The objective of this proposal is to develop the applicant as a sophisticated independent researcher in psychiatric epidemiology. The career development plan includes advanced level coursework in methodology and statistical analysis through participation in the Psychiatric Epidemiology Training Program, and supervision of a research program by the preceptor with consultation from the individuals listed above. The research program consists of 3 interrelated projects designed to develop an appropriate methodology and then delineate the coping process exhibited by children with chronic illness. Studying the coping process will permit identification of those components of that process which contribute to the increased prevalence of psychiatric disorders in this population and those components which enhance competence and promote good adjustment. Project I delineates the effect of level of stress on the other components of the coping process (coping strategies used and social network) and on outcome (emotional distress and psychosocial functioning). This will be done by evaluating these variables in children with cancer and their parents at times of low and high illness related stress. Project I also tests the validity of the coping strategy instrument by evaluating the relationship of coping strategies to other theoretically related constructs like personal dispositions. Project II develops and establishes the psychometric properties of an instrument to measure the coping strategies used by children to deal with illness. An instrument modified from the adult instruments will be piloted on 30 hospitalized children. Internal consistency reliability will be tested on data from 100 hospitalized children and test retest reliability on data from 30 children with cancer. Project III is a longitudinal, case control study of coping in children with cancer. The components on the coping process (life events, personal dispositions, social network and coping strategies) and outcome (emotional distress, psychological and social functioning and medical compliance) will be measured in 100 children with cancer and their parents at diagnosis, quarterly for one year, and at specific times of illness related stress. The controls will be evaluated initially and quarterly for one year. The relationships of the components of the coping process to each other and to outcome will be evaluated within each group and compared across groups. This will permit us to detemrine how the coping process exhibited by children with cancer and their families compares to that of the controls as well as how the coping process relates to outcome in both groups.
