The contribution of cognitive disengagement syndrome symptoms to depressive symptoms among pediatric brain tumor survivors.

Objective: Pediatric brain tumor survivors (PBTS) are at risk for neurocognitive late effects that can resemble symptoms of cognitive disengagement syndrome (CDS). In the current study, we compared the CDS symptoms of PBTS to those of healthy comparison classmates (CC) and examined whether CDS might explain group differences in depressive symptoms. We also explored whether CDS symptoms were associated with engagement-based coping strategies and stress responses, thereby testing one mechanism by which CDS could lead to affective difficulties.

Methods: Data were from a larger, multisite study examining the psychosocial impact of pediatric brain tumors on survivors (ages 8-15; 1- to 5-year post-treatment) and their families. PBTS (n = 68) and CC (n = 64) were matched on age and sex and reported depressive symptoms, coping strategies, and stress responses during a home-based assessment. Caregivers reported child CDS symptoms. Analyses used multiple regression with post hoc bootstrapping to test indirect effects.

Results: CDS symptoms were elevated in PBTS compared to CC (d = 0.49, p = .005), and elevated CDS symptoms partially explained higher depressive symptoms for PBTS. Exploratory serial mediation models suggested that coping strategies and stress responses did not account for the relationship between CDS and depressive symptoms. Alternative mechanisms to explain the association between CDS and depressive symptoms are discussed.

Conclusions: CDS may be a relevant framework to understand why some PBTS are at risk for depressive symptoms. Although additional research is needed, clinicians should consider screening for CDS symptoms to assess risk for depressive symptoms in survivorship.