorer sleep. The current study aimed to extend this research to a sample of parents of children newly diagnosed with cancer. We hypothesized that illness uncertainty would have an indirect effect on sleep quality through increased posttraumatic stress symptoms (PTSS).

A sample of 72 caregivers (Mage = 38+7.5; 91% Female; 30% BIPOC) of children (Mage = 8.4+5.8; 58% Male; 34% BIPOC) diagnosed with cancer within 1-12 months were recruited from a Midwestern pediatric cancer center. Caregivers completed a battery of psychosocial measures, including a demographic survey, the Parent Perception of Uncertainty Scale (PPUS), the Impact of Events Scale-Revised (IES-R), and the Pittsburgh Sleep Quality Index (PSQI). Structural equation modeling in Stata 16.1 was used for data analysis. Preliminary analyses explored the relationships between both total and subscale scores and demographic variables to optimize model fit to the data.

The final model estimated the total, direct, and indirect effects of PPUS Ambiguity Subscale→ IES-R Total Score → PSQI Global Score with maximum likelihood estimation for missing values and bootstrapping with 1000 resamples. Annual income and child sex were included as covariates based on preliminary analyses. The model demonstrated good fit, χ2(0) = 0.00, p < .001, RMSEA = 0.00, AIC = 1771.37, BIC =1816.90, CFI = 1.00; TLI = 1.00. Greater illness uncertainty significantly predicted increased PTSS, a = 0.89, SE = 0.19, p < .001. Greater PTSS significantly predicted lower sleep quality, b = 0.02, SE = 0.00, p < .001.

The total effect of illness uncertainty on sleep quality was statistically significant, c = 0.02, SE = 0.01, p < .001. The direct effect of illness uncertainty on sleep quality was not statistically significant, c’ = 0.01, SE = 0.01, p = .140. The indirect effect of sleep quality on negative parent illness experiences via PTSS was statistically significant, ab = 0.01, SE = 0.01, p = .010. These preliminary findings demonstrate the potential for heightened illness uncertainty (i.e., specifically, the perception of the child’s illness as ambiguous or unclear) to contribute to poor sleep due to increased parental distress.

Limitations include cross-sectional data precluding assumptions of causality, the small sample size, and limited racial/ethnic and gender diversity. Nevertheless, the current study supports the role of psychologists in providing cognitive-behavioral treatment for PTSS to parents to mitigate the impact of illness uncertainty upon sleep outcomes. Future research should evaluate the effectiveness of tailored posttraumatic stress interventions among parents of children with cancer and other life-threatening medical conditions to potentially improve sleep quality and thus overall well-being.