Psychological adaptation profiles are associated with coping style, social support, and family intimacy in caregivers of children with hematologic malignancies: a cross-sectional study

Although the survival time of children with hematologic malignancies has gradually prolonged, a cancer diagnosis can have devastating psychosocial effects on the family. The trajectory of childhood cancer care is physically demanding, often involving prolonged duration ranging from hours to weeks, months or even years, which places significant strain on caregivers’ overall health [1]. Studies have shown that caregivers of children with hematologic malignancies often experience a low quality of life [2‐4], with approximately 50% and 36% of caregivers reporting moderate and severe care burdens, respectively [3]. A study exploring the mental health of parents of children with leukemia in China revealed that 87.8% of caregivers showed signs of anxiety, while 45.9% had depression [5]. Despite the fact that a significant number of parents struggle with mental fatigue, anxiety and symptoms of post-traumatic stress after treatment of the child’s cancer illness, there are also many parents who may experience positive adaptations [6, 7]. Research suggests that some caregivers develop individual resilience, characterized by positive emotions and proactive coping strategies such as seeking support, which fosters a more protective environment for both themselves and their families [7].

As a group, parents of children with hematologic malignancies demonstrate a relatively high level of resilient. The psychological adaptability of caregivers plays a crucial role in improving the prognosis of children [8]. Study have shown that the ability of family caregivers to overcome and cope with the various strains associated with the diagnosis and treatment trajectory is essential to the quality of life of children and adolescents diagnosed with cancer [9]. Psychological problems in caregivers not only endanger their own quality of life but also impair their capacity to provide effective care [10]. Desjardins et al. [11] found that symptoms of anxiety and depression win caregivers were associated with poorer quality of life in their children. Hile et al. [12] have shown that parental stress significantly predicts the functional outcome of pediatric cancer survivors. Moreover, evidence suggests that the psychological adaptation of caregivers positively influences the adaptation of their children [13]. However, the overall level of psychological adaptation among caregivers of children with hematologic malignancies remains unclear. Existing research has highlighted variability in caregiver adaptation [14], undergoing the need to better understand the factors that facilitate psychological adaptation in caregivers of children with cancer so that these factors can be fostered [15]. Therefore, exploring the different categories of psychological adaptation among caregivers and identifying the influencing factors are key steps to providing precise and individualized care strategies.

Literature reviews have identified several predictors of parental psychological adaptation during pediatric cancer treatment. Study have found that psychological adaptation is influenced by gender [16]. Specifically, mothers are often thought to be more prone to maladjustment compared to fathers [17, 18]. Furthermore, Individual level risk factors associated with poorer psychological adaptation include lower education levels and lower socio-economic status [19]. Furthermore, coping styles, defined as relatively permanent, individual-specific involuntary behaviors used to manage stressful situations [20], may influence psychological symptoms [21] and, consequently, psychological adaptation. In addition, the extent of perceived social support is another factor of interes [22]. Being highly confident about the availability of adequate social support when needed may promote emotional well-being, because social contacts may provide positive experiences [23]. Moreover, the feeling of being close with relatives may reduce the intensity of unpleasant psychological symptoms such as fear or helplessness. Seyedeh et al. [24] study on the quality of life of caregivers of hemodialysis patients found that those with better social support and stronger marital relationships reported higher quality of life. However, there is no literature examining the correlation between these variables and psychological adjustment in the childhood cancer caregiver population. This highlights the need for further research to explore how coping styles and social support contribute to psychological adaptation in this specific group.

Psychological adaptation is a multifaceted process influenced by both internal factors (e.g., coping strategies) and external factors (e.g., family intimacy and social support). In recent years, Social Cognitive Theory (SCT) has become a key framework for understanding the interaction between these factors. Proposed by Bandura [25], SCT emphasizes the dynamic interplay between individual behavior, cognitive processes, and environmental influences—a concept known as triadic reciprocal determinism. This theory highlights that an individual’s behavior is not solely determined by internal psychological processes but is also shaped by environmental factors, such as social support systems and interpersonal relationships [26]. When these three factors interact, individuals can adjust their behavior in response to changing circumstances to achieve their goals. According to SCT, a supporting social environment promotes active cognitive processing of stressful experiences, leading to positive adaptation. On the other hand, a socially restrictive environment, such as poor communication or lack of support, can lead to poor adaptation [27].

To address these gap, this study integrates Latent Profile Analysis (LPA) with mediation analysis. LPA is employed to identify distinct psychological adaptation profiles among caregivers, allowing us to account for the heterogeneity in adaptation outcomes. Following this, multinomial logistic regression is used to explore the key predictors of adaptation profiles, and mediation analysis is conducted to further investigate the pathways affects psychological adaptation. This approach not only aligns with SCT but also bridges the gap between theory and practice by providing tailored insights for intervention strategies targeting specific psychological adaptation profiles. Drawing on SCT, proposed by Bandura, this study examines how environmental factors such as family intimacy and social support contribute to coping strategies, which subsequently influence psychological adaptation. Thus, this study aims to: (1) identify distinct psychological adaptation profiles among caregivers using LPA; (2) explore the effects of family intimacy, social support and coping strategies influence on psychological adaptation; (3)examine the mediating role of coping strategies in the relationship between environmental factors (family intimacy, social support) and psychological adaptation.

This study is the first to utilize latent profile analysis (LPA) to identify distinct psychological adaptation profiles among caregivers of children with hematologic malignancies and to explore the influencing factors associated with each profile. The results revealed three psychological adaptation categories: the “well-adapted group”, “general adaptation group” and “maladaptive group”. Furthermore, family intimacy was found to have both direct and indirect effects on psychological adaptation, with positive coping strategies serving as a significant pathway linking these variables. These findings underscore the dynamic interplay between environmental factors (e.g., family relationships) and individual behaviors (e.g., coping strategies) in shaping psychological outcomes. By elucidating these mechanisms, the study provides an evidence-based foundation for developing targeted interventions aimed at enhancing psychological adaptation among caregivers.

