This review assessed population-based estimate rates of cancer patients with minor and young adult children (≤ 25 years), children and young adults having a parent with cancer as well as the psychosocial situation and well-being of children and young adults affected by parental cancer. Eighteen publications on population-based studies were included. Studies varied in the age ranges of both cancer patients and children. The prevalence rates of cancer patients having children ranged from 14 to 24.7% depending on the sample structure (e.g., age, gender). Studies reported that between 1.6 and 8.4% of children resp. young adult children have a parent with a history of cancer. Seven publications reported on the psychosocial situation or well-being in children and young adults affected by parental cancer. Estimate rates of psychosocial problems, psychiatric diagnoses or distress ranged between 2.5 and 34% of children depending on the method of measurement and outcome. The differences in the sample structure between the studies impeded the comparison of prevalence rates. However, the findings help to determine the need for specific support services and health care planning. The results emphazise the importance to routinely include issues on the parental role of patients and questions on the well-being and coping of children into psychooncological care. If necessary, support should be provided to families living with a cancer diagnosis.

Although the level of mental stress in adolescents with gender dysphoria is found to be generally high in many studies, differences have been shown between samples of gender dysphoria clinics for adolescents in different countries. However, a comparison within the German speaking area is lacking. In this article we compared samples of gender dysphoria clinics from Munster (Germany) and Zurich (Switzerland) and tested potential correlates of mental stress using quantitative methods. Subsequently, we interviewed clients from both clinics regarding mental stressors and protective factors. There were no quantitative differences in the level of mental stress of clients between Munster and Zurich, whereas health-related quality of life was significantly higher in Munster. Problems in physical well-being and school environment were the strongest correlates of mental stress. This reflects in the interviews, too, in addition to further related factors reported. We conclude that physical well-being and inclusion at school should be addressed with special emphasis in counseling or treatment of adolescents with gender dysphoria to counter the in average high levels of mental stress.

"If One Feels Better Like That …". Adolescent Sibling Relationship in the Context of Transgender Development A transgender development in youth can influence the relationship of concerned youth and their siblings. While in most surveys, the focus lies on transgender adolescents, both sides shall be interviewed here to capture the situation of siblings and to relate the results. For this purpose, guide interviews with ten transgender adolescents and twelve of their siblings were analysed in accordance to Grounded Theory. In most cases, participants were satisfied with the sibling relationship. After the coming-out of the transgender adolescent they showed both positive and negative reactions that, however, changed to respect and acceptance by time without exception. Doubt, compassion and grief were short lived and often replaced by joy for the transgender adolescent. Transgender youth were mostly satisfied with the reaction of their sibling though the amount of support varied. The time of coming-out and transition often led to an improvement in sibling relationship, more closeness and family cohesion. In general, siblings seem to be immediately concerned by transgenderism in adolescence. In clinical practice, they should thus be included from the beginning. By taking into account their situation, negative developments can be prevented, and the sibling relationship become usable as a resource.

Medizinisch begleitete Transitionen geschlechtsdysphorischer Patienten verlagern sich zunehmend in das Kindheits- und Jugendalter vor. In diesem Beitrag werden Behandlungsprinzipien für die Psychotherapie bei Jugendlichen mit Geschlechtsdysphorie dargestellt, die sich aus den jeweils aktuellen Diskursen zur medizinischen Ethik, zur Ätiologie der Transidentität, zur Variationsbreite von Entwicklungsverläufen sowie aus differenzialdiagnostischen Überlegungen ableiten. Fachgerechte psychotherapeutische Begleitung ist dabei eingebettet in einen schrittweise sich vollziehenden Prozess der sozialen Transition einschließlich somatomedizinischer Behandlungsschritte und deren Indikationsstellung.

Persistent feelings of gender dysphoria (GD) are accompanied by distress and body dissatisfaction in most clinically referred adolescents and adults. Transition-related medical interventions (e.g., puberty suppression, hormones, or surgery) may alleviate body dissatisfaction. The aim of the present cross-sectional study was to compare multidimensional body image across clinically referred adolescents and adults undergoing different transition-related medical interventions. Two clinical samples of adolescents (n = 82) and adults (n = 120) referred to specialized departments of four different transgender health services in Germany participated in the study. In total, 202 individuals from the female-to-male (FtM individuals) and male-to-female (MtF individuals) spectrum aged 14–74 years were included at different stages of their transition. Four scales assessing multidimensional aspects of body image (measured by the Body Image Assessment Questionnaire, FBeK) were compared across three groups: sample, gender, and medical interventions (while controlling for age and treatment duration). The results indicated less favorable body image scores compared with the norm in both adolescents and adults with GD. Individuals who had undergone transition-related medical interventions presented a significantly better body image on two of the four scales. Differences according to gender and age were also present. These findings suggest that medical interventions, especially gender-affirming hormones and surgery, are generally beneficial to the body image in individuals with GD. However, not all of the less favorable outcomes in multidimensional body image were positively influenced by the treatment conditions and may thus benefit from additional integrative counseling before and during transition.

