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Lupini F, Rubinstein TB, Mackey ER, Sule S. Behavioral health outcomes and social determinants of health in children with diabetes and juvenile arthritis. RESEARCH SQUARE 2023:rs.3.rs-3610878. [PMID: 38076886 PMCID: PMC10705696 DOI: 10.21203/rs.3.rs-3610878/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Objective Children with chronic illnesses, including arthritis, are at increased risk for adverse psychosocial outcomes influenced by social determinants of health (SDOH). Comparing psychosocial outcomes in families affected by juvenile arthritis compared to other chronic illnesses may help identify areas in need of special attention vs areas that may be addressed through adopting other disease examples' care models. We examined child and parent behavioral health outcomes for families with juvenile arthritis compared to diabetes, accounting for SDOH. Methods Secondary data analysis of the National Survey of Children's Health including 365 children (<18yrs) with arthritis and 571 children with diabetes. Psychosocial outcomes were depression, anxiety, ADHD, physical pain, behavioral problems, and treatment for mental health. School outcomes were school engagement, school absence, involvement in clubs/organization, and involvement in organized activities. Parent outcomes were family resilience, emotional support, coping with daily demands of raising a child, job change due to problems with childcare, and parent mental health. SDOH variables were food insecurity, food/cash assistance, unsafe neighborhood, detracting neighborhood elements, parent education, households earning <100% of the federal poverty line. Logistic regression analyses were utilized to examine variation in child and parent outcomes, variation in SDOH, and the role of SDOH. Results Children with arthritis experienced significantly more physical pain, anxiety, depression, ADHD, and behavior problems compared to children with diabetes. Children with arthritis were more likely to see a mental health professional and get treatment for problems with emotions/behaviors. When considering SDOH, children with arthritis were still more likely to experience adverse psychosocial outcomes but were no longer more likely to get treatment. Children with arthritis had increased likelihood of school absence and were less involved in organized activities than children with diabetes. Parents of children with arthritis had poorer mental health than parents of children with diabetes. SDOH were more prevalent in children with arthritis than children with diabetes. Conclusions Increased risk for adverse psychosocial outcomes in youth with arthritis compared to youth with diabetes indicates a need to mirror endocrinology models of care in rheumatology clinics. The role of SDOH highlights the need for regular SDOH screening in clinic.
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Affiliation(s)
| | | | - Eleanor R Mackey
- Children's National Medical Center: Children's National Hospital
| | - Sangeeta Sule
- Children's National Medical Center: Children's National Hospital
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Torres-Made MD, Peláez-Ballestas I, García-Rodríguez F, Villarreal-Treviño AV, Fortuna-Reyna BDJ, de la O-Cavazos ME, Rubio-Pérez NE. Development and validation of the CAREGIVERS questionnaire: multi-assessing the impact of juvenile idiopathic arthritis on caregivers. Pediatr Rheumatol Online J 2020; 18:3. [PMID: 31937332 PMCID: PMC6961380 DOI: 10.1186/s12969-020-0400-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 01/06/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The primary caregiver is an important person in the life of patients with JIA. Their reactions depend on social, emotional and economic factors that affect the therapeutic alliance. Some generic instruments have been used to evaluate burden, anxiety, or quality of life of caregivers. This study aims to develop a specific instrument to measure the psychosocial and economic impacts on primary caregivers of patients with JIA. METHODOLOGY This is a mixed methods research, that includes qualitative and quantitative data, and was carried out in two phases. First phase: a pragmatic qualitative study (questionnaire construction) was conducted in two parts, a non-systematic literature review followed by interviews with primary caregivers. Second phase: a cross-sectional study (questionnaire validation) to complete validation and estimate Cronbach's alphas based on tetrachoric correlation coefficients, correlation matrix and Cohen's kappa coefficient test. RESULTS There were 38 articles found related to the experience of caregivers. 15 primary caregivers were interviewed (female 93%, median age 45 years). Thematic analysis identified 9 important topics from the perspective of participants (economic impact, coping, family roles, impact of diagnosis, mental health, couple/mate relationships, impact at work, religion, and knowledge of the disease). These topics were combined to create the interview questionnaire (56 items). Later, it was modified to 62 items that were divided into five dimensions: impact of the disease (psychosocial, economic, family, and relationships), knowledge of the disease, alternative medicine, future, and religion. The interview questionnaire was applied to 32 primary caregivers (female 93%, median age 37 years), results identify depression on 29 (90%), 18 (56%) feel sadness at diagnosis, 20 (63%) mentioned that JIA has influenced in their financial situation, 23 (72%) feel anxiety about the future, and 11 (37%) considered that their family relationships have changed. Statistical analysis identified inconsistencies during convergent and divergent validity of the construct. Consequently, 11 items were eliminated, 3 relocated, 6 modified, and 39 compacted obtaining the "Impact of Pediatric Rheumatic Diseases on Caregivers Multi-assessment Questionnaire" (CAREGIVERS questionnaire). This final version resulted on an eight-dimension (28 items) instrument. CONCLUSIONS The CAREGIVERS questionnaire captures perspectives of both the participants and clinicians. It will be helpful to measure the impact of the disease and thus, to improve the quality of care of children with JIA and their families.
