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Cited by 86Childhood Cancer Survivors' Quality of LifeResilience and Mental HealthFamily and Disability Support Research

Psychosocial Factors Predicting Resilience in Family Caregivers of Children with Cancer: A Cross-Sectional Study

Open access
Toledano-Toledano, Filiberto, Luna, David, Moral de la Rubia, José, Martínez Valverde, Silvia, Bermúdez Morón, Carlos Alberto, Salazar García, Marcela, Vasquez Pauca, Mario José·2021·International Journal of Environmental Research and Public Health
DOI 10.3390/ijerph18020748PMC PMC7830523
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Abstract

Chronic diseases in childhood can affect the physical and mental health of patients and their families. The objective of this study was to identify the sociodemographic and psychosocial factors that predict resilience in family caregivers of children with cancer and to define whether there are differences in the levels of resilience derived from these sociodemographic variables. Three hundred and thirty family caregivers of children with cancer, with an average age of 32.6 years were interviewed. The caregivers responded to a battery of tests that included a questionnaire of sociodemographic variables, the Measuring Scale of Resilience, the Beck Depression Inventory, the Inventory of Quality of Life, the Beck Anxiety Inventory, an interview of caregiver burden and the World Health Organization Well-Being Index. The main findings indicate that family caregivers of children with cancer reported high levels of resilience, which were associated positively with quality of life, psychological well-being and years of study and associated negatively with depression, anxiety and caregiver burden. The variables that predicted resilience in families of children with cancer were quality of life, psychological well-being, depression and number of children. Family caregivers who were married and Catholic showed higher resilience scores. We conclude that being a caregiver in a family with children with cancer is associated with symptoms of anxiety and with depressive episodes. These issues can be overcome through family strength, well-being, quality of life and positive adaptation processes and mobilization of family resources.

AI snapshot

Written from the paper’s full text.

TL;DR

In a cross-sectional study of 330 family caregivers of children with cancer in Mexico City, caregivers reported high resilience, which was positively associated with quality of life, psychological well-being, and years of study and negatively associated with depression, anxiety, and caregiver burden. A regression model explained 41% of the variance in resilience, retaining quality of life, well-being, depression, caregiver burden, and years of study as predictors.

Key findings

  • Resilience correlated positively with quality of life (rho = 0.51), well-being (rho = 0.51), and years of study (rho = 0.14), and negatively with depression (rho = −0.46), anxiety (rho = −0.29), and caregiver burden (rho = −0.33), all p < 0.01.
  • The stepwise regression retained all correlated variables except anxiety and accounted for 41% of the variance in caregiver resilience (R² = 0.419; adjusted R² = 0.410; F(5, 324) = 46.70, p < 0.001). The Discussion identifies quality of life, psychological well-being, and years of study as positive predictors and depression and caregiver burden as negative predictors; the Abstract also lists number of children, but the Results/Discussion do not retain it.
  • Married caregivers had higher overall resilience than those in domestic partnerships (U = 6677.50, Z = −2.160, p < 0.05) and higher social competence (U = 6321, Z = −2.806, p < 0.05). Catholic caregivers scored higher on the structure factor than Christians (χ² = 6.790, p < 0.05, N = 329).
  • No overall resilience differences were detected by caregiver sex, pediatric patient sex, or caregiver religion (p > 0.05).

Methods

  • Non-experimental, cross-sectional, ex post facto design using convenience and non-probabilistic sampling. Participants were 330 family caregivers of hospitalized children with cancer at the Hospital Infantil de México Federico Gómez, Mexico City; 82% were women, mean age 32.60 years (SD = 8.59), and pediatric patients had a mean age of 6.33 years (SD = 5.13).
  • Measures included a sociodemographic questionnaire (Q-SV) and six self-report instruments: RESI-M resilience scale, Beck Depression Inventory-II, Beck Anxiety Inventory, WHOQOL-BREF quality of life, Zarit Burden Interview, and WHO Well-Being Index.
  • Analyses used Spearman correlations, chi-square tests with Kramer’s V, stepwise linear regression on natural-log-transformed resilience with collinearity and residual diagnostics, Mann–Whitney U tests, Kruskal–Wallis tests, and Nemenyi post hoc tests; significance was set at p ≤ 0.05.

