Parent pain catastrophizing predicts child depressive symptoms in youth with sickle cell disease

Parental stress in the relationship with children affected by chronic hematologic disease

BACKGROUND

Sickle cell disease (SCD) and autoimmune thrombocytopenic purpura (AITP) are pediatric diseases which frequently are associated with cognitive, social and emotional complications and can lead caregivers to important consequences. The aim of this study was to examine the potential psychologic parental distress and the plausible interference with suffering of their children.

METHODS

We recruited 39 parents of 44 pediatric patients and divided them into two groups: patients affected by SCD and patients affected by AITP. Parenting Stress Index Short-form (PSI-SF) was proposed to the parents. We investigated the statistical correlations between the PSI-SF variables of the test, the patients scores at the cognitive test, the patients age, and the scores obtained at the mood test.

RESULTS

The analysis of the parents scores obtained by the test reported that the stress levels of the parents of children affected by SCD are higher than those the other group. The analysis of the data showed that 72% of the patients score was average in the cognitive test, whereas 28% of them obtained a score below average; in the mood assessment tests: 35% of the patients reported elevated scores in the depression subscale; 21% showed an elevated score in the anxiety subscale.

CONCLUSIONS

The data obtained provide us useful indications about pattern of behavior between the parents and the children affected by chronic hematological diseases. The differences in the perception of the parental distress were associated with children's disease, social problems increased parental distress, which was correlated with depression symptoms of the children.

A dyadic analysis of parent and child pain catastrophizing and health-related quality of life in pediatric sickle cell disease

ABSTRACT

The purpose of this study was to examine the dyadic and individual level effects of parent and child pain catastrophizing on child health-related quality of life (HRQOL) in pediatric sickle cell disease. Questionnaires assessing child pain frequency, child and parent pain catastrophizing, and child HRQOL were completed by youth and their primary caregiver. A Common Fate Model was estimated to test the dyadic level relationship between parent and child pain catastrophizing and child HRQOL. An Actor-Partner-Common Fate Model hybrid was estimated to test the relationship between child HRQOL and individual-level child pain catastrophizing and parent pain catastrophizing, respectively. In each model, child HRQOL was modelled as a dyadic variable by factoring parent and child ratings. Patients (N = 100, M age = 13.5 years, 61% female) and their caregivers (M age = 41.8 years, 86% mothers) participated. Dyad-level pain catastrophizing was negatively associated with child HRQOL, demonstrating a large effect (β = -0.809). Individual-level parent and child pain catastrophizing were each uniquely negatively associated with child HRQOL, demonstrating small to medium effects (β = -0.309, β = -0.270). Individual level effects were net of same-rater bias, which was significant for both parents and children. Both the unique and the overlapping aspects of parent and child pain catastrophizing are significant contributors to associations with child HRQOL, such that higher levels of pain catastrophizing are associated with worse child HRQOL. Findings suggest the need for multipronged intervention targeting factors common to parent-child dyads and factors unique to parents and children, respectively.

Internalizing Symptoms in Adolescents With Sickle Cell Disease

OBJECTIVE

Sickle cell disease (SCD) is a genetic blood disorder that may affect patients' mood and behavior. However, measuring the prevalence of internalizing symptoms (anxiety and depression) in patients with SCD has been elusive. We assessed internalizing symptoms in adolescents with SCD to evaluate prevalence and to test whether neurocognitive performance and frequency of pain-related episodes were associated with internalizing concerns.

METHODS

One hundred eighty-five patients (57% HbSS/HbSß0-thalassemia, 43% HbSC/HbSß+-thalassemia), ages 12-18 years, received a neuropsychological evaluation as a part of a larger cohort study. Internalizing symptoms were measured using the Behavior Assessment System for Children, Second or Third Edition. Scores on the depression and anxiety scales were compared to normative values using Wilcoxon signed rank test. Spearman correlations examined associations between neurocognitive performances and internalizing symptoms. Robust multivariable regression models measured associations between internalizing symptoms and age, sex, sickle genotype, total hemoglobin, fetal hemoglobin, socioeconomic status, and frequency of pain episodes.

RESULTS

Parent- and self-reported ratings of internalizing symptoms were not elevated compared to normative expectations. Overall, 1.8% and 6.3% of the sample displayed clinically elevated symptoms of anxiety and depression based on self-report, respectively. There were no associations between internalizing symptoms and neurocognitive performance (all p > .05). In multivariable analyses, the frequency of pain episodes was positively associated with self-reported anxiety (p = .006) and parent-reported depressive symptoms (p = .017).