Background Aim of the study was to analyze parenting concerns in cancer survivors and to identify covariats for parenting concerns.Method In a cross-sectional epidemiological sample of cancer survivors with minor children (n=1416) demographic and disease-related variables and psychological distress (HADS) were assessed. Parenting concerns were assessed using the Parenting Concerns Questionnaire (PCQ). The instrument covers the 3 subscales concerns about the practical impact' of the disease on the children, about the emotional impact' and concerns about the co-parent'.Results 73% of survivors were female; mean age was 47.5 years (SD 5.9). 24% to 71% of patients reporting parenting concerns showed normal levels of anxiety and depression. We identified living alone, younger age of the youngest child, higher tumor stage and suffering from a comorbidity as significantly associated with parenting concerns in all subscales of the PCQ. Low socio-economic status was found to be significantly associated with parenting concerns regarding the emotional and practical impact of the disease. Being a mother was associated with concerns in the subscale co-parent.Discussion Parents with cancer not only suffer from psychological distress but also from parenting concerns about the impact of their disease on their children. Psychological support services should broach the issue of parenting concerns. Families at risk should be identified to allocate tailored support.

Background: Anxiety and depression can be a long-term strain in cancer survivors. Little is known about the emotional situation of cancer survivors who have to deal with work-and family-related issues. The purpose of this study was to investigate anxiety and depression in working-age cancer survivors and associated factors.Methods: A register-based sample of 3370 cancer survivors (25 to 55 years at time of diagnosis) diagnosed up to six years prior to the survey was recruited from two German cancer registries. Demographic and medical characteristics as well as self-reported measures were used.Results: Overall, approximately 40% of the survivors reported moderate to high anxiety scores and approximately 20% reported moderate to high depression scores. Compared to the general population, working-age cancer survivors were more anxious but less depressed (p < .001). Subgroups with regard to time since diagnosis did not differ in anxiety or depression. Anxiety and depression in cancer survivors were associated with various variables. Better social support, family functioning and physical health were associated with lower anxiety and depression.Conclusions: Overall, we found higher anxiety levels in cancer survivors of working-age than in the general population. A considerable portion of cancer survivors reported moderate to high levels of anxiety and depression. The results indicate the need for psychosocial screening and psycho-oncological support e.g. in survivorship programs for working-age cancer survivors. Assessing the physical health, social support and family background might help to identify survivors at risk for higher emotional distress.

The Use of Interpreters in the Work with Refugee Children, Adolescents, their Families and Key Persons in Psychotherapeutic Care System Psychotherapy with interpreters is demanding and poses specific challenges to all participants. Simultaneously it can generate resources which are beneficial to the therapeutic process. In the present paper, problems and chances of working with interpreters are discussed in reference to psychiatric and psychotherapeutic care for young refugees. Recommendations to optimize the work with interpreters in this field are presented in order to facilitate the establishment of quality standards.

Leiden Mutter oder Vater an einer schweren oder fortgeschrittenen Krebserkrankung, hat das Folgen für die psychosoziale Anpassung aller Familienmitglieder. Die Betroffenen sollten aufrichtige, jedoch altersentsprechende Gespräche mit ihren Kindern führen und zu Nachfragen ermutigen.

Objective: The concept of family functioning is gaining importance in psycho-oncology research and health care services. The Family Assessment Device (FAD) is a well-established measure of family functioning. Psychometric properties inherent in the German 51-item adaptation of the FAD are examined in different samples of families with parental cancer. Methods: Acceptance, reliability, and validity of FAD scales are analysed in samples from different study settings (N = 1701 cancer patients, N = 261 partners, N = 158 dependent adolescent children 11 to 18 years old). Results: Missing items in the FAD scales (acceptance) are rare for adults (<1.1%) and adolescent children (<4.4%). In samples of adults and older adolescents (15 to 18 years), all FAD scales except for the Roles scale are significantly reliable (0.75 <= Cronbach's alpha <= 0.88). The scales correlate highly (0.46 <= Pearson's r <= 0.59) with the criterion satisfaction with family life (convergent validity), and have smaller correlations (0.16 <= r <= 0.49) with measures of emotional distress and subjective well-being (divergent validity). In most FAD scales, adults seeking family counselling report worse family functioning (0.24 <= Cohen's d <= 0.59) than adults in other samples with parental cancer (discriminative validity). Conclusion: Overall, the German 51-item adaptation of the FAD reveals good acceptance, reliability, and validity for cancer patients and their relatives. Particularly the scale General Functioning shows excellent psychometric properties. The FAD is suitable in the assessment of families with parental cancer for adults and adolescents older than 11 years. (C) 2016 Elsevier Inc. All rights reserved.

