Parent- and Youth-Reported Illness Uncertainty: Associations With Distress and Psychosocial Functioning Among Recipients of Liver and Kidney Transplantations

My Kidney Identity: Contextualizing pediatric patients and their families kidney transplant journeys

BACKGROUND

Even though having a kidney transplant is the treatment of choice for children with kidney failure, it can cause anxiety for patients and their families resulting in decreased psychosocial functioning, adherence, and self-management. We set out to identify the information needs required to help pediatric patients and their families contextualize their posttransplant experiences as they recalibrate their understanding of normalcy throughout their transplant journey.

METHODS

Participants submitted photographs related to feeling: (1) worried, (2) confident, (3) similar to peers without kidney disease, and (4) different from these peers. The photographs served as a foundation for an in-depth interview.

RESULTS

Nineteen individuals (10 pediatric transplant recipients and 9 caregivers) were interviewed at a mean of 8 years posttransplant. We identified five specific themes and tensions our participants associated with recalibrating their version of "normal" throughout the transplant journey: (1) exchanging information (information consumers vs. information contributors, (2) transitional management (family management vs. self-management), (3) building confidence (worry vs. confidence), (4) telling one's story (hiding vs. self-expression), and (5) normalizing kidney transplantation (feeling different vs. feeling similar). These five themes/tensions form one's Kidney Identity, shift from negative to positive throughout the transplant journey, illustrating a more abstract and complex account of kidney transplantation over time.

CONCLUSIONS

Having a patient view their Kidney Identity over time may support self-reflection of one's progress posttransplant and potentially help clinicians, patients, and their caregivers identify barriers and areas where they may need more support to ensure their successful engagement in their care.

The psychosocial needs of adolescent and young adult kidney transplant recipients, and associated interventions: a scoping review

Background

Renal transplantation is considered the gold standard treatment for end-stage kidney disease. Adolescent and young adult kidney transplant recipients have the highest rate of graft loss amongst transplanted patients. It is largely accepted this is due to psychosocial and behavioural difficulties, which impact adherence to prescribed therapies. This phenomenon is not isolated to a particular healthcare system having been observed in multiple countries across different continents. It is a global issue of concern. We sought to review the psychosocial needs of these patients, and the interventions designed to meet these needs.

Methods

A scoping review was conducted based on Arksey and O’Malley’s six-stage framework. Eligibility criteria included primary studies of any type that investigated the psychosocial needs of adolescent and/or young adult renal transplant recipients or studies which examined interventions designed to address these needs. Search strategies were developed and conducted on PsycINFO, PubMed, Embase, and CINAHL. Articles meeting the inclusion criteria were critically reviewed using a descriptive-analytical narrative method.

Results

Thirty-nine studies met our inclusion criteria, 30 of which related to psychosocial needs, and the remainder examined psychosocial interventions. Four main themes were derived from our analysis of psychosocial needs literature, as follows: the need for (1) emotional support, (2) acceptance, (3) direction, (4) equality in healthcare. 2 main themes emerged from analysis of psychosocial intervention literature, namely: psychosocial (1) capability, (2) assessment. Despite the evidence that graft health is strongly associated with psychosocial wellbeing, findings revealed a significant lack of literature investigating how best to meet psychosocial needs. Trends were observed amongst intervention studies, namely interventions of novel and non-evidenced based design, with the aim of improving medication adherence through organisational strategies and education. However, literature regarding psychosocial needs showed non-adherence to therapies was not simply a result of disorganisation or lack of understanding, but rather, was founded on a recipient’s idiosyncratic relationship with their prescribed therapies e.g., psychological, social or financial reasons for non-adherence.

Conclusions

Future research should be directed at investigating the efficacy of evidence-based interventions that empower the individual patient to overcome their specific barrier to an optimal relationship with their therapies.

Uncertainty and Perceived Control as Predictors of Communicative Participation and Mental Health in Adults Who Stutter

PURPOSE

This study examined the role of uncertainty and perceived control in predicting the communicative participation and mental health of adults who stutter.

METHOD

Two hundred sixty-nine adults who stutter completed measures of uncertainty about stuttering, perceived control of stuttering, communicative participation, and global mental health. In addition, participants self-reported on a variety of demographic and speech-related measures. Correlational analyses and hierarchical regression were performed to determine associations between variables of interest.

RESULTS

Uncertainty accounted for significant variance in communicative participation and global mental health after statistically controlling for the effects of demographic and speech-related variables. Perceived control accounted for significant variance in communicative participation over and above what was accounted for by demographic variables, speech-related variables, and uncertainty.

CONCLUSIONS

The findings suggest that uncertainty about stuttering and perceived control of stuttering should be accounted for during assessment and intervention with adults who stutter. Interventions that specifically target uncertainty and perceived control may be useful in improving therapeutic outcomes for individuals who stutter.