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Affiliation(s)
- Marcia Daniela Torres-Made
- 0000 0004 1760 058Xgrid.464574.0Department of Pediatrics, Universidad Autónoma de Nuevo León, Hospital Universitario “Dr. José E. González”, Monterrey, Mexico
| | - Ingris Peláez-Ballestas
- 0000 0001 2221 3638grid.414716.1Rheumatology Unit, Hospital General de México “Dr. Eduardo Liceaga”, Mexico City, Mexico
| | - Fernando García-Rodríguez
- 0000 0004 1760 058Xgrid.464574.0Department of Pediatrics, Universidad Autónoma de Nuevo León, Hospital Universitario “Dr. José E. González”, Monterrey, Mexico
| | - Ana Victoria Villarreal-Treviño
- 0000 0004 1760 058Xgrid.464574.0Department of Pediatrics, Universidad Autónoma de Nuevo León, Hospital Universitario “Dr. José E. González”, Monterrey, Mexico
| | - Brenda de Jesús Fortuna-Reyna
- 0000 0004 1760 058Xgrid.464574.0Department of Pediatrics, Universidad Autónoma de Nuevo León, Hospital Universitario “Dr. José E. González”, Monterrey, Mexico
| | - Manuel Enrique de la O-Cavazos
- 0000 0004 1760 058Xgrid.464574.0Department of Pediatrics, Universidad Autónoma de Nuevo León, Hospital Universitario “Dr. José E. González”, Monterrey, Mexico
| | - Nadina Eugenia Rubio-Pérez
- Department of Pediatrics, Universidad Autónoma de Nuevo León, Hospital Universitario "Dr. José E. González", Monterrey, Mexico.
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Scott D, Scott C, Jelsma J, Abraham D, Verstraete J. Validity and feasibility of the self-report EQ-5D-Y as a generic Health-Related Quality of Life outcome measure in children and adolescents with Juvenile Idiopathic Arthritis in Western Cape, South Africa. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2019; 75:1335. [PMID: 31392295 PMCID: PMC6676980 DOI: 10.4102/sajp.v75i1.1335] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 04/23/2019] [Indexed: 01/10/2023] Open
Abstract
Background Health-Related Quality of Life (HRQoL) data together with clinical findings allow for monitoring of intervention efficacy and the effect on HRQoL. Children with Juvenile Idiopathic Arthritis (JIA) experience symptoms often persisting into adulthood, emphasising the need to track HRQoL. Objectives The aim of this study was to investigate psychometric properties of the EuroQol five-dimensional youth questionnaire (EQ-5D-Y) in children with JIA. Methods A cross-sectional, analytical study design was used. Children 8 to 15 years were recruited, completing the self-report EQ-5D-Y and two other HRQoL questionnaires. Known group validity was established by comparing the effect size between children with different disease severities. Concurrent validity was tested using Kruskal–Wallis to compare the ranking of scores on different questionnaires. Feasibility was assessed by number of missing responses and time to complete each questionnaire. Results All questionnaires were able to distinguish between children with different JIA severity. There was a significant difference in ranking of most Juvenile Arthritis Multidimensional Assessment Report dimension scores across EQ-5D-Y levels, (p < 0.05), indicating concurrent validity. There was poor concurrent validity with the PedsQL dimensions tested with EQ-5D-Y, except for ‘pain’ (p = 0.001). The EQ-5D-Y was the quickest to complete with no missing values. Conclusion This study showed that the EQ-5D-Y is valid and feasible in measuring HRQoL in JIA children and adequately responsive to detect change over time. Clinical implications It is quick and easy to use in a busy clinical setting, allowing for effective JIA management monitoring.
