Correlates of quality of life in mothers of children with diagnosed epilepsy

The Sleep Patterns of Children and Adolescents with Chronic Conditions and Their Families: An Integrative Literature Review

Sleep is of vital necessity for health, and it has a restorative and protective function for children and adolescents with chronic conditions and their families. The purpose of this study was to identify the scientific production on sleep patterns in children and adolescents with chronic conditions and their families. This integrative review was conducted between March and June 2022 using the databases of MEDLINE, Web of Science, CINAHL and PsycINFO. The articles included were original papers published between January 2007 and mid-2022. Excluded were review studies that did not evaluate sleep and whose participants did not have chronic conditions or were not children, adolescents and/or their families. The searches returned 814 abstracts. After exclusions, 47 studies were selected to be read in full; of these, 29 were selected and were grouped empirically into four categories: major alterations in the sleep patterns of children and adolescents with chronic conditions; the relationship between sleep disorders and symptoms in children and adolescents with chronic conditions; the impaired sleep patterns of families of children and adolescents with chronic conditions; and sleep alterations and their relationship with other problems in families of children and adolescents with chronic conditions. All studies showed sleep pattern impairment in children and adolescents with chronic conditions as well as their families.

Sleep Quality and Evening Salivary Cortisol Levels in Association with the Psychological Resources of Parents of Children with Developmental Disorders and Type 1 Diabetes

BACKGROUND

Sleep deprivation can decrease parental well-being and degrade mental and physical health in parents of children with chronic illness. The aim of this study was to explore the associations of sleep quality, psychological stress perception, and evening salivary cortisol concentration with self-esteem, optimism and happiness in parents of children with type 1 diabetes and developmental disorders compared to parents of healthy, typically developing children.

METHODS

We studied 196 parents of children with chronic conditions, including autistic spectrum disorder (N = 33), cerebral palsy (N = 18), Down syndrome (N = 33), and diabetes mellitus type 1 (N = 40) and parents of healthy children (N = 72). We evaluated parental sleep quality, evening salivary cortisol levels, self-esteem, optimism and happiness. Multiple linear regression models were used to assess associations between variables.

RESULTS

Compared with those of the control group, the parents of children with autistic spectrum disorders had higher evening cortisol concentrations (β = 0.17; p = 0.038) and lower perceptions of happiness (β=-0.17; p = 0.017), while parents of children with type 1 diabetes had disrupted sleep quality (β = 0.25; p = 0.003). Optimism was negatively associated with the evening cortisol concentration (β=-0.18; p = 0.023) and sleep quality index (β=-0.20; p = 0.012).

CONCLUSIONS

Public health programs aimed at lifestyle habit improvement, respite care, and relaxation for parents of children with chronic conditions would be useful for improving parental sleep quality, self-esteem, optimism and happiness.

Direct and Indirect Predictors of Burden in Arab-Bedouin and Jewish-Israeli Mothers Caring for a Child with Epilepsy

OBJECTIVE

Caring for a child with epilepsy poses various psychological, physical and medical challenges; these can lead to caregiver burden. The aim of this study was to identify predictors of burden with mothers caring for a child with epilepsy. Our analyses included sociodemographic (e.g., ethnicity), mental health (e.g., symptoms of anxiety, depression) and physiological factors (e.g., extent of pharmacotherapy).

METHODS

A total of 168 mothers caring for a child with epilepsy were recruited while attending the Pediatric Neurology Clinic at Soroka Medical Center, Be'er Sheva, Israel. This cross-sectional sample included 130 Jewish-Israeli and 38 Arab-Bedouin mothers who completed parallel questionnaire batteries that included the Zarit Burden Interview and other scales translated and validated in Hebrew and Arabic. We computed path analyses to identify both direct and indirect predictors of caregiver burden.

RESULTS

Burden was directly predicted by emotional exhaustion, symptoms of anxiety and (Bedouin) ethnicity. Indirect effects on burden included illness severity (via emotional exhaustion), ethnicity and emotional exhaustion (both via anxiety). That is, both ethnicity and emotional exhaustion directly and indirectly predicted caregiver burden via greater anxiety. Illness severity indirectly predicted symptoms of depression, anxiety and caregiver burden. We found that 55% of epilepsy care burden was predicted by this path model.

