M
Narges Raoofi Adegani; Maryam Zarnaghash; Majid Barzegar; Nadere Sohrabi Shegefti
Abstract
Objective: Cancer is one of the most important health problems worldwide. Childhood cancer is a leading cause of death worldwide, and the leading cause of death in children and adolescents. The World Health Organization (2021) estimates that the number of new cases of cancer will increase to 26 million ...
Read More
Objective: Cancer is one of the most important health problems worldwide. Childhood cancer is a leading cause of death worldwide, and the leading cause of death in children and adolescents. The World Health Organization (2021) estimates that the number of new cases of cancer will increase to 26 million worldwide by 2040, increasing the global burden of cancer. Despite significant advances in the treatment of this chronic disease, this diagnosis is still devastating for family members of children and causes major changes in their lives. The changes in the child's condition, the impact of the side effects of the medication used, and the disease on his physical condition will cause severe psychological problems in mothers. Parental burnout is a significant psychological concern that can adversely affect parenting quality, particularly in mothers who care for children with chronic illnesses such as cancer. These mothers often experience elevated levels of psychological distress due to the emotional, physical, and financial demands of caring for a child with a life-threatening condition. Exposure of parents to prolonged stress related to childcare leads to parental burnout, a state of intense and overwhelming fatigue related to the parental role, in which parents become emotionally distant from their children and, unlike in the past, doubt their capacities as effective and good parents. In recent years, attachment theory and mindfulness have emerged as critical psychological constructs that may influence how individuals cope with stress and caregiving demands. According to Bowlby's attachment theory, the early emotional bonds between the child and the mother (caregiver) are internalized in the form of mental models and are generalized to the child's wider range of interpersonal relationships in the future. The mental model creates a set of expectations and beliefs about the self and others and the relationships between them. Which arouses the individual's emotions in stressful situations. The pattern of these relationships, in the form of attachment style, remains relatively constant throughout the individual's life. Bowlby described three types of attachment in childhood: secure, avoidant, and anxious (ambivalent). This has also been confirmed in adulthood. Mindfulness is defined as paying attention on purpose in the present moment, without judgment. In other words, mindfulness is adopting a non-judgmental attitude toward personal experiences. It is an ongoing, moment-to-moment process that allows the individual to be less reactive and more accepting of these experiences. Mothers with children with chronic diseases, especially cancer, are at serious risk of developing parental burnout syndrome. And so far, parental burnout has not been studied in this at-risk and care-seeking community. Therefore, examining the present conceptual model will be necessary to improve local knowledge about parental burnout in Iranian mothers, especially the sensitive community of mothers with children with cancer, and also to create a perspective to reduce this distressing experience by cultivating awareness in them. Understanding how maternal attachment styles and mindfulness interact to influence parental burnout can contribute to the development of targeted interventions for at-risk mothers. Method: The present study aimed to examine a causal model of parental burnout based on maternal attachment, with the mediating role of mindfulness, in mothers of children diagnosed with cancer. This study employed a descriptive-correlational design using structural equation modeling (SEM) to test the hypothesized relationships among variables. The statistical population included all mothers of children with cancer who were referred to pediatric oncology units of Omid Hospital in Esfahan, Iran, in 2024. Using convenience sampling, 250 mothers were selected and asked to complete three standardized questionnaires: the Parental Burnout Assessment (PBA), the Adult Attachment Scale (Collins & Read, 1990), and the Five Facet Mindfulness Questionnaire (FFMQ). Results: The data were analyzed using SPSS version 26 and AMOS version 24. The structural model showed a good fit to the data (χ²/df =3.89, RMSEA=0.078, CFI=2.963). The findings indicated that the direct relationship between secure attachment (β=-0.213, p<0.05), avoidant attachment style (β = 0.256, p<0.05), anxious attachment style (β=0.137, p<0.05), and mindfulness (β=-0.66, p<0.05) had significant direct relationships with parental burnout. Nonetheless, the indirect effects of all three attachment styles (secure, anxious, avoidant) on parental burnout through mindfulness as a mediator were found to be significant (p<0.001). Conclusion: This study aimed to investigate the causal model of parenting burnout in mothers of children with cancer based on maternal attachment with the mediating role of maternal mindfulness. The results supported the direct relationship between secure attachment style and avoidant attachment style negatively, anxious attachment style positively, and maternal mindfulness negatively with parenting burnout. The results showed that maternal mindfulness has a mediating role in parenting burnout based on attachment styles (secure, avoidant, anxious). The study's findings showed that a secure attachment style is negatively associated with burnout among mothers. This means that mothers with secure attachment style experience less parenting burnout. These findings support the theoretical proposition that mindfulness acts as a protective factor against parental burnout and that secure attachment fosters adaptive coping strategies through increased present-moment awareness and emotion regulation. The results emphasize the need for preventive and therapeutic interventions that focus on promoting secure attachment and enhancing mindfulness in mothers of children with cancer. Mindfulness-based parenting programs and attachment-informed counseling could be particularly effective in reducing parental stress and burnout in this high-risk group. In conclusion, this study contributes to the growing body of literature highlighting the interplay between attachment, mindfulness, and psychological well-being among caregiving mothers. It underscores the importance of incorporating psychological factors into pediatric cancer care, not only for the child but also for the primary caregiver. Future research may explore longitudinal designs and intervention studies to establish causal links and practical applications.