Limitations

  • Stated: the cross-sectional design prevents establishing causal relationships or verifying consistency over time; the study relied on a single informant; anxiety may not reflect the psychological health consequences of caregiving, and psychological stress should be included; future studies should add family functioning, family support, and social support networks.
  • Evident: convenience/non-probabilistic sampling at one hospital limits generalizability; all measures were self-report; the sample was predominantly mothers, married or in domestic partnerships, Catholic, and low-income.
  • Evident: the Abstract states number of children predicted resilience, while the Results and Discussion report years of study as the sociodemographic predictor retained, indicating an internal inconsistency in the paper.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.3390/ijerph18020748

Cites

69 of 69 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

13 of 30 cited sources checked · 4 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    Families caring for children with cancer are at risk of developing anxiety, depression and parental stress.

    “The effects and consequences experienced by families caring for children with cancer include the risk of developing anxiety, depression and parental stress [8,9,10]”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites [8] Cernvall, M., Hovén, E., Ljungman, L., Ljungman, G., Carlbring, P., and von Essen, L. (2016). Posttraumatic stress and attentional bias towards cancer-related stimuli in parents of children recently diagnosed with cancer. PLoS ONE, 11. source

      The Introduction describes parenting a child recently diagnosed with cancer as stressful and links parents’ posttraumatic stress symptoms with depression and anxiety. The Results (Participants) also report higher depression and anxiety in parents with higher posttraumatic stress symptoms. The paper concerns parents, however, and does not establish that other family members are at risk or that these conditions develop because of caregiving. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
    • cites [9] Haegen, 2015, Stress, psychosocial mediators, and cognitive mediators in parents of child cancer patients and cancer survivors: Attention and working memory pathway perspectives, J. Psychosoc. Oncol. source
    • cites [10] 2018, Factors associated with anxiety in family caregivers of children with chronic diseases, BioPsychosoc. Med. source

      The Background identifies anxiety as a common concern for caregivers of children with chronic diseases and discusses depression and parental stress alongside it. The Discussion says three-quarters of the children studied had cancer, but their caregivers scored low on all three measures. The paper therefore supports these as potential caregiver concerns, not a demonstrated risk of developing all three specifically among families caring for children with cancer. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
  • Findingown data

    Resilience in family caregivers of children with cancer is positively associated with years of study.

    “years of study (rho = 0.14)”
    Quote in the paperNot a substantial claim
  • Findingown data

    Resilience in family caregivers of children with cancer is positively associated with psychological well-being.

    “well-being index (rho = 0.51)”
    Quote in the paperSubstantial claim
  • Findingown data

    Psychological well-being predicted resilience in family caregivers of children with cancer.

    “psychological well-being”
    Quote in the paperSubstantial claim
  • Findingown data

    Resilience in family caregivers of children with cancer is negatively associated with depression.

    “negative correlations appeared with the variables depression (rho = −0.46)”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. 26
  • May combine two claims. 17
  • The quote only partly states this claim. 2

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Caregivers of children with cancer experience stressful events, the most common of which are poor health, caregiver burden and burnout.

    “caregivers of such children experience a host of stressful events, the most common of which are poor health [11], caregiver burden and burnout [12,13]”
    Quote in the paperNot a substantial claim2 of 3 sources checked
    • cites [11] Young, 2018, Stressful life events and resilience among carers of Aboriginal children in urban New South Wales: Cross-sectional findings from the Study of Environment on Aboriginal Resilience and Child Health (SEARCH), BMJ Open source

      The Results (Frequency, spectrum and correlations between SLEs) identify family members’ health problems as the most commonly reported stressful events among carers of Aboriginal children. The study does not establish this finding for caregivers of children with cancer. In the citing sentence, caregiver burden and burnout are attached to other citations, not this source. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [12] 2019, Psychosocial factors related with caregiver burden among families of children with chronic conditions, BioPsychosoc. Med. source

      The Background links caregiver burden with high levels of burnout, and the Discussion includes caregivers of children with cancer in the study population (page numbers not supplied). But the study also includes other chronic diseases, does not establish that burden and burnout are the most common stressful experiences, and reports low average burden in its sample. Poor health has a separate citation in the citing sentence and is not assessed here. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [13] Khanna, 2015, Social, psychological and financial burden on caregivers of children with chronic illness: A cross-sectional study, Indian J. Pediatr. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Childhood cancer patients and their families frequently experience effects on their quality of life.