CONCLUSIONS

Bedouin mothers reported greater illness severity, symptoms of depression, anxiety and caregiver burden. Differences between groups in epilepsy severity suggest that less severe cases in the Bedouin community do not come to clinical attention (e.g., are concealed due to stigma). These findings underscore the need for health promotion strategies and interventions for caregivers tailored to account for ethnic and cultural differences.

'No one's ever said anything about sleep': A qualitative investigation into mothers' experiences of sleep in children with epilepsy

INTRODUCTION

Sleep problems in children with epilepsy (CWE) are common. However, little is known about parental experiences and feelings about managing sleep in their CWE. To provide the most appropriate services' provision, it is essential that the lived experience of parents of this patient group and the issues and problems that they face in managing their child's sleep is understood.

METHOD

In 2018, nine mothers of CWE (aged 5-15 years) were interviewed about their perceptions and experiences around their child's sleep, sleep problems and their management, the impact of sleep difficulties on the child and their family and available support.

RESULTS

Four themes were identified that represented the nature of the child's sleep problems, including settling and night-waking issues, parasomnias and child anxiety around sleep. Seven themes represented mothers' experiences of managing their child's sleep and any associated problems, including the longstanding challenging nature of child sleep issues, management strategies adopted, challenges related to managing sleep over time, the link between sleep and seizures, the negative impact of poor sleep on daytime functioning, role of antiseizure medication and maternal concerns about child sleep. One theme represented the perceived lack of information, help and support available.

CONCLUSIONS

Findings suggest there are unmet needs in supporting parents to deal with sleep, sleep problems and their management in CWE.

PATIENT OR PUBLIC CONTRIBUTION

This individual study was conducted under the umbrella of the CASTLE research programme (see https://castlestudy.org.uk/). Parents who have lived experience of parenting a child with epilepsy were co-applicants for the programme and were involved in the original conception, aims, design and funding application for the research programme (including the project reported in this paper) and advised on project design. Mothers of CWE who have lived experience of managing sleep and sleep problems in their child were participants who shared their experiences through the interviews, which formed the data of the current study.

Correlates of Caregiving Burden among Bedouin-Muslim Mothers of Children Diagnosed with Epilepsy

A paucity of research exists on caregiving burden (CB) and the factors associated with it among minority groups, such as Bedouin mothers of children diagnosed with epilepsy (CDE). The aim of this study was to explore associations between CB and care-recipients' characteristics, contextual factors, and caregivers' characteristics among those mothers.

METHODS

A total of 50 mothers completed self-report questionnaires while visiting pediatric neurology outpatient clinic centers, using valid and reliable measures.

RESULTS

Bivariate associations were found between social support, number of medications, and CB. General self-efficacy and place of residence emerged as significant predictors of caregiver burden.

CONCLUSIONS

These findings provide health professionals with a better understanding of the factors that should be assessed in order to address caregiver burden among Bedouin mothers of CDE. Understanding the unique characteristics and culture of the Bedouin community can help professionals in targeting caregivers with a lower sense of self-efficacy, and those that reside in Bedouin cities, in order to reduce their caregiving burden.

Attitudes and beliefs of medicine and social work students about medical cannabis use for epilepsy

The current study sought: (i) to explore whether health profession students possess formal medical cannabis (MC) education, feel prepared to answer questions about MC, and perceive it as an effective therapy for epilepsy; (ii) to assess students' attitudes and beliefs about MC use; and (iii) to explore the associations between students' background characteristics, MC-related attitudes and beliefs regarding its effectiveness for epilepsy. A sample of 310 students (141 from medicine and 169 from social work) voluntarily participated in the anonymous online survey. The vast majority (92.5%) indicated they had no formal education about MC, and only 11.2 % reported being prepared to answer clients' MC-related questions. Participants reported favorable beliefs about MC benefits, the need for training, and recreational marijuana use legalization. Less supportive attitudes were reported regarding MC risks. Prior cannabis use (e.g., self-use, friends, or family) and individuals from a secular background were associated with more positive beliefs about MC benefits and its legalization for recreational purposes. Prior recreational cannabis use [OR=1.541] and having friends who recreationally use the substance [OR=1.891] were associated with the belief that MC is an effective therapy for epilepsy. These findings indicate an urgent need for students' MC education to provide future physicians and social workers with MC-related capacities. Development of curricula and training programs in Israel are encouraged.