The association between uncertainty and mental health: a scoping review of the quantitative literature

BACKGROUND

The current moment is characterised by deep-rooted uncertainties, such as climate change and COVID-19. Uncertainty has been reported to be associated with negative mental health outcomes, such as stress and anxiety. However, no comprehensive review on the association between uncertainty and mental health exists.

AIM

The aim of the current scoping review was to systematically explore and describe the literature on the link between uncertainty and mental health.

METHODS

A scoping review was undertaken following guidelines by Arksey and O'Malley (2005).

RESULTS

One hundred and one papers addressing the association between uncertainty and mental health were identified. Most were cross-sectional studies (67%) conducted in the fields of medicine or nursing (59%), in high-income countries, among adult populations (74%), and in medical settings. Substantial heterogeneity was identified in the measurements of uncertainty and mental health. Most studies (79%) reported a positive association between uncertainty and mental health problems.

CONCLUSIONS

Research is needed in more diverse contexts and populations. More robust designs are required to provide insight into the directionality and strength of the association between uncertainty and mental health. Few studies reported how individuals coped with uncertainty. Future studies should address the identified gaps and investigate interventions to address uncertainty and its determinants.

Emotional and behavioral problems in children with dilated cardiomyopathy

BACKGROUND

Dilated cardiomyopathy (DCM) in children is an important cause of severe heart failure and carries a poor prognosis. Adults with heart failure are at increased risk of anxiety and depression and such symptoms predict adverse clinical outcomes such as mortality. In children with DCM, studies examining these associations are scarce.

AIMS

We studied whether in children with DCM: (1) the level of emotional and behavioral problems was increased as compared to normative data, and (2) depressive and anxiety problems were associated with the combined risk of death or cardiac transplantation.

METHODS

To assess emotional and behavioral problems in children with DCM, parents of 68 children, aged 1.5-18 years (6.9±5.7 years), completed the Child Behavior Checklist.

RESULTS

Compared to normative data, more young children (1.5-5 years) with DCM had somatic complaints (24.3% vs. 8.0%; p < .001), but fewer had externalizing problems (5.4% vs. 17.0%; p = .049). Overall internalizing problems did not reach significance. Compared to normative data, more older children (6-18 years) showed internalizing problems (38.7% vs. 17.0%; p = .001), including depressive (29.0% vs. 8.0%; p < .001) and anxiety problems (19.4% vs. 8.0%; p = .023), and somatic complaints (29.0% vs. 8.0%; p < .001). Anxiety and depressive problems, corrected for heart failure severity, did not predict the risk of death or cardiac transplantation.

CONCLUSION

Children of 6 years and older showed more depressive and anxiety problems than the normative population. Moreover, in both age groups, somatic problems were common. No association with outcome could be demonstrated.

Examining Uncertainty in Illness in Parents and Children With Chronic Kidney Disease and Systemic Lupus Erythematosus: A Mediational Model of Internalizing Symptoms and Health-Related Quality of Life

To examine if parent illness uncertainty is indirectly associated with child depression, anxiety, and HRQOL in the CKD/SLE population. Parent-child dyads (N = 31) from outpatient rheumatology and nephrology clinics included children (ages 9-18) diagnosed with CKD (Stage 1, 2, or nephrotic syndrome) or SLE. Parents completed demographic and uncertainty measures and children completed uncertainty, depression, anxiety, and HRQOL measures. This cross-sectional study examined mediational models using the percentile bootstrapping method. Parent uncertainty had an indirect effect on child depression, anxiety, and HRQOL through the mediator, child uncertainty. In other words, parents' illness uncertainty regarding their child's condition correlates to the child's illness uncertainty, which then is associated with the child's mental health and wellbeing. Reverse mediations illustrated that parent uncertainty did not mediate child uncertainty and outcome variables. Results extend previous research by examining parent and child illness uncertainty in understudied conditions (CKD/SLE) and the relationship to outcome variables commonly related to depression (e.g., anxiety and HRQOL). Findings allow health psychologists and medical personnel to understand the impact of uncertainty on the child's wellbeing and HRQOL. Clinical implications, including using specialized interventions to address illness uncertainty, are discussed.

Exploratory Factor Analysis of the Mishel Uncertainty in Illness Scale Among Adolescents and Young Adults With Chronic Medical Conditions

OBJECTIVE

To identify a developmentally relevant factor structure of the Mishel Uncertainty in Illness Scale-Community form (MUIS-C) among adolescents and young adults with chronic medical conditions.