    “and effects on their quality of life [17,18].”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [17] Choi, 2016, Factors associated with quality of life among family caregivers of terminally ill cancer patients, Psycho-Oncology source
    • cites [18] Toledano-Toledano, F., Moral de la Rubia, J., Nabors, L.A., Domínguez-Guedea, M.T., Salinas, G., Rocha, E., Luna, D., and Leyva, A. (2020). Predictors of Quality of Life among Parents of Children with Chronic Diseases: A Cross-Sectional Study. Healthcare, 8. source

      The Introduction says that children with chronic diseases and their caregivers can experience deteriorating quality of life as illness progresses. The Results report that 74% of the children studied had an oncological disease, but the study assesses parents’ quality of life across diagnoses and does not separately establish how frequently childhood cancer patients and their families are affected. (LLM, conf=0.82)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Childhood cancer patients and their families frequently experience decreases in psychological well-being.

    “decreases in psychological well-being [15,16]”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [15] Cosco, 2016, Resilience measurement in later life: A systematic review and psychometric analysis, Health Qual. Life Outcomes source

      The Background discusses children adapting to adversity, while the Results examine resilience scales, chiefly in older adults; neither section addresses childhood cancer patients or their families. Searches for childhood cancer, families, and decreases in psychological well-being found no passage supporting the claim. (LLM, conf=0.76)

      Experimental — accuracy not yet measured
    • cites [16] Caes, 2015, Systematic review: Family resilience after pediatric cancer diagnosis, J. Pediatr. Psychol. source

      The Abstract reports emotional distress in parents after diagnosis, and the General Family Functioning section describes disruption during treatment. But the review says children with cancer typically show no greater psychological dysfunction than population norms and most families function within normal limits. It therefore does not support the broad claim that patients and families frequently experience decreases in psychological well-being. (LLM, conf=0.85)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S2 (checkable).

    Premisecitation

    Interventions aimed at promoting resilience resources can provide a novel and complementary approach to improve outcomes for families dealing with pediatric cancer.

    “Interventions aimed at promoting resilience resources can provide a novel and complementary approach to improve outcomes for families dealing with pediatric cancer [46].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [46] Rosenberg, 2014, Resilience and psychosocial outcomes in parents of children with cancer, Pediatr. Blood Cancer source

  • May combine two claims.

    Premisecitation

    Parents of children with cancer are at risk for negative psychosocial outcomes, and those with low resilience may be at higher risk.

    “Parents of children with cancer are at risk for negative psychosocial outcomes, and those with low resilience may be at higher risk.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [46] Rosenberg, 2014, Resilience and psychosocial outcomes in parents of children with cancer, Pediatr. Blood Cancer source

  • Classified as probably not a substantial claim.

    Premisecitation

    There is a set of contextual factors and sociodemographic characteristics in family caregivers of pediatric patients that increase the risk of suffering repercussions on physical and psychological health.

    “There is also a set of contextual factors and sociodemographic characteristics in family caregivers of pediatric patients that increase the risk of suffering repercussions on physical and psychological health [19].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [19] Toledano-Toledano, F., Rodríguez-Rey, R., Moral de la Rubia, J., and Luna, D. (2019). A Sociodemographic variables questionnaire (Q-SV) for research on family caregivers of children with chronic disease. BMC Psychol., 7. source

  • Probably not a substantial claim: may not pass S2 (checkable).

    Premisecitation

    Family caregivers of children with cancer need to develop the ability to adapt and operate optimally to overcome adversity.

    “Researchers and clinicians have been pointing out that family caregivers of children with cancer need to develop the ability to adapt and operate optimally to overcome adversity [36,37].”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [36] Lassi, 2015, Role of religion and spirituality on mental health and resilience: There is enough evidence, Int. J. Emerg. Ment. Health source
    • cites [37] Lennon, 2015, Resilience and disruption in observed family interactions in youth with and without Spina Bifida: An eight-year, five-wave longitudinal study, J. Pediatr. Psychol. source

      The paper defines resilience as desirable adjustment despite adversity from pediatric chronic illness (opening section; page unavailable). Its Discussion suggests building on resilience already present in families of youth with spina bifida. It does not establish that caregivers of children with cancer need to develop this ability. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Caregiving for children with cancer can be experienced as a stressful process that can cause psychological and physical consequences.

    “Caregiving can be experienced as a stressful process, which can cause psychological and physical consequences [7].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [7] Teixeira, 2019, The impact of informal cancer caregiving: A literature review on psychophysiological studies, Eur. J. Cancer Care (Engl.) source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The family itself constitutes the support network in most cases of family caregivers of children with cancer.

