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Field NK, Franck LS, Shellhaas RA, Glass HC, Young KA, Dhar S, Hamlett A, Pilon B, Means K, Soul JS, Massey SL, Wusthoff CJ, Chu CJ, Thomas C, Rogers E, Berl MM, Benedetti GM, Anwar T, Lemmon ME. Life After Neonatal Seizures: Characterizing the Longitudinal Parent Experience. Pediatr Neurol 2024; 161:76-83. [PMID: 39317023 DOI: 10.1016/j.pediatrneurol.2024.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 08/06/2024] [Accepted: 08/19/2024] [Indexed: 09/26/2024]
Abstract
BACKGROUND Parents of neonates with seizures report persistent symptoms of depression, anxiety, and posttraumatic stress. We aimed to characterize the parent experience of caring for children impacted by neonatal seizures, including longitudinal assessment across childhood. METHODS This prospective, observational, multicenter study was conducted at Neonatal Seizure Registry (NSR) sites in partnership with the NSR Parent Advisory Panel. Parents completed surveys at discharge; 12, 18, and 24 months; and 3, 4, 5, 7, and 8 years. Surveys included demographic information and open-ended questions targeting parent experience. A conventional content analysis approach was used. RESULTS A total of 320 caregivers completed at least one open-ended question, with the majority of respondents at discharge (n = 142), 12 months (n = 169), 18 months (n = 208), and 24 months (n = 245). We identified the following three primary themes. (1) Personal Burden of Care: Parents experienced emotional distress, financial strain, physical demands, and fears for their child's unknown outcome; (2) Managing Day-to-Day Life: Parents described difficulties navigating their parenting role, including managing their child's challenging behaviors and understanding their child's needs amid neurodevelopmental impairment; (3) My Joys as a Parent: Parents valued bonding with their child, being a caregiver, and watching their child's personality grow. CONCLUSIONS Parents of children impacted by neonatal seizures face persistent challenges, which are interwoven with the joys of being a parent. Our findings suggest that future interventions should promote resiliency, address caregivers' psychosocial needs longitudinally, and provide enhanced support for parents caring for children with medical complexity.
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Affiliation(s)
| | - Linda S Franck
- Department of Family Health Care Nursing, University of California, San Francisco, San Francisco, California
| | - Renée A Shellhaas
- Division of Pediatric Neurology, Department of Neurology, Washington University in St. Louis, St. Louis, Missouri
| | - Hannah C Glass
- Department of Pediatrics, UCSF Benioff Children's Hospital, University of California, San Francisco, San Francisco, California; Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, California
| | | | - Saisha Dhar
- Trinity College, Duke University, Durham, North Carolina
| | - Ashley Hamlett
- NSR Parent Partner, Duke University Medical Center, Durham, North Carolina
| | - Betsy Pilon
- NSR Parent Partner, Executive Director - Hope for HIE, West Bloomfield, Michigan
| | - Katie Means
- NSR Parent Partner, Cincinnati Children's Hospital Medical Center, Fort Thomas, Kentucky
| | - Janet S Soul
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts
| | - Shavonne L Massey
- Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Courtney J Wusthoff
- Departments of Neurology and Pediatrics, Stanford University, Palo Alto, California
| | - Catherine J Chu
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Cameron Thomas
- Department of Pediatrics, University of Cincinnati and Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Elizabeth Rogers
- Department of Pediatrics, UCSF Benioff Children's Hospital, University of California, San Francisco, San Francisco, California
| | - Madison M Berl
- Departments of Psychiatry and Behavioral Sciences, Children's Research Institute, Children's National Hospital, George Washington University, Washington, District of Columbia
| | - Giulia M Benedetti
- Division of Pediatric Neurology, Department of Pediatrics, C.S. Mott Children's Hospital and the University of Michigan, Ann Arbor, Michigan
| | - Tayyba Anwar
- Departments of Neurology and Pediatrics, Children's National Hospital and The George Washington University School of Medicine, Washington, District of Columbia
| | - Monica E Lemmon
- Departments of Pediatrics and Population Health Sciences, Duke University School of Medicine, Durham, NC, USA, Duke-Margolis Center for Health Policy, Washington, District of Columbia.
