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Does Resilience Mediate Carer Distress After Head and Neck Cancer?

Simpson, Grahame K. PhD; Dall’Armi, Luci MNurs; Roydhouse, Jessica K. MPH(Hons); Forstner, Dion MBBS(Hons); Daher, Maysaa BPsych; Simpson, Teresa MCounselling; White, Kathryn J. PhD

doi: 10.1097/NCC.0000000000000229

Background: Caring for patients with head and neck cancer (HNC) can have significant negative psychological and practical impact; however, some carers seem able to cope effectively. Little research has investigated this resilience among carers.

Objective: The objective of this study was to investigate the resilience levels among carers of patients with HNC.

Methods: Carers (n = 51) from 2 cancer services in New South Wales completed the Resilience Scale (RS), the Head and Neck Information Needs Questionnaire, and the Hospital Anxiety and Depression Scale. Hospital Anxiety and Depression Scale cutoff scores (>8) were used to classify carers with clinically significant levels of anxiety or depression.

Results: The majority of carers (67% [34/51]) reported moderately high to high resilience. Rates of anxiety and depression among carers were 27.4% and 9.8%, respectively. Higher resilience scores were significantly correlated with lower anxiety and depression scores, as well as increasing age. Resilience Scale scores were independent of the severity of the HNC. There were no significant correlations between RS scores and Head and Neck Information Needs Questionnaire scores. Finally, increasing RS scores were associated with a decreasing probability of possible anxiety or depression.

Conclusions: These results indicate that higher resilience in carers of HNC patients was associated with lower levels of psychological distress. Further investigation into the relationship between resilience and carer psychological wellbeing is warranted.

Implications for Practice: If further evidence supports the findings of this study, then investigating ways to build resilience will be an important clinical option for reducing carer morbidity associated with anxiety and depression. The RS could be used to assess resilience levels among carers of HNC patients.

Author Affiliations: Liverpool Brain Injury Rehabilitation Unit, Liverpool Hospital (A/Prof Simpson); Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research (A/Prof Simpson and Ms Daher); John Walsh Centre for Rehabilitation Research, Sydney School of Medicine, University of Sydney (A/Prof Simpson); Cancer Therapy Centre, Liverpool Hospital (Dr Forstner, Mss Dall’Armi and Simpson); Cancer Nursing Research Unit, Sydney Nursing School, Royal Prince Alfred Hospital and University of Sydney (Ms Roydhouse and Prof White); Radiation Oncology, Liverpool and Macarthur Cancer Therapy Centres, Liverpool Hospital (Dr Forstner), Sydney, Australia.

This study was funded by the NSW Cancer Institute.

The authors have no conflicts of interest to disclose.

Correspondence: Grahame K. Simpson, PhD, Liverpool Brain Injury Rehabilitation Unit, Liverpool Hospital, Locked Bag 7279, Liverpool, BC New South Wales 1871, Australia (

Accepted for publication November 21, 2014.

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