Parental distress - a predictor of treatment adherence in pediatric neuroblastoma: a cross-sectional study of chinese families.

OBJECTIVE

This cross-sectional study examined whether parental distress is associated with treatment adherence in children with neuroblastoma and identified specific parental psychological factors as independent risk markers for non-adherence.

METHODS

Three hundred fifty families from four tertiary medical centers in China were enrolled. Parents completed the Parenting Stress Index-Short Form (PSI-SF), Medication Adherence Rating Scale (MARS-5), Beck Depression Inventory-II (BDI-II), and Family Assessment Device-General Functioning (FAD-GF). Path analysis examined associations between parental distress, family functioning, disease risk, and treatment adherence. Common method bias was assessed using Harman's single-factor test. Sensitivity analyses examined MARS-5 cutoff robustness using median split and MARS-5 < 18 thresholds.

RESULTS

Parental distress was significantly associated with lower treatment adherence (beta = -0.35, p = 0.002). Family functioning was statistically consistent with partial mediation (indirect beta = -0.12, p = 0.003), though causal interpretation is precluded by the cross-sectional design. Paternal depressive symptoms emerged as the strongest independent risk marker for non-adherence (OR = 2.2, 95% CI 1.18-4.09, p = 0.013). Mothers reported significantly higher parenting stress than fathers (Bonferroni-corrected p < 0.008; Cohen's d = 0.37-0.62). Families with poor functioning were 2.8 times more likely to exhibit suboptimal adherence. Harman's single-factor test yielded 8 factors with eigenvalues > 1.0, with the first factor explaining 28.4% of total variance-below the 40% threshold indicative of substantial common method bias. Sensitivity analyses using alternative MARS-5 cutoffs confirmed the robustness of paternal depression and family functioning as predictors.

CONCLUSIONS

Parental distress, particularly paternal depressive symptoms, represents a modifiable risk marker associated with treatment non-adherence. Screening for paternal psychological distress and family dysfunction may support treatment adherence in pediatric neuroblastoma. Given the cross-sectional design, these associations should be interpreted as concurrent rather than causal.