Family cohesion and expressiveness promote resilience to the stress of pediatric bone marrow transplant: a preliminary report.

The effect of perceived family environment as a determinant of adjustment in children undergoing bone marrow transplant (BMT) was assessed in a prospective, longitudinal study. Measures of patients' social competence, behavior problems, and self-esteem, along with perceived family conflict, cohesion, and expressiveness, were obtained before hospital admission for BMT and again in the period 6 to 12 months post-BMT. Significant declines were observed in post-BMT social competence and overall self-concept. Before BMT, perceptions of family conflict showed a moderate inverse correlation with patient adjustment, whereas family cohesion and expressiveness were unrelated or were weakly related with adjustment measures. In contrast, all pre-BMT family environment variables were highly predictive of adjustment post-BMT. Using a cross-lagged correlational approach, it was determined that perceived family cohesion and expressiveness act as protective factors, promoting resilience to the stresses of BMT, whereas family conflict acts directly as a risk factor that adversely affects adjustment regardless of stress level.