    “as reported in previous studies [66], the family itself constitutes the support network in most cases.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [66] Litzelman, 2011, Quality of life among parents of children with cancer or brain tumors: The impact of child characteristics and parental psychosocial factors, Qual. Life Res. source

      The Methods section identifies the parent most involved in the child’s care, and the Discussion recommends seeking social support. Neither says that the family itself is caregivers’ support network in most cases. Searches for family support networks and sources of social support found no passage establishing that claim; page numbers were unavailable in our copy. (LLM, conf=0.75)

      Experimental — accuracy not yet measured

  • The quote only partly states this claim.

    Findingown data

    Family caregivers who were married showed higher resilience scores.

    “Family caregivers who were married and Catholic showed higher resilience scores.”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    Family caregivers who were Catholic showed higher resilience scores.

    “Family caregivers who were married and Catholic showed higher resilience scores.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The sociodemographic variable years of study showed a positive correlation with resilience in family caregivers of children with cancer, but the degree of association was low.

    “the findings of this research indicated that the sociodemographic variable years of study showed a positive correlation with resilience. However, the degree of association between these variables was low.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In family caregivers of children with cancer, quality of life, psychological well-being, and years of study were positive predictors of resilience in a multiple regression model.

    “A multiple regression model revealed that the psychosocial factors quality of life and psychological well-being and the sociodemographic variable years of study were positive predictors of resilience”
    • Also stated in: § 4. Discussion · boosted
      “According to the regression model, these findings confirm that the psychosocial variables that predict family resilience in the face of illness are quality of life, psychological well-being and depression and that the sociodemographic variable that predicts the levels of resilience in family caregivers of children with cancer is years of study.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    For the structure factor, a lower number of Christians with moderate resilience was detected and a greater number with mild resilience.

    “For the structure factor, a lower number of Christians with moderate resilience was detected and a greater number with mild resilience (χ2 = 9.5, df = 4, V = 0.12, p = 0.05).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The social support factor had a greater number of caregivers with moderate resilience when their incomes were low, but with a high level of resilience with higher incomes.

    “Finally, the social support factor had a greater number of caregivers with moderate resilience when their incomes were low, but with a high level of resilience with higher incomes (χ2 = 9.08, df = 2, V = 0.01, p < 0.01).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Anxiety was not kept in the regression model predicting resilience.

    “all except one (anxiety) were kept in a regression model”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The four remaining factors presented an almost significant tendency (p = 0.07), showing higher scores for married family caregivers.

    “The four remaining factors presented an almost significant tendency (p = 0.07), which showed higher scores for married family caregivers.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The DBI-II has excellent internal consistency (α = 0.91) among the 330 family caregivers.

    “Among the 330 family caregivers in the present study, the overall internal consistency of the 21 items was excellent through Cronbach alpha coefficient (α = 0.91).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The BAI has excellent internal consistency (α = 0.92) in the present sample.

    “In the present sample, the overall internal consistency of the 21 items was excellent (α = 0.92).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationnone given

    These issues can be overcome through family strength, well-being, quality of life and positive adaptation processes and mobilization of family resources.

    “These issues can be overcome through family strength, well-being, quality of life and positive adaptation processes and mobilization of family resources.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductnone given

    The instruments used in the study were validated in the Mexican population and with families of children with chronic diseases.

    “To guarantee the accuracy of the data obtained, the instruments were validated in the Mexican population and with families of children with chronic diseases.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The WHO-WBI was validated specifically for this study using the Forward-Backward Translation strategy.

    “This instrument was validated specifically for this study, with the sample described above, using the Forward-Backward Translation strategy.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Religious support is one of the components of resilience with the greatest weight in chronically and terminally ill patients.

    “Religious support is one of the components of resilience with the greatest weight in chronically and terminally ill patients [35].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [35] Hegadoren, 2016, Sociodemographic factors and health conditions associated with the resilience of people with chronic diseases: A cross sectional study, Rev. Latino-Am. Enfermagem

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    All family caregivers were informed of the objectives and scope of the research and their rights according to the Declaration of Helsinki.

    “All family caregivers were informed of the objectives and scope of the research and their rights according to the Declaration of Helsinki [59].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [59] World Medical Association (2013). World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA, 310, 2191–2194. source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Religious beliefs and the practice of prayer provide hope and confidence and open a path to find meaning in adverse situations.

    “Religious beliefs and the practice of prayer provide hope and confidence. They even open a path to find meaning in the adverse situation that is experienced [36].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [36] Lassi, 2015, Role of religion and spirituality on mental health and resilience: There is enough evidence, Int. J. Emerg. Ment. Health source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Childhood cancer patients and their families frequently experience psychosocial distress associated with cancer and its treatment.