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Affiliation(s)
- Desiree Scott
- Department of Health and Rehabilitation Sciences, Division of Physiotherapy, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Christiaan Scott
- Department of Paediatrics, Paediatric Rheumatology, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Jennifer Jelsma
- Department of Health and Rehabilitation Sciences, Division of Physiotherapy, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Deepthi Abraham
- Department of Paediatrics and Child Health, Faculty of Health Sciences, Tygerberg Hospital, University of Stellenbosch, Cape Town, South Africa
| | - Janine Verstraete
- Department of Health and Rehabilitation Sciences, Division of Physiotherapy, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Knight A, Vickery M, Faust L, Muscal E, Davis A, Harris J, Hersh AO, Rodriguez M, Onel K, Rubinstein T, Washington N, Weitzman ER, Conlon H, Woo JMP, Gerstbacher D, von Scheven E. Gaps in Mental Health Care for Youth With Rheumatologic Conditions: A Mixed Methods Study of Perspectives From Behavioral Health Providers. Arthritis Care Res (Hoboken) 2019; 71:591-601. [PMID: 29953741 DOI: 10.1002/acr.23683] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 06/26/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To identify behavioral health provider perspectives on gaps in mental health care for youth with rheumatologic conditions. METHODS Social workers (n = 34) and psychologists (n = 8) at pediatric rheumatology centers in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) completed an online survey assessing current practices and mental health care needs of youth with rheumatologic conditions. Responses were compared to a published survey of CARRA rheumatologists (n = 119). Thematic analysis of 20 semi-structured interviews with behavioral health providers was performed. RESULTS One-third of CARRA centers (n = 100) had no affiliated social worker or psychologist. Only 1 behavioral health provider reported current universal mental health screening at their rheumatology clinic, yet routine depression screening was supported by >85% of behavioral health providers and rheumatologists. Support for anxiety screening was higher among behavioral health providers (90% versus 65%; P < 0.01). Interviews illustrated a need for interventions addressing illness-related anxiety, adjustment/coping/distress, transition, parent/caregiver mental health, and peer support. Limited resources, lack of protocols, and patient cost/time burden were the most frequent barriers to intervention. Inadequate follow-up of mental health referrals was indicated by 52% of providers. More behavioral health providers than rheumatologists favored mental health services in rheumatology settings (55% versus 19%; P < 0.01). Only 7 social workers (21%) provided counseling/therapy, and interviews indicated their perceived underutilization of these services. CONCLUSION Behavioral health providers indicated an unmet need for mental health interventions that address illness-related issues affecting youth with rheumatologic conditions. Implementation of mental health protocols and optimizing utilization of social workers may improve mental health care for these youth.
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Affiliation(s)
- Andrea Knight
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Lauren Faust
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Eyal Muscal
- Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Alaina Davis
- Monroe Carell Junior Children's Hospital, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Julia Harris
- Children's Mercy Kansas City, University of Missouri, Kansas City
| | | | - Martha Rodriguez
- Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana
| | - Karen Onel
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Tamar Rubinstein
- Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Nina Washington
- Mississippi Center for Advanced Medicine, Madison, Mississippi
| | - Elissa R Weitzman
- Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts
| | - Hana Conlon
- Columbia University Medical Center, New York, New York
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Davis AM, Rubinstein TB, Rodriguez M, Knight AM. Mental health care for youth with rheumatologic diseases - bridging the gap. Pediatr Rheumatol Online J 2017; 15:85. [PMID: 29282086 PMCID: PMC5745617 DOI: 10.1186/s12969-017-0214-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 12/14/2017] [Indexed: 12/21/2022] Open
Abstract
Youth with rheumatologic diseases have a high prevalence of comorbid mental health disorders. Individuals with comorbid mental health disorders are at increased risk for adverse outcomes related to mental health as well as their underlying rheumatologic disease. Early identification and treatment of mental health disorders has been shown to improve outcomes, but current systems of care fall short in providing adequate mental health services to those in need. Pediatric rheumatologists are uniquely positioned to provide mental health screening and intervention for youth with rheumatologic diseases due to the frequency of patient encounters and ongoing therapeutic relationship with patients and families. However, additional training is likely required for pediatric rheumatologists to provide effective mental health care, and focusing efforts on providing trainees with mental health education is key to building competency. Potential opportunities for improved mental health education include development of clinical guidelines regarding mental health screening and management within pediatric rheumatology settings and incorporation of mental health didactics, workshops, and interdisciplinary clinic experiences into pediatric rheumatology fellowship curricula. Additional steps include mental health education for patients and families and focus on system change, targeting integration of medical and mental health care. Research is needed to better define the scope of the problem, determine effective strategies for equipping pediatric rheumatologists with skills in mental health intervention, and develop and implement sustainable systems for delivery of optimal mental health care to youth with rheumatologic diseases.