METHODS

Data on college students with a self-reported chronic medical condition (N = 238) were collected between November 2013 and May 2015. Participants completed the MUIS-C as part of a larger questionnaire battery. An exploratory factor analysis and a confirmatory factor analysis were conducted.

RESULTS

The exploratory factor analysis resulted in a 22-item model with two factors termed: (a) Ambiguity/Future Uncertainty (α = .93), and (b) Unpredictability (α = .89). The confirmatory factor analysis and a correlated uniquenesses model, which evaluated method effects, supported the two-factor model.

DISCUSSION

These findings highlight the unique nature of illness uncertainty among adolescents and young adults and show the clinical and research utility of the MUIS-C for this population. Future investigations should examine how the two factors relate to distress among adolescents and young adults.

Evaluating the Reliability and Validity of the Arabic Version of the Parents Perceptions of Uncertainty Scale (A-PPUS)

BACKGROUND

Uncertainty often accompanies illness and may be a major aversive component of the patients' treatment process. There is evidence that parental uncertainty has a negative impact on their own and on their child's coping strategies and may affect family functioning. Key to the provision of competent care, to address uncertainty, is the use of an appropriate validated assessment tool to understand key parental concerns. The 'Parent Perception of Uncertainty Scale' (PPUS) has been widely used for this purpose.

AIM

This study reports on the validity and reliability testing of the Arabic version of the Parents Perception of Uncertainty Scale (A-PPUS).

METHODS

The scale was translated to Arabic using the translation-back-translation method. Appropriate statistical tests were performed including measurements of internal consistency, item to total scale correlation, and univariate and multivariate analyses.

RESULTS

The study included 240 parents of children with chronic illnesses. Cronbach's alpha coefficient of the whole scale was 0.93. All the items were positively correlated to the total score. The univariate and multivariate analysis supported the previous tests and the assertion that the Arabic version of the PPUS provided a relevant measure of the uncertainty level.

CONCLUSION

This study has identified that the A-PPUS is a reliable tool for parent report of their uncertainty, in the UAE and Arabic population.

The quality of information received by parents of children with chronic ill health attending hospitals as indicated by measures of illness uncertainty

BACKGROUND

The effectiveness of communication can be defined in terms of one of its outcomes: the uncertainty that it eliminates. Clear unambiguous communication is important for the parents of children to help them understand problems, explore alternative solutions and help make decisions. Persistent uncertainty is known to produce anxiety, unpredictable responses, emotional distress and poor quality of life. The uncertainty experienced by parents is one indicator of quality in the healthcare system which could have diagnostic and predictive value.

AIM

To assess the uncertainty experienced by parents of children with chronic conditions in the United Arab Emirates (UAE).

DESIGN

An exploratory descriptive, cross-sectional design was chosen across different sites in the UAE.

METHODS

Data were collected from parents accompanying children receiving treatment either as an inpatient or outpatient, using the previously validated, culturally adapted 'Parent Perception of Uncertainty Scale' (PPUS).

RESULTS

Most study participants experienced moderate or high levels of uncertainty. Parents who did not speak the local language, whose child was less than 1 year old or who was acutely ill had significantly more uncertainty than others, as did those parents whose child was approaching adolescence and puberty.

CONCLUSIONS

As only 5% of all participants reported low levels of uncertainty this should be of major concern as both an indicator of the quality of communication between health professionals and parents, and of the adverse health effects and poor quality of life experienced by parents of patients with chronic illness.

Child Attitude Toward Illness Scale (CATIS): A systematic review of the literature

OBJECTIVE

The objective of this study was to systematically review the literature utilizing the Child Attitude Toward Illness Scale (CATIS) as a measure of illness attitudes within pediatric chronic illness, including epilepsy, and provide recommendations for its use. This review includes an examination of the psychometric properties of the CATIS and the relationship between the CATIS and psychological, academic, behavioral, and illness variables.

METHOD

Electronic searches were conducted using Medline and PsychINFO to identify twenty-two relevant publications.

RESULTS

The CATIS was identified as a reliable and valid self-report assessment tool across chronic illnesses, including pediatric epilepsy. Although originally developed for children ages 8-12, the CATIS has demonstrated reliability and validity in youth ages 8-22. The CATIS scores were reliably associated with cognitive appraisal variables and internalizing symptoms. Initial support exists for the relation between illness attitudes and externalizing behavior, academic functioning, and psychosocial care needs. Mixed findings were reported with regard to the relation between illness attitudes and demographic and disease variables, as well as both social and family functioning.

CONCLUSION

The CATIS is a psychometrically sound self-report instrument for measuring illness attitudes and demonstrates clinical utility for examining adjustment outcomes across chronic illnesses, particularly pediatric epilepsy.