CONCLUSIONS

Adolescents with SCD do not report elevated internalizing symptoms compared to normative expectations. Further research is needed to examine the trajectory of internalizing symptoms and the bidirectional relationship between pain and psychosocial functioning in SCD.

Prevalence of clinical manifestations suggestive of depression in patients with sickle cell disease: a review

ABSTRACT Objective: To assess the prevalence of clinical manifestations suggestive of depression in patients with sickle cell disease. Methods: A systematic search was performed in the electronic databases PubMed®, LILACS and SciELO, with the following inclusion criteria: cross-sectional studies that assessed the prevalence of depression in patients with sickle cell disease, published in English or Portuguese in the last 10 years. The selection of the articles was performed in two stages by two independent researchers following the PRISMA (Preferred reporting items for systematic reviews and meta-analyses) recommendations. The first stage consisted on screening the titles and abstracts, and in the second stage the full text was appraised, both following the pre-defined inclusion and exclusion criteria. Results: From the 42 articles available, nine were included in this review. Seven instruments were used to screen for depression with different cutoff points, and the Patient Health Questionnaire-9 (PHQ-9) was the most used instrument. The worldwide prevalence of clinical manifestations suggestive of depression ranged from 11 to 40%, according to several variables. Conclusion: The prevalence of clinical manifestations suggestive of depression in patients with sickle cell disease is higher compared to the prevalence of depression in the general population. Thus, the multidisciplinary follow-up for these people, with a focus on mental health, is of great importance.

Parental Psychosocial Distress in Pediatric Sickle Cell Disease and Chronic Pain

BACKGROUND

Pediatric sickle cell disease (SCD) management can result in considerable caregiver distress. Parents of youth with chronic SCD pain may face the additional challenge of managing children's chronic pain and chronic illness. This study examined associations between parent psychological distress and child functioning and the moderating role of chronic pain among youth with SCD.

METHODS

Youth presenting to pediatric outpatient comprehensive SCD clinics and their primary caregivers completed a battery of questionnaires. Parents reported on parenting stress, parent mental and physical health, and family functioning. Children completed measures of pain characteristics, depressive symptoms, catastrophic thinking, functional disability, and quality of life.

RESULTS

Patients (N = 73, Mage = 14.2 years, 57% female) and their caregivers (Mage = 41.1 years, 88% mothers, 88% Black) participated. Worse parent functioning was associated with worse child pain, functioning, quality of life, and depressive symptoms. Beyond the effects of SCD, chronic SCD pain magnified the negative associations between parenting stress frequency and child quality of life, parent physical health and child quality of life, and parent depressive symptoms and child depressive symptoms.

CONCLUSIONS

Chronic pain may exacerbate the relations between parent and child functioning beyond the effects of SCD alone. The management of both SCD and chronic pain may present additional challenges for parents that limit their psychosocial functioning. Family-focused interventions to support parents and youth with chronic SCD pain are warranted to optimize health outcomes.

Descriptive analysis of sickle cell patients living in France: The PHEDRE cross-sectional study

Background

Sickle cell disease (SCD) induces chronic haemolytic anaemia and intermittent vaso-occlusion that results in tissue ischaemia causing acute, severe pain episodes that can lead to frequent hospitalizations. These consequences can have repercussions on family, social, school and/or professional life. Here, we present some of the results of the PHEDRE study (Pharmacodépendance Et DREpanocytose—drug dependence and sickle-cell disease), which is the largest study of patients with SCD in France. This paper intends to describe characteristics of the French SCD population. We also aimed to assess the impact of the disease on the lives of patients using objective and subjective variables.

Methods

The PHEDRE study was a national multicentric observational study. Adults, adolescents and children with a confirmed SCD diagnosis were included in the study by their referring doctor. Then, they were interviewed by phone about their socioeconomic status, about the impact of the disease on their lives and about their analgesic and psychoactive drug use.

Results

The study population consisted of 872 patients (28% were minors). Seventy-two percent of adults were active, and all minors were in school. Many patients presented criteria of severe SCD. Seventy-five percent were homozygous SS, 15% were double heterozygotes SC and 8% were heterozygotes Sβthal, 87% received specific treatment, 58% were hospitalized at least once for vaso-occlusive crisis in the past 12 months, and the number of analgesic drugs taken averaged 3.8. Seventy-five percent of patients reported academic or professional consequences related to their SCD, and 52% reported social consequences.