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Affiliation(s)
- Alaina M. Davis
- 0000 0004 1936 9916grid.412807.8Division of Pediatric Rheumatology, Vanderbilt University Medical Center, Monroe Carell Junior Children’s Hospital at Vanderbilt, 2200 Children’s Way, Doctor’s Office Tower 11240, Nashville, TN 37232 USA
| | - Tamar B. Rubinstein
- 0000000121791997grid.251993.5Division of Pediatric Rheumatology, Albert Einstein College of Medicine, Children’s Hospital at Montefiore/ Albert Einstein College of Medicine, 3415 Bainbridge Avenue, Bronx, NY 10467 USA
| | - Martha Rodriguez
- 0000 0000 9682 4709grid.414923.9Section of Pediatric Rheumatology, Riley Hospital for Children at Indiana University Health, 705 Riley Hospital Dr, Indianapolis, IN 46202 USA
| | - Andrea M. Knight
- 0000 0001 0680 8770grid.239552.aDivision of Rheumatology, The Children’s Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South St, Ste 10253, Philadelphia, PA 19146 USA ,0000 0001 0680 8770grid.239552.aThe Children’s Hospital of Philadelphia, Roberts Center for Pediatric Research, Center for Pediatric Clinical Effectiveness, 2716 South St, Ste 10253, Philadelphia, PA 19146 USA ,0000 0001 0680 8770grid.239552.aThe Children’s Hospital of Philadelphia, Roberts Center for Pediatric Research, PolicyLab, 2716 South St, Ste 10253, Philadelphia, PA 19146 USA
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Sociocultural Considerations in Juvenile Arthritis: A Review. J Pediatr Nurs 2017; 37:13-21. [PMID: 28911961 DOI: 10.1016/j.pedn.2017.08.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 08/07/2017] [Accepted: 08/09/2017] [Indexed: 11/24/2022]
Abstract
PROBLEM Juvenile Arthritis (JA) is one of the most common autoimmune diseases in children. A variety of sociocultural factors that influence health outcomes in children with JA have been examined in previous research. However, clinical guidelines to guide the care of these children lack support because this research has not been systematically examined and synthesized. ELIGIBILITY CRITERIA Primary research articles from five internet databases were included if they were peer-reviewed articles in English of studies conducted in the U.S. or Canada and referenced one or more determinants of health, quality of life, socioeconomic status, or health disparities in children with JA. SAMPLE The final sample included 16 articles representing 2139 children and 939 parents. RESULTS Topics covered in the studies included medication compliance, electronic medical records, environmental risk factors, economic hardship, parental coping, leisure activities, and their effects on patient outcomes including disability and quality of life. Patients with Medicaid experienced more severe outcomes than patients with private insurance despite equivalent levels of healthcare utilization. Other important topics, such as effects of the physical environment and alcohol use, were missing from the literature. CONCLUSIONS Five categories of health determinants were found to influence outcomes: biology, individual behaviors, social environment, physical environment, and health services. Disparities continue to exist for racial and ethnic minority children with JA and those of low socioeconomic status. IMPLICATIONS Sociocultural factors should be taken into consideration when developing care plans, research studies, and policies in order to remove barriers and promote the best outcomes for this vulnerable population.