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Winsor AA, Richards C, Seri S, Liew A, Bagshaw AP. Quality of life in children with epilepsy: The role of parental mental health and sleep disruption. Epilepsy Behav 2024; 158:109941. [PMID: 39024683 DOI: 10.1016/j.yebeh.2024.109941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 06/14/2024] [Accepted: 07/04/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Parents of children with epilepsy (CWE) are at increased risk of mental health difficulties including anxiety and depression, as well as sleep difficulties. From both the child's and parent's perspectives, health-related quality of life has been shown to be strongly related to parental mental health. However, there is no literature on parental sleep as a predictor of child health-related quality of life. The role of parental variables has been assessed in relation to epilepsy-specific variables (e.g., seizure severity, anti-seizure medications) and how these relate to health-related quality of life, but prior studies have failed to consider the role of co-occurring conditions which are prevalent in CWE. The current study aims to assess how common anxiety symptoms, depression symptoms and sleep problems are in parents of CWE; and to determine the impact these parental variables as well as child co-occurring conditions have on health-related quality of life in CWE. METHODS 33 CWE aged 4-14 years old were recruited from two hospitals and parents were asked to complete a series of questionnaires assessing both child and parental variables. RESULTS It was found that 33.3 % and 12.0 % of parents of CWE experienced clinically significant anxiety and depression symptoms respectively. In addition 67.9 % of parents presented with significant sleep problems. In initial analysis, parental anxiety symptoms, depression symptoms and sleep problems were all significantly predictive of child health-related quality of life. However when co-occurring child sleep problems and neurodevelopmental characteristics were included, parental variables were no longer significantly predictive of child health-related quality of life. CONCLUSION These results suggest that child co-occurrences mediate the relationship between parental variables and child health-related quality of life. The current data highlight the need for a systemic approach to epilepsy management and suggest that support for co-occurrences could benefit health-related quality of life for children and their parents.
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Affiliation(s)
- Alice A Winsor
- Centre for Human Brain Health, University of Birmingham, UK; School of Psychology, University of Birmingham, UK; Maurice Wohl Clinical Neuroscience Institute, King's College London, UK.
| | | | - Stefano Seri
- Children's Epilepsy Surgery Programme, Birmingham Children's Hospital, UK; Aston Institute of Health and Neurodevelopment, Aston University, Birmingham, UK
| | - Ashley Liew
- Evelina London Children's Hospital, South London and Maudsley NHS Foundation Trust, UK; University of Warwick, UK
| | - Andrew P Bagshaw
- Centre for Human Brain Health, University of Birmingham, UK; School of Psychology, University of Birmingham, UK
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Bulduk M, Can V. Stigma perception and health fatalism in parents of children with epilepsy: A cross-sectional study. Heliyon 2024; 10:e35525. [PMID: 39170317 PMCID: PMC11336770 DOI: 10.1016/j.heliyon.2024.e35525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Revised: 07/28/2024] [Accepted: 07/30/2024] [Indexed: 08/23/2024] Open
Abstract
Aim The aim of this study was to examine the factors that affect stigma perceptions and health fatalism of parents of children with epilepsy in eastern Turkey, the relationship between these and the impact of these on their social lives. Method This descriptive and cross-sectional study was conducted between August 2022 and January 2023 with the parents of children under the age of 18 who had been diagnosed with epilepsy for at least 1 year and who were followed up in the only hospital with a paediatric neurology outpatient clinic in Van province of Turkey. No sample selection was made in the study. Healthy parents (n = 123) who presented to the outpatient clinic within the specified time period and who agreed to participate in the study after being explained the purpose of the study participated in the study. Results In this study, parental age was found to have a statistically weak positive correlation with Health Fatalism Scale (HFS) (r = 0.251; p = 0.005). A weak positive correlation was also found between the years patients had epilepsy and Parent Stigma Scale (PSS) (r = 0.275; p = 0.002). In addition, a statistically positive and weak relationship was found between Parent Stigma Scale scores and Health Fatalism Scale scores (r = 0.212; p = 0.018). This study found significant relationships between stigma perception and health fatalism in parents of epileptic children. Stigma perception increased with disease duration and lower parental education levels. Conclusion While providing an important basis for understanding the difficulties experienced by parents and developing support mechanisms, the present study can contribute to more informed support for parents of patients with epilepsy in the community. Nurses can contribute to ending stigma and discrimination by identifying patients' and parents' perceptions of epilepsy, focusing on addressing gaps in knowledge and raising awareness in the community.