The impact of elevated blood lead levels in children on maternal health-related quality of life

Kabwe is a mining town in Zambia that has been ranked among "the ten most polluted places in the world" with previous findings of serious lead (Pb) pollution. In this study, we aim to examine the impact of childhood Pb poisoning on the health-related quality of life (HRQoL) of mothers in Kabwe. The HRQoL was assessed using the Short-Form 36 survey for 404 mothers coming from residences in 40 randomly selected standard enumeration areas (SEAs). Blood lead levels (BLLs) of the household members including the mothers themselves were measured. We found a significant positive correlation between the BLLs of the mothers and their children (R = 0.6385, p < 0.0001), while the BLLs of preschool-aged and school-aged children were significantly higher than those of their mothers and fathers. Using the data sets containing the BLLs of the household members, the age of the mothers, the household income, and the household SEA, we performed stepwise multiple linear regression analyses. The results showed significant negative associations between the representative BLL of household children and the BLL of preschool-aged children with the vitality and mental health scores of their mothers. Additionally, the BLL of school-aged children was only significantly associated with the mental health score of their mothers. By contrast, there was a significant negative association between the BLLs of the mothers with the social role functioning score. This suggests that elevated BLLs in children have a negative impact on the mental health conditions of their mothers regardless of the mothers' BLL.

Associations between Infant and Parent Characteristics and Measures of Family Well-Being in Neonates with Seizures: A Cohort Study

OBJECTIVE

To characterize and determine risk factors for key dimensions of well-being at hospital discharge in families of neonates with acute symptomatic seizures.

STUDY DESIGN

This prospective, observational cohort study enrolled 144 parent-infant dyads among neonates with acute symptomatic seizures from 9 pediatric hospitals in the Neonatal Seizure Registry. One parent per family completed a discharge survey, which included measures of anxiety and depression, health-related quality of life, and impact on the family. Multivariable regression analyses adjusted for site were constructed to examine parent and infant characteristics associated with well-being.

RESULTS

At discharge, 54% of parents reported symptoms of anxiety and 32% reported symptoms of depression. Parents of infants with hypoxic-ischemic encephalopathy reported more depression and worse quality of life than parents of infants with other seizure etiologies. Parental quality of life was also lower with greater infant age at discharge. A higher level of maternal education was associated with greater impact on the family. All these differences were medium to large effect sizes, ranging from 0.52 to 0.78.

CONCLUSIONS

Symptoms of anxiety and depression are common in parents of infants with neonatal seizures, and several parent and infant characteristics are associated with poorer parental quality of life and family well-being. These findings are a call to action to improve mental health screening and services for parents of infants with neonatal seizures.

Psychosocial assessment of families caring for a child with acute lymphoblastic leukemia, epilepsy or asthma: Psychosocial risk as network of interacting symptoms

The purpose of this study is to assess psychosocial risk across several pediatric medical conditions and test the hypothesis that different severe or chronic pediatric illnesses are characterized by disease specific enhanced psychosocial risk and that risk is driven by disease specific connectivity and interdependencies among various domains of psychosocial function using the Psychosocial Assessment Tool (PAT). In a multicenter prospective cohort study of 195 patients, aged 5–12, 90 diagnosed with acute lymphoblastic leukemia (ALL), 42 with epilepsy and 63 with asthma, parents completed the PAT2.0 or the PAT2.0 generic version. Multivariate analysis was performed with disease as factor and age as covariate. Graph theory and network analysis was employed to study the connectivity and interdependencies among subscales of the PAT while data-driven cluster analysis was used to test whether common patterns of risk exist among the various diseases. Using a network modelling approach analysis, we observed unique patterns of interconnected domains of psychosocial factors. Each pathology was characterized by different interdependencies among the most central and most connected domains. Furthermore, data-driven cluster analysis resulted in two clusters: patients with ALL (89%) mostly belonged to cluster 1, while patients with epilepsy and asthma belonged primarily to cluster 2 (83% and 82% respectively). In sum, implementing a network approach improves our comprehension concerning the character of the problems central to the development of psychosocial difficulties. Therapy directed at problems related to the most central domain(s) constitutes the more rational one because such an approach will inevitably carry over to other domains that depend on the more central function.