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Vaingankar JA, Chong SA, Abdin E, Picco L, Shafie S, Seow E, Pang S, Sagayadevan V, Chua BY, Chua HC, Subramaniam M. Psychiatric morbidity and its correlates among informal caregivers of older adults. Compr Psychiatry 2016; 68:178-85. [PMID: 27234200 DOI: 10.1016/j.comppsych.2016.04.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 04/22/2016] [Accepted: 04/23/2016] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE This present study estimated the psychiatric morbidity among informal caregivers of older adults and investigated its association with their socio-demographic factors and older adult's health status, including dementia, depression and physical health conditions. METHODS Data from a national cross-sectional survey were used. For each participating older adult, an informal caregiver who 'knew the older adult best' and was aware of their health condition, was also interviewed to collect information on the older adults' care needs, and behavioral and psychological symptoms of dementia (BPSD). Data from 693 pairs was used. Informal caregivers were administered the Self Reporting Questionnaire (SRQ)-20 and psychiatric morbidity was defined as those with a total SRQ score of ≥8. Measures included informal caregivers' socio-demographic characteristics, assessment of dementia and depression in the older adults and self-report on their lifetime and current physical conditions. The association of socio-demographic characteristics, health conditions, care assistance and BPSD was investigated using backward stepwise logistic regression analysis where psychiatric morbidity (total SRQ score<or ≥8) was used as a dependent variable and all other variables served as independent covariates. RESULTS Among informal caregivers, 8.8% exhibited psychiatric morbidity. Higher proportions of spousal caregivers and caregivers of older adults having more care needs and BPSD exhibited psychiatric morbidity. After adjusting for all covariates, caregivers' marital status, and the presence of BPSD and dementia in the older adults were identified as the strongest correlates of caregivers' psychiatric morbidity. The prevalence of psychiatric morbidity was 10%, 13.9% and 12.7% respectively in these groups. Married caregivers had higher odds of psychiatric morbidity (OR 2.50, 95% CI: 1.13-5.52). In addition, caregivers of older adults' with any BPSD (OR 5.87, 95% CI: 2.60-13.24) and dementia (OR 2.28, 95% CI: 1.23-4.20) were also associated with higher odds of psychiatric morbidity. CONCLUSION Informal caregivers' marital status and presence of any BPSD and dementia in the older adults in their care were identified as the strongest correlates of caregivers' psychiatric morbidity. Clinicians should be cognizant of the risk in this group of caregivers and assess and intervene to alleviate caregivers' psychological problems.
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Affiliation(s)
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747
| | - Edimansyah Abdin
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747
| | - Louisa Picco
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747
| | - Saleha Shafie
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747
| | - Esmond Seow
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747
| | - Shirlene Pang
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747
| | - Vathsala Sagayadevan
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747
| | - Boon Yiang Chua
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747
| | - Hong Choon Chua
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747
| | - Mythily Subramaniam
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747
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Chausset A, Gominon AL, Montmaneix N, Echaubard S, Guillaume-Czitrom S, Cambon B, Miele C, Rochette E, Merlin E. Why we need a process on breaking news of Juvenile Idiopathic Arthritis: a mixed methods study. Pediatr Rheumatol Online J 2016; 14:31. [PMID: 27209342 PMCID: PMC4875712 DOI: 10.1186/s12969-016-0092-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 05/11/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Juvenile Idiopathic Arthritis is the most common chronic pediatric rheumatic disease. The announcement of Juvenile Idiopathic Arthritis poses for parents a number of challenges that make it hard to accept a diagnosis of the disease for their child; yet to our knowledge, no study to date has focused on the time period immediately surrounding the diagnosis. This study sets out to describe parents' experiences in engaging with their child's diagnosis of Juvenile Idiopathic Arthritis. METHODS This is a mixed methods study. Semi-structured interviews of families with a Juvenile Idiopathic Arthritis child were conducted. A grounded-theory thematic analysis was performed. Items that emerged in the interviews were compiled into a self-administered questionnaire. RESULTS Eleven families participated in the qualitative study. Sixty families responded to the questionnaire. The path of parents was characterized by doubt (before, during and after diagnosis) while the disease tended to take center stage. Doubt was generated through mismatches in perspectives between the parents' circle of acquaintances, physicians, and the parents' own subjective experiences of symptoms. This study also found that social support and parent associations occupied an ambiguous position between help and stigmatization. CONCLUSIONS Doubt fuels self-energizing spirals that take root as parents learn the news that their child has Juvenile Idiopathic Arthritis. These spirals of doubt may influence parents' experiences at every stage throughout the course of disease. Our data support the implementation of a specific process dedicated to breaking the news of Juvenile Idiopathic Arthritis to parents.