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Affiliation(s)
- Mehmet Bulduk
- Van Yuzuncu Yil University, Faculty of Health Sciences, Department of Pediatric Nursing, 65000, Van, Turkey
| | - Veysel Can
- Van Yuzuncu Yil University, Faculty of Health Sciences, Department of Pediatric Nursing, 65000, Van, Turkey
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Idowu J, Meades C, Cross JH, Muggeridge A, Lakhanpaul M, Robinson K, Sherar LB, Pearson N, Reilly C. Mental health in secondary school-aged children with epilepsy and their primary caregivers: A case control study. Seizure 2024; 120:150-156. [PMID: 38996573 DOI: 10.1016/j.seizure.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 06/11/2024] [Accepted: 07/02/2024] [Indexed: 07/14/2024] Open
Abstract
PURPOSE To describe the prevalence and associated factors of mental health problems in secondary school-aged (11-16 years) children with epilepsy and their primary caregivers compared to a control group without epilepsy. METHODS Children with epilepsy (n = 60), controls (n = 49), and caregivers (n = 60 epilepsy and n = 49 control group) completed a measure of the child's mental health (Strengths and Difficulties Questionnaire; SDQ). Primary caregivers in both groups completed a measure of their own mental health (Depression, Anxiety, and Stress Scale-21; DASS-21). Factors associated with child and caregiver mental health in the epilepsy group were explored using linear regression. RESULTS There were no significant differences between the epilepsy and control group regarding age, gender, ethnicity and socioeconomic status. A higher proportion of children with epilepsy scored in the at-risk range on the SDQ indicating more mental health problems than the control group, as reported by the children (45% vs. 24 %) (p = 0.026) and caregivers (52% vs. 14 %) (p < 0.001). Primary caregivers of children with epilepsy had more symptoms of depression (p = 0.001), anxiety (p = 0.028) and stress (p = 0.019) than caregivers in the control group. Children with epilepsy with greater motor coordination problems had greater mental health difficulties. Children with epilepsy with more mental health difficulties had caregivers with more difficulties and caregivers of children with earlier onset of seizures had more mental health difficulties. CONCLUSIONS Epilepsy confers a high risk for mental health problems in adolescents and their primary caregivers. There is a need to better understand the relationship between caregiver and child mental health difficulties in epilepsy.
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Affiliation(s)
- J Idowu
- Research Department, Young Epilepsy, Lingfield, Surrey RH7 6PW, UK
| | - C Meades
- Research Department, Young Epilepsy, Lingfield, Surrey RH7 6PW, UK
| | - J H Cross
- Research Department, Young Epilepsy, Lingfield, Surrey RH7 6PW, UK; UCL Great Ormond Street Institute of Child Health (ICH), 30 Guilford Street, London WC1N 1EH UK; Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London WC1N 3JH, UK
| | - A Muggeridge
- Research Department, Young Epilepsy, Lingfield, Surrey RH7 6PW, UK
| | - M Lakhanpaul
- UCL Great Ormond Street Institute of Child Health (ICH), 30 Guilford Street, London WC1N 1EH UK; Whittington Health NHS Trust, Magdala Avenue, London N19 5NF, UK
| | - K Robinson
- Whittington Health NHS Trust, Magdala Avenue, London N19 5NF, UK
| | - L B Sherar
- School of Sport Exercise and Health Sciences, Loughborough University, LE11 3TU UK
| | - N Pearson
- School of Sport Exercise and Health Sciences, Loughborough University, LE11 3TU UK
| | - C Reilly
- Research Department, Young Epilepsy, Lingfield, Surrey RH7 6PW, UK; UCL Great Ormond Street Institute of Child Health (ICH), 30 Guilford Street, London WC1N 1EH UK.
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Lindsay N, Martin J, Adegboye D, Absoud M, Charman T, Tye C. Impact of and research priorities in early onset epilepsy: An investigation of parental concerns. Epilepsy Behav 2024; 156:109794. [PMID: 38733908 DOI: 10.1016/j.yebeh.2024.109794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 04/13/2024] [Accepted: 04/14/2024] [Indexed: 05/13/2024]
Abstract
[Background and aim] Early onset epilepsy is a neurological condition with significant developmental consequences, and presents affected children and families with challenges which pervade many aspects of family life. Whilst the concerns of parents and the impact on quality of life is well documented in qualitative research, little emphasis has been placed on the context of 'early onset', and the implications of these concerns for research priority setting. We aimed to explore parental perspectives regarding concerns and the impact of early onset epilepsy on the child and family, and to identify priorities for future paediatric epilepsy research. [Methods] The Brain development in Early Epilepsy: Parent Priorities (BEE-PP) project employed a mixed methods approach to collect information on parents' experience of having a child diagnosed with early onset epilepsy before 36 months old and aged up to 16 years old. Parents completed an online survey (n = 15) followed by a focus group (n = 5) to explore their main concerns regarding early onset epilepsy, the impact on family life and research priorities. [Results] A thematic analysis of the focus group data generated eight themes related to concerns of parents, the impact on the family and research priorities. The three main concerns identified were the expected trajectory of their child's development, a lack of seizure control following diagnosis and adverse behavioural side effects of medication. Within family life, early onset epilepsy had an impact on sibling autonomy and psychosocial adaptation, poorer parental wellbeing and restricted social and personal activities. The need for clearer information regarding their child's developmental trajectory, and managing the side effects of medication and their interactions with behaviour over time were topics of priority for future epilepsy research. [Interpretation] The impact of early onset epilepsy on the family is pervasive and requires the provision of appropriate healthcare service-led support for families to improve quality of life and children's adjustment to epilepsy. Regular monitoring of the concerns of parents and the impact of the diagnosis would be beneficial for addressing epilepsy-related and psychosocial needs of the wider family throughout their child's development. Implications for future research priority setting with regards to improved clinician-to-parent information sharing and managing the behavioural side effects of medication are discussed.