In the psychosocial support of families with a chronically ill or disabled child siblings are increasingly addressed as a target group for prevention and rehabilitation projects intending to reduce the risk for adverse health consequences. The following article presents a childfocused approach to family counselling as a short-term intervention. Ten flexibly applicable counselling core points covering commonly reported problems of affected siblings and their families are available - including the communication about the disease within the family or the expression of the sibling's feelings and needs. For this purpose an approach in specific counselling sessions has been determined which is used similarly by adept child and youth psychotherapists. The counselling approach is founded theoretically. Furthermore, the counselling approach provides guidance for the structured approach in the diagnosis of potential difficulties, the choice of core points and setting, the closure of counseling sessions as well as the recommendation of additional programs.

Objective: Parents with cancer are concerned about the impact of their disease on their children. However, parenting concerns and associated factors in cancer survivors have not previously been analyzed. The purpose of this study is to examine parenting concerns and to test a path model for understanding parenting concerns in cancer survivors.Methods: In a cross-sectional study, a total of 1416 parents with cancer (mean age 47.5 years, 74% women) having minor or young-adult children were recruited through two cancer registries. Parenting concerns were assessed using the Parenting Concerns Questionnaire. Structural equation modeling (SEM) was used to analyze the associations between social support, parenting confidence, emotional distress, family functioning and parenting concerns.Results: Mothers reported higher total parenting concerns than fathers (p < 0.001). We observed strong effects of emotional distress and parenting confidence on parenting concerns. Family dysfunctioning was associated with lower concerns. An indirect association between social support and parenting concerns was identified.Conclusion: Parenting concerns in cancer survivors display the need for interventions and after care programs that focus on affected families with minor and young adult children. The results of the structural path model illustrate the associations between psychological and interactional factors. Supporting parents with cancer in their parenting confidence and strengthen social support and family functioning may not only reduce the long-term burden on the parents themselves but also the burden on the entire family. (C) 2016 Elsevier Inc. All rights reserved.

Objective: Although cancer patients with minor children have become more of a focus of psychooncological research, little is known about specific parenting concerns. Instruments to assess the concerns and worries of parents with cancer are rare. The Parenting Concerns Questionnaire (PCQ) addresses this issue. We analyzed parenting concerns in cancer survivors and evaluated the German version of the PCQ.Methods: A total of 1416 cancer survivors with minor and young adult children (<= 21 years) were recruited in a register-based study. Descriptive analyses as well as reliability and validity analyses were conducted. We performed a confirmatory factorial analysis of the factor structure proposed by the authors of the original version on the PCQ.Results: Seventy-three percent of the cancer survivors were women, average age was 47.5 years (SD 5.9). Mean time since diagnosis was 44 months (SD 23.4). Between 18 and 31% of survivors reported that they were concerned about their children. The PCQ proved to be a reliable and valid instrument showing medium correlations with standardized measures in expected directions and discriminating between survivors with and without use of psychosocial support services. The factor structure was supported by the confirmatory factorial analysis.Conclusions: Assessing parenting concerns gives an additional insight into the situation of parents with cancer. In our sample of cancer survivors, we identified one out of three survivors being concerned regarding the impact of their illness on their children. The PCQ can be considered as a valid and reliable instrument with regard to identifying concerned parents with cancer. Copyright (C) 2015 John Wiley & Sons, Ltd.

Clinical Treatment of Children and Adolescents with Gender Dysphoria from International Experts' Point of View The clinical treatment of children and adolescents with gender dysphoria is still a controversial issue. The aim of this study was to get an overview of the knowledge and experience of international experts and to highlight shared views as well as differences in theoretical convictions and treatment approaches. Half-structured, guide-line based interviews were carried out with international experts in the field. The interviews were analyzed using qualitative content analysis (Mayring, 2010).

The presence of cancer and additional parental responsibilities can increase strain for individual patients as well as for their children. The construct of health‐related quality of life (HRQL) is appropriate to measure a combination of physical, mental and social consequences as a result of disease. However, previous research has merely focused on symptom checklists. This study addresses the following questions: (i) does HRQL in children and their parents with cancer differ compared to the general population? (ii) Are there any variables that are associated with HRQL in children? (iii) What are current psychosocial support needs? A population‐based survey of 976 survivors (<6 years post diagnosis) with minor children between 6 and 18 years (n = 1,449) was conducted with two German cancer registries. HRQL was assessed using SF‐8 (survivors) and Kidscreen (children). The results were compared to normative populations, and predictors associated with HRQL in children were evaluated within a multilevel model. We found that the HRQL in children was better compared to the norm. Only children with support needs had worse HRQL. Older age, having a mother with cancer, having a parent not living together with a partner, and worse parental physical and mental health influenced HRQL in children. Illness characteristics were irrelevant. Even with a mean of 3.5 years after diagnosis, survivors had lower physical and mental health compared to the norm. Our findings reinforce the need for health professionals to pay attention to younger patients and their children. Even years after diagnosis, life might not have returned to normal.

Despite rising demand for treatment, far too few specialist services for gender dysphoric children and adolescents exist. Due to complex issues related to indication of physical treatment with lifelong consequences a thorough interdisciplinary treatment service with development-related evaluation is necessary. The aim of this paper is to outline the professional and social tension, in which the practitioner works, as well as to provide insight into the diversity of developmental trajectories and difficult decisions or dilemmas.