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Affiliation(s)
- Aurélie Chausset
- Pédiatrie, CHU Estaing, Clermont-Ferrand, France. .,Pédiatrie, INSERM-CIC1405, CHU Estaing, 1, place Lucie & Raymond Aubrac, 63003, Clermont-Ferrand, cedex 1, France.
| | | | - Nathalie Montmaneix
- Pédiatrie, CHU Estaing, Clermont-Ferrand, France ,Pédiatrie, INSERM-CIC1405, CHU Estaing, 1, place Lucie & Raymond Aubrac, 63003 Clermont-Ferrand, cedex 1 France
| | | | | | - Benoit Cambon
- Département de médecine générale, Faculté de Médecine, Clermont-Ferrand, France
| | - Cécile Miele
- CRIAVS, Pôle Santé Publique, CHU Gabriel Montpied, Clermont-Ferrand, France
| | - Emmanuelle Rochette
- Pédiatrie, CHU Estaing, Clermont-Ferrand, France ,Pédiatrie, INSERM-CIC1405, CHU Estaing, 1, place Lucie & Raymond Aubrac, 63003 Clermont-Ferrand, cedex 1 France
| | - Etienne Merlin
- Pédiatrie, CHU Estaing, Clermont-Ferrand, France ,Pédiatrie, INSERM-CIC1405, CHU Estaing, 1, place Lucie & Raymond Aubrac, 63003 Clermont-Ferrand, cedex 1 France
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Gómez-Ramírez O, Gibbon M, Berard R, Jurencak R, Green J, Tucker L, Shiff N, Guzman J. A recurring rollercoaster ride: a qualitative study of the emotional experiences of parents of children with juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2016; 14:13. [PMID: 26961237 PMCID: PMC4784365 DOI: 10.1186/s12969-016-0073-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 03/02/2016] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Despite the wealth of clinical research carried out in children with juvenile idiopathic arthritis (JIA), little is known about the emotional experiences of their parents. This article describes the predominant emotional experiences reported by parents of children with JIA in two Canadian cities. METHODS Research participants included 15 experienced parents and 8 novice parents (<6 months since children's JIA diagnosis). Their children were 2 to 16 years old with various JIA categories. A qualitative dataset including audio recordings and verbatim transcripts of three focus groups, and written reports of 59 reciprocal interviews (parents interviewing each other) were examined by a multidisciplinary research team following a four-step qualitative analytical process. RESULTS Parents of children with JIA experienced recurrent mixed negative and positive emotions that varied over time. Between disease onset and diagnosis, mounting anxiety, fear and confusion were the predominant emotions. Shortly after diagnosis there were shock, disbelief, and fear, with a sense of having being blindsided by the disease. At times of disease quiescence there was hope and gratitude, but also fatigue and frustration with ongoing treatment and fear of flares. During periods of increasing or ongoing symptoms there was admiration and sympathy for the courageous way children coped with JIA, as well as sorrow and frustration for ongoing pain and limitations. There were at times, frustration and indignation with peers and teachers unable to understand the child's fluctuations in physical activity and schoolwork. Throughout the disease, parents felt an underlying anxiety and powerlessness. CONCLUSIONS Parents of children with JIA described complex emotional journeys akin to the recurring ups and downs of rollercoaster rides, instead of ordered emotional phases ending in resolution. This has implications for healthcare providers who need to be aware of the complexity of these emotional journeys to support parents more effectively, thereby helping improve patient outcomes.
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Affiliation(s)
- Oralia Gómez-Ramírez
- Department of Anthropology, University of British Columbia, 6303 NW Marine Drive, Vancouver, British Columbia V6T 1Z1 Canada
| | - Michele Gibbon
- Division of Rheumatology, Children’s Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario K1H 8 L1 Canada
| | - Roberta Berard
- Department of Pediatrics, Western University and Children’s Hospital, London Health Sciences Centre, 800 Commissioners Road East, London, Ontario N6A 5 W9 Canada
| | - Roman Jurencak
- Department of Pediatrics, University of Ottawa and Children’s Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario K1H 8 L1 Canada
| | - Jayne Green
- British Columbia Children’s Hospital, Room K4-116, 4480 Oak Street, Vancouver, British Columbia V6H 3V4 Canada
| | - Lori Tucker
- Department of Pediatrics, University of British Columbia and British Columbia Children’s Hospital, 4480 Oak Street, Vancouver, British Columbia V6H 3V4 Canada
| | - Natalie Shiff
- Department of Pediatrics, University of Florida, and Department of Community Health and Epidemiology, University of Saskatchewan, 1600 Archer Road, Gainesville, Florida USA
| | - Jaime Guzman
- Department of Pediatrics, University of British Columbia and British Columbia Children's Hospital, 4480 Oak Street, Vancouver, British Columbia, V6H 3V4, Canada.