Conclusions

The impact of SCD on patients’ lives can be significant, nevertheless their social integration seems to be maintained. We highlighted respect of recommendations regarding analgesic treatments and only a few patients used tobacco, alcohol or cannabis.

Trial registration

Clinical Trials, NCT02580565; https://clinicaltrials.gov/ Registered 16 October 2015.

Pain-Related Injustice Appraisals in Youth with Sickle Cell Disease: A Preliminary Investigation

OBJECTIVES

Sickle cell disease (SCD) is a genetic disorder that affects approximately 100,000 Americans, the majority of whom are African American. SCD-related pain often has deleterious effects on functioning and quality of life. The inherited nature of SCD, SCD-related stigma, and serious physical and functional impact of SCD-related pain create a situation ripe for individuals to appraise their SCD-related pain as unfair or unjust. The aim of this preliminary investigation is to explore the extent to which pediatric patients with SCD appraise their pain as unjust and how these appraisals relate to functioning.

METHODS

Participants were youth with SCD (N = 30, mean age = 11.3, 57% boys) who attended a hematology clinic visit. Patients were invited to complete paper-based questionnaires assessing pain-related injustice appraisals, pain catastrophizing, pain and hurt, functional disability, depression, anxiety, and peer relationships.

RESULTS

Results of hierarchical regressions indicate that pain-related injustice significantly predicted functional disability, depression, and anxiety after controlling for patient pain and catastrophizing.

CONCLUSIONS

These findings suggest that pain-related injustice appraisals are an important contributor to the pain experience of youth with SCD. Early identification and remediation of pain-related injustice appraisals could have long-term functional benefits for youth with SCD.

Optimizing the management of chronic pain in sickle cell disease

Chronic pain in sickle cell disease (SCD) refers to pain present on most days lasting over six months. It can start during childhood and the prevalence increases with age. By adulthood, over 55% of patients experience pain on over 50% of days; 29% reporting pain on 95% of days. The true prevalence of chronic pain in SCD is likely underappreciated as it is mostly managed at home. Patients with chronic pain and SCD frequently seek acute care for exacerbation of underlying chronic pain difficult to distinguish from their usual acute vaso-occlusive crises. When treating chronic pain in SCD, the challenge is distinguishing between non-SCD related etiologies versus chronic pain resulting from SCD pathophysiological processes. This distinction is important to delineate as it will drive appropriate management strategies. Chronic pain in SCD has profound consequences for the patient; is often associated with comorbid psychiatric illnesses (depression and anxiety), not dissimilar from other chronic pain syndromes. They may also experience challenges with sleep hygiene, various somatic symptoms, and chronic fatigue that impair quality of life. How best to treat chronic pain in SCD is not definitively established. Both acute and chronic pain in SCD is typically treated with opioids. Emerging data suggests that chronic opioid therapy (COT) is a suboptimal treatment strategy for chronic pain. This review will discuss the complexity of managing chronic pain in SCD; pain that may be dependent or independent of the underlying SCD diagnosis. We will also describe alternative treatment approaches to high-dose COT.

Changes in Pain and Psychosocial Functioning and Transition to Chronic Pain in Pediatric Sickle Cell Disease: A Cohort Follow-up Study

OBJECTIVES

This study aimed to: (1) examine changes in pain, psychosocial functioning, and health care utilization among children and adolescents with sickle cell disease (SCD) over a 2-year period and (2) identify baseline biopsychosocial variables associated with the development and maintenance of chronic SCD pain at follow-up.

MATERIALS AND METHODS

Forty-two youth (8 to 18 y old) with SCD completed a battery of self-report measures at baseline and 2-year follow-up. Analgesic, Anesthetic, and Addiction Clinical Trial Translational Innovations Opportunities and Networks and American Pain Society Pain Taxonomy (AAPT) diagnostic criteria were used to categorize patients into pain frequency groups at both timepoints: chronic (pain on most [≥15] d/mo for the past 6 mo, per AAPT diagnostic criteria), episodic (pain on 1 to 14 d/mo), or asymptomatic (0 d/mo).