The findings of this study revealed that 91.3% of caregivers of children with hematologic malignancies demonstrated moderate to high levels of psychological adaptation, suggesting that this group possesses a certain level of resilience despite the substantial physical and emotional challenges they face. This observation aligns with previous studies that highlighted the adaptive capacity of caregivers in high-stress caregiving environments [34]. Wang et al., [35] also found that caregivers can adapt to children’s cancer experiences over time, and showed courage and strength. However, it is noteworthy that 54.9% of caregivers were classified in the “general adaptation group,” reflecting moderate levels of psychological adaptation. This indicates that while most caregivers demonstrate a baseline level of resilience, their psychological adaptation remains a critical area of concern. For the majority of caregivers, their capacity for psychological adaptation can be seen as a potential resource for intervention. Therefore, there is a pressing need to address their psychological challenges through appropriate interventions to prevent the worsening of mental health problems.

Positive coping strategies were found to play a critical role in enhancing psychological adaptation among caregivers of children with hematologic malignancies. This study highlighted that caregivers employing positive coping mechanisms were more likely to belong to the “well-adapted group,” demonstrating better psychological outcomes. These findings align with previous research, which has consistently shown a strong positive association between active coping strategies and improved mental health outcomes [36, 37]. From a theoretical perspective, positive coping reflects key behavioral components of social cognitive theory, emphasizing the reappraisal of stressors and proactive behavior to mitigate emotional distress [25]. Fairfax et al., [38] also provided coping strategies considered to be adaptive were positively associated with quality of life while, maladaptive strategies were negatively associated with quality of life. These results underscore the practical value of integrating coping strategy training into interventions aimed at improving caregiver well-being.

Family intimacy was found to exert both direct and indirect effects on psychological adaptation among caregivers of children with hematologic malignancies. Caregivers with higher levels of family intimacy were more likely to belong to the “well-adapted group,” demonstrating better psychological outcomes. Family intimacy is an important aspect of family function. Studies have shown that better family intimacy can enable family members to have stronger cohesion and get better support and help when family members encounter difficulties, so as to obtain more positive emotional experience and improve adaptability [39]. This aligns with existing literature emphasizing the critical role of family relationships in alleviating psychological distress and fostering emotional well-being [40]. Toledano-Toledano et al. [34] found caregivers psychological distress issues can be overcome through mobilization of family resources. strong family bonds can reduce feelings of isolation, increase emotional support, and provide tangible resources, all of which contribute to improved psychological adaptation. These findings highlight the importance of family-centered interventions, such as family counseling programs, communication training, and emotional support initiatives, to strengthen family relationships and improve caregivers’ psychological health.

This study provides a new perspective for understanding the mechanism between family environment and individual psychological behavior. Our study found that the family environment not only influences psychological adjustment through direct support, but also exerts an indirect effect by shaping the individual’s coping style. Zhang et al. [41] found that family function directly affected individual coping styles. In the context of high family cohesion, individuals are more likely to adopt positive coping strategies. The study of Mo et al. also believes that close emotional connection and mutual support among family members can help individuals form a positive attitude to cope with stress and life difficulties, and help individuals relieve anxiety and depression [42]. The buffer view of social support holds that external factors such as social support can indirectly affect mental health by influencing factors such as cognition and coping styles of individuals [43]. Good family relationship can provide emotional support for individuals to a large extent, increase their positive emotional experience, and help individuals actively seek ways to relieve stress, so as to improve their adaptability in the process of care. The findings of this study provide a new perspective for understanding the mechanism between family environment and individual psychological behavior. This suggests that future training in coping strategies (e.g., problem-solving skills and emotional regulation) for caregivers needs to be implemented, and such interventions should be integrated into the family unit and focus on the supportive family environment.

This study has several limitations. First, as a cross-sectional study, it cannot establish causal relationships between variables, and future longitudinal studies are needed to confirm the findings. Second, the sample was drawn from specific provinces in China, which may limit the generalizability of the results to other regions or cultural contexts. Third, data were collected using self-reported questionnaires, which may introduce reporting bias or inaccuracies. Lastly, we applied Bonferroni correction to control for multiple comparisons and reduce the risk of Type I error. However, this approach is conservative and may increase the likelihood of Type II error, potentially leading to the failure to detect smaller but meaningful associations. Future studies with larger sample sizes or alternative correction methods may help address this limitation.

This study identified three distinct psychological adaptation profiles among caregivers of children with hematologic malignancies: the well-adapted group, the general adaptation group, and the maladaptive group. These findings underscore the heterogeneity in psychological adaptation among caregivers, emphasizing the need for tailored interventions. Specifically, caregivers in the maladaptive group should be prioritized for interventions aimed at improving their coping skills and psychological resilience. For the general adaptation group, enhancing family support networks and providing training in effective coping strategies could further strengthen their psychological adaptation. Future intervention programs should be designed based on these psychological adaptation classifications to address the unique needs of each subgroup, ensuring more targeted and effective support.

Moreover, the study highlighted the critical roles of family intimacy and positive coping strategies in promoting psychological adaptation. Family intimacy was shown to have both direct and indirect effects on psychological outcomes, mediated by positive coping strategies. These findings suggest that interventions should focus on strengthening family bonds and improving communication within the family unit. Incorporating family-based psychological support and coping skills training into caregiver support programs could significantly enhance caregivers’ mental health and overall well-being. By addressing both family-level and individual-level factors, these interventions hold the potential to mitigate the psychological burden of caregiving and promote sustainable resilience among caregivers.