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Knafl K, Leeman J, Havill NL, Crandell JL, Sandelowski M. The Contribution of Parent and Family Variables to the Well-Being of Youth With Arthritis. JOURNAL OF FAMILY NURSING 2015; 21:579-616. [PMID: 26318728 DOI: 10.1177/1074840715601475] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Among developed countries, the reported prevalence of juvenile idiopathic arthritis (JIA) varies from 16 to 150 per 100,000. Previous reviews have identified risks faced by children with chronic conditions and indicate a relationship between parent/family characteristics and child adaptation. This analysis provides a mixed-methods synthesis of 29 research reports addressing the intersection of family life and JIA. Data were extracted using a structured template, and effect sizes were calculated for reported relationships between variables. Results were coded using a scheme that differentiated types of family factors. Meta-analysis revealed a moderately strong positive relationship between parent and child psychological functioning, and a medium negative relationship between family conflict and child psychosocial well-being, and parental depression and child physical functioning. Thematic analysis of qualitative results identified parenting challenges related to pain management and regimen demands. Results indicate that interventions to enhance parenting competence and family relationships may improve caregiver and patient outcomes.
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Determinants of health-related quality of life impairment in Egyptian children and adolescents with juvenile idiopathic arthritis: Sharkia Governorate. Rheumatol Int 2014; 34:1095-101. [PMID: 24469640 DOI: 10.1007/s00296-014-2950-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Accepted: 01/17/2014] [Indexed: 10/25/2022]
Abstract
The aim of this study was to identify the possible determinants of impaired health-related quality of life (HRQOL) in Egyptian children and adolescents with juvenile idiopathic arthritis (JIA). Fifty-eight consecutive patients of JIA aged from 8 to 18 years underwent assessment of socio-economic and demographic characteristics; HRQOL using Pediatric Quality of Life Inventory 4.0 Generic Core Scale, disease activity using the Juvenile Arthritis Disease Activity Score based on 27 joints (JADAS-27), functional ability using the childhood health assessment questionnaire (CHAQ), pain score on visual analog scale and psychological symptoms using the Children's Depression Inventory (CDI) score. Multivariate modeling was applied to determine the factors that associated with HRQOL impairment. A total of 55 % of the patients (32 of 58) had impaired HRQOL (<78.6). In multiple regression analyses, high CHAQ scores (OR 6.0, 95 % CI 2.0-17.5, P = 0.001), pain (OR 3.1, 95 % CI 1.9-6.3, P = 0.01), stop going to school (OR 3.9, 95 % CI 2.0-7.3, P = 0.01), low socioeconomic status (OR 2.3, 95 % CI 1.09-4.7, P = 0.04) and high psychological symptoms (OR 4.2, 95 % CI 2.0-12.6, P = 0.001) were determinants for HRQOL impairment. HRQOL impairment is a significant problem in Egyptian children and adolescents with JIA. These findings underscore the critical need for monitoring of HRQOL in these patients. More attention should be given to JIA patients who stop going to school and who has low socioeconomic status.