RESULTS

At baseline, 31% (n=13) had chronic pain, 50% (n=21) episodic pain, and 19% (n=8) were asymptomatic. At follow-up, 40.5% (n=17) had chronic pain, 52.4% (n=22) episodic pain, and 7.1% (n=3) were asymptomatic. Between baseline and 2-year follow-up, 12% (n=5) developed chronic SCD pain. Depressive symptoms and admissions for pain significantly increased over time for youth with chronic pain (Ps<0.05). An interaction effect revealed that baseline pain groups differed in their change in pain intensity over time (P<0.01). Baseline psychosocial factors (ie, higher functional disability, greater depressive symptoms, higher pain catastrophizing, and lower quality of life) were significantly associated with chronic pain at follow-up.

DISCUSSION

Biopsychosocial factors may be associated with the development and maintenance of chronic SCD pain and their relative contributions warrant further study.

The Effect of Progressive Muscle Relaxation Exercises on Pain on Patients with Sickle Cell Disease: Randomized Controlled Study

PURPOSE

The study aimed to evaluate the effect of progressive muscle relaxation exercises on pain in patients with sickle cell disease.

MATERIALS-METHOD

This randomized controlled interventional study was conducted in a hospital in Mersin, Turkey between October 2017 and July 2018. The study sample comprised 58 patients who were aged >18 years, conscious, had sickle cell disease, reported pain, and were treated with non-opioid or weak opioid analgesic based on the physician's recommendation (treatment group = 29, control group = 29). Data were collected by the individual presentation form and visual analog scale. During the study, both groups were treated with analgesics prescribed by the physician for three days. In addition to the analgesics, the treatment group was performed progressive muscle relaxation exercises for 30 minutes whereas the control group was rested. Pain level of both groups was evaluated at three time points every day for three days. In the study, frequency distributions and descriptive statistics were presented for categorical and numerical variables, respectively. Chi-square analysis, independent samples t-test, Mann-Whitney U test, three-way ANOVA, and Sidak test were used to analyze the difference between the variables.

RESULTS

The mean age of the patients was 29.59 ± 6.94 years, and 53.4% of the patients were female and 69% were single. The mean pain score of the treatment group at the third time point on days 1, 2, and 3 was significantly lower than the control group (p < .05). There was no statistically significant difference between the two groups in terms of coping methods for pain, pain location, and complaints accompanying pain (p > .05).

CONCLUSION

Progressive muscle relaxation exercises were found to be effective in the pain management of patients with sickle cell anemia.

Incorporating integrative medicine and patient preferences into a pilot interdisciplinary sickle cell wellness clinic

OBJECTIVE

Sickle Cell Disease (SCD) is an inherited blood disorder that includes acute pain episodes and chronic pain that can dramatically impact quality of life and goal-achievement. Our staff had limited success in connecting families with the Pain, Palliative Care and Integrative Medicine Clinic (PPCIM) to receive specialized skills for pain management. We created a partnership between Hematology and PPCIM to provide SCD patients/families with needed resources.

DESIGN/SETTING

In 2016, key stakeholders collaborated to create a Sickle Cell Wellness Clinic (SCWC) clinic to provide families access to integrative medicine and wellness strategies. Design/structure, based on family focus group data and staff expertise, included a half-day, 7-discipline clinic housed in the PPCIM space. Patients with SCD, ages 8-20, learned strategies in an effort to improve health care utilization and increase overall quality of life.

MAIN OUTCOME MEASURES/RESULTS

Feedback from two successful pilot clinics in 2017 was incorporated into the formal roll-out of SCWC in 2018. SCWCs continued monthly for one year, serving a total of 20 families post-pilot. SCD patients increased follow-up appointment engagement in the PPCIM clinic following SCWC and reported high levels of satisfaction with their healthcare experience.

CONCLUSIONS

It is feasible to run a multidisciplinary clinic focused on pain management, coping skills, and healthy living with SCD. Providers benefited from the opportunity to collaborate with other disciplines. Patient and family feedback was positive, highlighted benefits of being introduced to new modalities, and reported advantages of meeting other patients/families in a new setting.

Daily Associations between Child and Parent Psychological Factors and Home Opioid Use in Youth with Sickle Cell Disease

BACKGROUND

Opioid analgesics are frequently used in the home setting to manage episodic pain in youth with sickle cell disease (SCD). Given the risk of adverse side effects, including constipation and sedation, understanding factors associated with at-home opioid use is important for maximizing pain relief while minimizing negative side effects.

PURPOSE

The present study aimed to evaluate the relationship between individual psychological factors (pain catastrophizing and negative affect), caregiver psychological factors (catastrophizing about child's pain and caregiver negative affect), and home opioid use in youth with SCD.