Medical Family Therapists in Action: Embracing Multiple Roles

Medical family therapy (MedFT) is a growing area of interest within the field of marriage and family therapy. Its practice necessitates a shift from conventional family therapy practices to include diverse ways of providing care. Literature highlights approaches for patients with specific illnesses and for particular healthcare contexts. Less is understood about frameworks for treating patients with different illnesses across settings. Contributing to the growing discourse surrounding MedFT, we present a role-based practice framework that identifies six consistent roles, Therapist, Brief Interventionist, Health Coach, Patient Advocate, Consultant to Health Professionals, and Trainer specific tasks associated with each. We describe the skills needed to perform each role and describe how we move fluidly between roles to provide comprehensive care.

Illness uncertainty and quality of life in children with cancer

BACKGROUND

Illness uncertainty is prevalent in children with cancer and has been associated with increased psychological distress. The relationship between illness uncertainty and quality of life in pediatric cancer patients remains unclear. The aim of the present study was to examine illness uncertainty as a predictor of health-related quality of life in children diagnosed with cancer. It was hypothesized that child-reported illness uncertainty would be negatively associated with child health-related quality of life.

PROCEDURE

Children aged 8 to 18 years old and receiving treatment for cancer were recruited to participate in this study. One hundred twenty children and their parent(s) completed measures of illness uncertainty, pain, anxiety, and quality of life during a routine visit to the Cancer Center at Children's Hospital of Orange County.

RESULTS

Illness uncertainty was significantly associated with child age (P=0.02), overall health-related (P<0.001) and cancer-related (P<0.001) quality of life, but not with treatment status (on/off chemotherapy) or demographic variables including sex and household income. Regression analyses statistically controlling for age, anxiety, and pain revealed that illness uncertainty significantly predicted child-reported cancer-related and health-related quality of life (P<0.01) as well as parent-reported cancer-specific quality of life (P<0.01).

CONCLUSIONS

Illness uncertainty is prevalent and associated with lower quality of life in children diagnosed with cancer. Improved communication with children regarding disease state, treatment expectations, and prognosis may alleviate uncertainty and improve functioning in this vulnerable patient population.

The psychosocial challenges of solid organ transplant recipients during childhood

A large proportion of pediatric solid organ transplant recipients are young children, yet dedicated studies on the challenges faced by these patients are sparse. The present article aims to provide a summary of key considerations for pediatric solid organ transplant teams, describing what challenges are more likely for younger patients and how they might identify and address these circumstances. Our findings suggest that the mental health of patients and caregivers, issues at school, neurocognitive difficulties, and self-management are areas of particular relevance for children. We offer several recommendations that stem from these identified areas of concern. Dedicated focus on the well-being of younger patients could in the long-term stave off adverse events that are often associated with adolescence. In the short-term, certainly intervening in any of these domains could lead to improved quality of life during childhood.

The relationship of maternal and child illness uncertainty to child depressive symptomotology: a mediational model

OBJECTIVE

To examine the relationship of parent and child ratings of illness uncertainty to depressive symptomotology in children with a chronic illness using a mediational model framework.

METHOD

Mother-child dyads (N = 103 pairs) each completed measures of perceived illness uncertainty, while youth also completed a measure of depressive symptomotology.

RESULTS

Maternal uncertainty was directly related to child depressive symptoms; however, this relationship was mediated by child uncertainty.

CONCLUSION

It would appear that a key mechanism by which parent-related uncertainty influences child depressive symptoms is through child uncertainty, underscoring the importance of examining cognitive appraisal variables and means of transmission in parent-child interactions.

The association of illness uncertainty to parent and youth adjustment in juvenile rheumatic diseases: effect of youth age

OBJECTIVE

: This study sought to examine the differential effect of youth age on the association between parental uncertainty and both parent distress and youth depressive symptoms within the context of juvenile rheumatic disease.

METHOD

: The sample comprised 51 youth aged 9 to 17 years diagnosed with a juvenile rheumatic disease and their parents. Youth completed a measure of depressive symptoms (i.e., Children's Depression Inventory); parents completed measures of illness uncertainty (i.e., Parental Perceptions of Uncertainty Scale) and parental distress (i.e., Brief Symptom Inventory).

RESULTS

: Parental uncertainty demonstrated a significant main effect on both parent distress and youth depressive symptoms. However, these main effects were qualified by significant parental uncertainty × youth age interactions. Parental uncertainty was significantly related to parent distress for both younger and older youth but was only significantly related to youth depressive symptoms in the sample of older youth.

CONCLUSION

: Parental uncertainty due to illness seems to be more predictive of both parent and youth distress with increasing youth age. These findings indicate that the impact of parental illness uncertainty on adjustment outcomes is pronounced as children transition into developmental periods of increasing autonomy and independence.