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Ezzahri M, Amine B, Rostom S, Badri D, Mawani N, Gueddari S, Shyen S, Wabi M, Moussa F, Abouqal R, Chkirate B, Hajjaj-Hassouni N. Factors influencing the quality of life of Moroccan patients with juvenile idiopathic arthritis. Clin Rheumatol 2014; 33:1621-6. [DOI: 10.1007/s10067-014-2489-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 12/30/2013] [Accepted: 01/05/2014] [Indexed: 10/25/2022]
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Mawani N, Amine B, Rostom S, El Badri D, Ezzahri M, Moussa F, Shyen S, Gueddari S, Wabi M, Shkirat B, Hassouni NH. Moroccan parents caring for children with juvenile idiopathic arthritis: positive and negative aspects of their experiences. Pediatr Rheumatol Online J 2013; 11:39. [PMID: 24138932 PMCID: PMC3854764 DOI: 10.1186/1546-0096-11-39] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 10/13/2013] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA) can lead to serious disability in children and adolescents, requiring intensive home care usually provided by parents .These parents must also cope with physical, familial, social and financial constraints.The aim of this study is to evaluate the positive and negative impacts of caregiving on parents to children with JIA, and identify diseases-related variables that affect these outcomes. METHODS Cross-sectional study including 47 patients diagnosed with JIA defined by the International League of association for Rheumatology (ILAR) 2001 classification. Socio-demographic, clinical and biological data related to patient and disease were collected. Positive and negative effects of caregiving on parents of children with JIA were assessed via a validated instrument; the Caregiver Reaction Assessment (CRA).The CRA assesses parent's self-esteem, financial problems, health problems, disrupted schedule and lack of family support. All parents completed the CRA questionnaire. A statistical analysis was conducted to determine the influence of disease-related variables on caregivers. RESULTS Forty-seven patients were included with 40.4% female. The average patient age was 11 years, and a mean patient body mass index (BMI) was 18. Forty patients were in school. Median disease duration of JIA was 4 years. The most frequent arthritis subtype was persistent oligoarthritis in 12-patients. Nearly 15% had extra-articular manifestations most frequently ocular involvement (6.4%). Median of global Visual analogic scale (VAS) was 20 and median Child health assessment questionnaire (CHAQ) was 0. The primary caregiver was the mother for all patients. Mean maternal age was 38 years, 42% of mothers were illiterate, and nearly all (95%) were without employment. The mean values of different dimensions of the CRA were respectively: self-esteem 3.5, financial problems 3.7, health problem 2.4, disrupted schedule 3.6 and familial support 2.9. Disrupted schedule of parents was correlated with disease severity assessed by physician VAS (p = 0.02). Financial problems of parents were significantly associated with disease duration (p = 0.04). There was no significant association between the type of JIA, activity or severity of the disease and other dimensions of the CRA. CONCLUSION This study suggests that the management of children with JIA has a high negative impact among caregiving parents, represented mainly by the disruption of their activities, the lack of family support, financial problems and health problems. However, caregiving often also improves caregiver's self-esteem (feeling of gratification to be helping).
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Affiliation(s)
- Nada Mawani
- Department of Rheumatology, El Ayachi hospital, University Hospital of Rabat-Sale, PO Box: 10000, Salé, Morocco.
| | - Bouchra Amine
- Department of Rheumatology, El Ayachi hospital, University Hospital of Rabat-Sale, PO Box: 10000, Salé, Morocco
| | - Samira Rostom
- Department of Rheumatology, El Ayachi hospital, University Hospital of Rabat-Sale, PO Box: 10000, Salé, Morocco
| | - Dalal El Badri
- Department of Rheumatology, El Ayachi hospital, University Hospital of Rabat-Sale, PO Box: 10000, Salé, Morocco
| | - Majda Ezzahri
- Department of Rheumatology, El Ayachi hospital, University Hospital of Rabat-Sale, PO Box: 10000, Salé, Morocco
| | - Fanata Moussa
- Department of Rheumatology, El Ayachi hospital, University Hospital of Rabat-Sale, PO Box: 10000, Salé, Morocco
| | - Siham Shyen
- Department of Rheumatology, El Ayachi hospital, University Hospital of Rabat-Sale, PO Box: 10000, Salé, Morocco
| | - Sanae Gueddari
- Department of Rheumatology, El Ayachi hospital, University Hospital of Rabat-Sale, PO Box: 10000, Salé, Morocco
| | - Moudjibou Wabi
- Department of Rheumatology, El Ayachi hospital, University Hospital of Rabat-Sale, PO Box: 10000, Salé, Morocco
| | - Bouchra Shkirat
- Department of Pediatrics Children Hospital, University Hospital of Rabat, Rabat, Morocco
| | - Najia Hajjaj Hassouni
- LIRPOS, URAC30, Mohammed V. Souissi University, Rabat, Morocco,Department of Rheumatology, El Ayachi hospital, University Hospital of Rabat-Sale, PO Box: 10000, Salé, Morocco,Laboratory of Biostatistics, Clinical Research and Epidemiology (LBRCE), Faculty of Medicine and Pharmacy, Rabat, Morocco
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