METHODS

Youth with SCD (n = 32) and a caregiver (n = 28) recruited during a routine outpatient hematology visit completed electronic 14 day diaries assessing pain, opioid use, and psychological factors.

RESULTS

Approximately 28% of youth (n = 9) reported pain ≥50% of diary days and a third of youth (n = 11, 34%) used opioid analgesics at least one of the diary days. The number of days opioid analgesics were used ranged from 0 to 7 (50% of diary days). Results from generalized linear mixed models indicated greater child negative affect accounted for increased odds of opioid use on a given day when accounting for pain intensity. Greater caregiver catastrophizing about children's pain was also associated with increased odds of children's opioid use.

CONCLUSIONS

Child and parent psychological factors relate to child opioid use at home for SCD-related pain. Future research is warranted in larger samples to identify targets for interventions to enhance pain management while reducing opioid-related risk and side effects.

Systematic Review: Pain and Emotional Functioning in Pediatric Sickle Cell Disease

The objective of this systematic review was to assess the relationship between pain (frequency/intensity/duration, impairment, coping) and emotional functioning in pediatric Sickle Cell Disease, and evaluate the state of the literature. Studies were included if they met each of the following criteria: (a) primarily pediatric sample of youth or young adults up to age 21 years with SCD, (b) examined emotional functioning including anxiety and/or depressive and/or internalizing symptoms, and/or affect, (c) examined pain intensity/frequency/duration and/or pain-related impairment and/or pain coping as it relates to emotional functioning, as defined above. Using the established guidelines for systematic reviews, we searched PsycINFO, PubMED, and CINAHL databases for studies published through June 2018. Screening resulted in 33 studies meeting inclusion criteria. Study data were extracted and evaluated for scientific merit, resulting in four studies being removed. 29 studies were included in the final synthesis. Studies provide strongest evidence of a relationship between increased pain frequency and higher depressive and anxiety symptoms. There are moderate-to-strong associations between pain-related impairment and depressive symptoms, and small-to-strong associations between pain-related impairment and anxiety. When examining pain-coping strategies, maladaptive cognitive strategies show the strongest association with emotional functioning. There is a need for more adequately powered, prospective studies based on theoretical frameworks in order to advance our understanding of the relationship between pain and emotional functioning in pediatric SCD.

An Integrative Review of the Prevalence of Depression among Pediatric Patients with Sickle Cell Disease

Sickle cell disease (SCD), a common hematological disorder, has received increased interest from researchers who set to discover whether individuals with SCD are at risk for depression. However, the prevalence of depression varies substantially between published studies. Therefore, two aims were identified in this critical review: (1) to summarize the prevalence of depression among children and adolescents diagnosed with SCD and (2) identify if disease severity predicts rates of depression within this population. Results from the 13 studies included in this review show the prevalence of depression was between 4%-46%. Pain predicted a higher occurrence of depression within this population.

Validation of the Swedish version of the Pain Catastrophizing Scale for Parents (PCS-P) for parents of children with cancer

OBJECTIVES

Pain is reported as one of the most common and burdensome symptoms for children with cancer. Pain catastrophizing is clearly related to pain intensity and disability. Catastrophizing in parents is associated with both child functioning and parent distress. The Pain Catastrophizing Scale for Parents (PCS-P) remains to be validated for parents of children with cancer. The aim of the study was to validate the Swedish version of the PCS-P for parents of children with cancer experiencing pain.

METHODS

Parents of all children who were being treated for cancer in Sweden at the time of the study were invited to participate. Study material was sent out to the registered address. Internal consistency, test-retest reliability, and convergent validity were calculated, and factor analysis was conducted. Descriptive statistics was used to investigate the background data and norm values.

RESULTS

A total of 243 parents participated in the study. The results did not support the original three-factor structure of the PCS-P, but rather suggested that a two-factor structure best represented the data. The results showed excellent internal consistency (a=0.93), excellent temporal stability (intraclass correlation coefficient =0.86) and moderate convergent validity (r=0.57). The mean (SD) for the PCS-P in the sample was 28.3 (10.7). A statistically significant difference was found between mothers and fathers, where mothers reported a higher level of pain catastrophizing than fathers.

CONCLUSION

The psychometric properties of the PCS-P has now been supported in a sample of parents of children with cancer, and norm values are now available. The factor structure does, however, deserve more investigation.