    “childhood cancer patients and their families frequently experience psychosocial distress associated with cancer and its treatment [14]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [14] Tsumura, 2020, Reliability and validity of a Japanese version of the psychosocial assessment tool for families of children with cancer, Jpn. J. Clin. Oncol. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The WHO-WBI has good overall internal consistency (α = 0.89).

    “The overall internal consistency of its 9 items was good (α = 0.89).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The study was approved by the Research, Ethics, and Biosafety Commissions of the Hospital Infantil de México Federico Gómez.

    “which was approved on 16 December 2014, by the Research, Ethics, and Biosafety Commissions of the Hospital Infantil de México Federico Gómez, National Institute of Health, in Mexico City.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Resilience helps individuals overcome the diagnosis crisis, lessens the impact of the tasks entailed by medical care and treatment and improves the psychosocial adjustment and well-being of caregivers during the child's chronic illness.

    “Resilience helps individuals overcome the diagnosis crisis, lessens the impact of the tasks entailed by medical care and treatment and improves the psychosocial adjustment and well-being of caregivers during the child’s chronic illness [9,28,38,43].”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [9] Haegen, 2015, Stress, psychosocial mediators, and cognitive mediators in parents of child cancer patients and cancer survivors: Attention and working memory pathway perspectives, J. Psychosoc. Oncol. source
    • cites [28] Eilertsen, 2016, Resilience factors play an important role in the mental health of parents when children survive acute lymphoblastic leukaemia, Acta Paediatr. source
    • cites [38] Rosenberg, 2013, Promoting resilience among parents and caregivers of children with cancer, J. Palliat. Med. source
    • cites [43] Ye, 2015, Resilience and psychosocial function among mainland chinese parents of children with cancer: A cross-sectional survey, Cancer Nurs. source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    Ethical rules and considerations for research with humans in Mexico and APA guidelines were followed.

    “the ethical rules and considerations for research with humans currently enforced in Mexico [57] and those outlined by the American Psychological Association [58] were followed.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [57] Sociedad Mexicana de Psicología (2010). Código Ético del Psicólogo [Ethical Code of the Psychologist], Trillas.

      Not checked in the free run.

    • cites [58] American Psychological Association (2017). Ethical Principles of Psychologists and Code of Conduct. With the 2016 Amendment to Standard 3.04, American Psychological Association Press. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The WHOQOL-BREF has excellent internal consistency (α = 0.92) among the 330 family caregivers.

    “Among the 330 family caregivers in the present study, the overall internal consistency of the 26 items was excellent (α = 0.92).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    The statistical power of the analysis was 0.99.

    “resulting in a statistical power (1 − β) = 0.99 [59].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [59] World Medical Association (2013). World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA, 310, 2191–2194. source

  • May combine two claims.

    Interpretationown data

    In family caregivers of children with cancer, support networks, level of parental education, and income are fundamental to decreasing the impact and effects of care.

    “In this group of family caregivers, the variables support networks, level of parental education and income are fundamental to decreasing the impact and effects of care.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The measurement instruments used in this study have reliability estimated through internal consistency in the current sample and other samples, with good or very good values, and have shown stability through test-retest reliability.

    “However, the measurement instruments have their reliability estimated through internal consistency in the current sample and other samples and these values are good or very good. They have even shown stability through test-retest reliability.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Study design and conductnone given

    The indicators used as effects of care, for example anxiety, likely do not reflect the consequences in the psychological health of the caregiver.

    “it is likely that the indicators used as effects of care—for example, anxiety—do not reflect the consequences in the psychological health of the caregiver”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    The interviewer checked that there were no questions without answers and asked participants to respond to missing items, avoiding missing values.

    “Before collecting the completed instruments, the interviewer checked that there were no questions without answers. If there were questions without answers, the participant was asked to respond to them, and in this way, we managed to avoid the presence of missing values.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    The present study was based on a single informant and did not have multiple informants among relatives, which may affect the reliability of the data.

    “the present study was based on a single informant and did not have multiple informants among relatives, as is usual in a survey study. It could be considered that this fact may affect the reliability of the data.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    The cross-sectional nature of the design prevents establishing causal relationships or verifying the consistency of results over time.

    “Among the limitations of this study is the cross-sectional nature of the design, which prevents establishing causal relationships or verifying the consistency of results over time.”
    Quote in the paperSubstantial claim
38 of 38

  • The paper relies on this without support.

    Relatively few studies have focused on identifying the psychosocial and sociodemographic factors that predict resilience in family caregivers of children with cancer.

