Seriously Ill Kids Put Up Defenses to Hide Depression

St. Jude Children's Research Hospital (ALSAC)
Tuesday, 29 January 2002

(Memphis, Tennessee, January 29, 2002) Children with cancer and other serious illnesses often adapt to their conditions by repressing their emotions and covering up feelings of depression and anxiety, according to a new study published in January's Psychosomatic Medicine.

"The children are not just engaging in denial or impression management but genuinely think of themselves as well adjusted, self controlled and content," said Sean Phipps, Ph.D., of St. Jude Children's Research Hospital. "They organize their behavior to protect that self image."

Phipps said that these young patients are likely to seem very healthy on all self-report measures of mental health.

St. Jude's Phipps and Ric Steele, Ph.D., of the University of Tennessee College of Medicine, authored the study.

Children with cancer and serious chronic illnesses were much less likely to appear depressed or anxious based on common screening questions. However, they were also much more likely to measure high for defensiveness on another common screening questionnaire.

Defensiveness is defined as a tendency to avoid or deny negative thoughts about oneself. It is assessed based on measures of "behaviors and attitudes that are socially desirable but improbable," characterized by statements such as, "I am always polite, even to people who are not nice to me."

The study included 130 children who were recently diagnosed with cancer, 121 children who had juvenile diabetes, cystic fibrosis or rheumatoid disease for more than a month, and 368 healthy children.

By seemingly blocking out depression and anxiety symptoms, defensiveness may help children better deal with the practical demands of their illnesses. But the repression of their feelings may also result in the children ignoring important signs of disease progression, Phipps said.

"The consistency in adaptive styles across the variety of illnesses sampled in the current study leads us to suggest that a shift toward increased defensiveness and more repressive styles of adaptation may be a general characteristic of children with serious illnesses," Phipps said.

Even if these children report no distress, further assessment using additional questions or additional screening may be indicated.

Psychosomatic Medicine is the official bimonthly peer-reviewed journal of the American Psychosomatic Society.

St. Jude Children's Research Hospital, in Memphis, Tennessee, was founded by the late entertainer Danny Thomas. The hospital is an internationally recognized biomedical research center dedicated to finding cures for childhood catastrophic diseases. The hospital's work is supported through funds raised by ALSAC, St. Jude's fundraising arm. ALSAC covers all costs not covered by insurance for medical treatment rendered at St. Jude Children's Research Hospital. Families without insurance are never asked to pay.

For more information, or to contact St. Jude Children's Research Hospital (ALSAC), see their website at: www.stjude.org