    “relatively few studies have focused on identifying the psychosocial and sociodemographic factors that predict resilience in family caregivers of children with cancer.”
1 of 1

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • ConsistentF(5, 324) = 46.7reported p < .001 · recomputed p < .001

    “F (5, 324) = 46.70, p < .001”

  • Consistentz = -2.16reported p < .05 · recomputed p = .031

    “Z = −2.160, p < .05”

  • Consistentz = -2.806reported p < .05 · recomputed p = .005

    “Z = −2.806, p < .05”

3 of 3

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Abstract names a different sociodemographic predictor

    Major

    The abstract identifies number of children as a predictor of resilience, but the results and discussion identify years of study as the sociodemographic predictor in the regression model.

  • Stated anxiety score range exceeds the maximum for 16 items

    Minor

    With 16 items scored from 0 to 3, the maximum total is 48, not the stated 63 points.

    Reported 63 · recomputed 48

  • Beck Anxiety Inventory is described as having both 16 and 21 items

    Minor

    The instrument description says it assesses anxiety through 16 items, while the reliability statement for the same inventory refers to 21 items.

  • Reported Cramér's V is inconsistent with the income chi-square

    Minor

    For the stated sample of 330 and a chi-square test with 2 degrees of freedom, V = 0.01 would imply χ2 = 0.033, not 9.08. The reported chi-square instead implies V of about 0.166.

    Reported 9.08 · recomputed 0.033

  • Income association is assigned to different resilience factors

    Minor

    The results assign the association between income and resilience to the social support factor, whereas the discussion says these findings concern the structure factor.

5 of 5

Cites

Flagged first, then by citations

5 of the 74 references couldn’t be matched to a known paper.

Cited by

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Authors
Toledano-Toledano, F., Luna, D., Moral de la Rubia, J., Martínez Valverde, S., Bermúdez Morón, C. A., Salazar García, M., & Vasquez Pauca, M. J.
Affiliations
  • Evidence-Based Medicine Research Unit, Hospital Infantil de México Federico Gómez, National Institute of Health, Dr. Márquez 162, Doctores, Cuauhtémoc, Mexico City 06720, Mexico
  • Comisión Nacional de Arbitraje Médico. Mitla No. 250-10 Piso, esq. Eje 5 Sur (Eugenia), Col. Narvarte, Benito Juárez, Mexico City 03020, Mexico
  • Facultad de Psicología, Universidad Autónoma de Nuevo León, Dr. Carlos Canseco, 110, Esq. Dr. Aguirre Pequeño, Col. Mitras Centro, Monterrey 64460, Mexico
  • Centro de Estudios Económicos y Sociales en Salud, Hospital Infantil de México Federico, Gómez, National Institute of Health, Dr. Márquez 162, Doctores, Cuauhtémoc, Mexico City 06720, Mexico
  • Facultad de Trabajo Social, Universidad Nacional del Altiplano Puno, Floral 1153, Puno 21001, Peru
ORCID
Venue
International Journal of Environmental Research and Public Health
Publisher
MDPI AG
Published
2021-01-17
Volume
18
Issue
2
Pages
748
ISSN
1660-4601 (ISSN-L)
DOI
10.3390/ijerph18020748
PMC
PMC7830523
OpenAlex
W3122499065
Semantic Scholar
0b62eb25eec7ceb743fb7e5d1d6075e0a7c72394
Cited by
86
References
74
Citations by year
2026: 14 · 2025: 24 · 2024: 14 · 2023: 9 · 2022: 18 · 2021: 7
FWCI
10.94
Type
journal article
Language
en
Open access
Licence
Locations
  • International Journal of Environmental Research and Public Health (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • PubMed Central (submittedVersion, cc-by)
  • RePEc: Research Papers in Economics (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Funders
Effects of mindfulness training on psychological distress and quality of life of the family caregiver (HIM/2015/017/SSA.1207)
Topics
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Childhood Cancer Survivors' Quality of Life
  • Social Sciences › Psychology › Clinical Psychology › Resilience and Mental Health
  • Social Sciences › Psychology › Clinical Psychology › Family and Disability Support Research
Keywords
resilience, family caregivers, childhood cancer, psychosocial factors, caregiver burden, quality of life, psychological well-being, depression, anxiety, sociodemographic factors, family resources, family strengths
MeSH terms
Adaptation, Psychological, Adult, Anxiety, Child, Cross-Sectional Studies, Depression, Family, Female, Humans, Male, Neoplasms, Quality of Life, Caregivers, Resilience, Psychological

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-14.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-14.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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