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Affiliation(s)
- Natasha Lindsay
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | - Jessica Martin
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Dolapo Adegboye
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Michael Absoud
- Department of Children's Neurosciences, Evelina London Children's Healthcare, Guy's and St Thomas' NHS Foundation Trust, London SE1 7EH, UK; Department of Women and Children's Health, Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
| | - Tony Charman
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Charlotte Tye
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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6
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Bolt C, Wallace T, Brandon N, Brayley A, D'Urso A. Evaluation of a pilot Tree of Life group for children with epilepsy and their families. Clin Child Psychol Psychiatry 2024; 29:982-993. [PMID: 37552137 DOI: 10.1177/13591045231193250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
BACKGROUND Tree of Life Groups (a narrative therapy technique) have been used successfully in a number of paediatric populations. The group intervention aims to give children a space to express their difficulties whilst also holding in mind their strengths and hopes, thereby creating a preferred identity incorporating their physical health condition. No studies were identified which described this approach in a paediatric epilepsy population or involving siblings, families and the multidisciplinary team. METHODS The current paper describes a pilot intervention to facilitate a one-day psychoeducational Tree of Life group for children with epilepsy, their siblings and parents. Separate parent and sibling groups were facilitated concurrently. The groups were co-facilitated by Paediatric Psychology and Paediatric Epilepsy team members. Quantitative feedback was completed by the patient group. Patients, siblings, and parents provided qualitative feedback. RESULTS A total of 6 patients, 14 siblings and 15 parents attended the group. Quantitative feedback indicated some improvement in patients' confidence and knowledge of managing epilepsy, as well as some improvements in psychological adjustment and thoughts about epilepsy. 87.5% of patients and siblings detailed that they would recommend the group to others. Qualitative feedback from patients, siblings and parents indicated the helpfulness of relating to others and safely expressing difficulties. CONCLUSIONS The results indicated that this pilot group intervention was well received by children with epilepsy and their families. Future studies incorporating a larger sample are warranted to explore this further.
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Affiliation(s)
- Charlotte Bolt
- Department of Paediatric Psychology, Bedfordshire Hospitals NHS Foundation Trust, Luton, UK
| | - Tamara Wallace
- Department of Paediatric Psychology, Bedfordshire Hospitals NHS Foundation Trust, Luton, UK
- Doctorate Programme in Clinical Psychology, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Nicola Brandon
- Department of Paediatric Psychology, Bedfordshire Hospitals NHS Foundation Trust, Luton, UK
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Amy Brayley
- Department of Paediatric Psychology, Bedfordshire Hospitals NHS Foundation Trust, Luton, UK
- Doctorate Programme in Clinical Psychology, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Anita D'Urso
- Department of Paediatric Psychology, Bedfordshire Hospitals NHS Foundation Trust, Luton, UK
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7
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Widjaja E, Puka K, Smith ML. Trajectory of health-related quality of life in parents of children treated with epilepsy surgery versus medical therapy. Qual Life Res 2024; 33:1297-1305. [PMID: 38381280 DOI: 10.1007/s11136-024-03607-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2024] [Indexed: 02/22/2024]
Abstract
PURPOSE Child health-related quality of life (HRQOL) has been shown to improve after epilepsy surgery and is linked to parent HRQOL. We postulated that the HRQOL of parents whose children underwent epilepsy surgery would improve over two years compared to those treated with medical therapy. The aim of the study was to evaluate the trajectory of HRQOL of parents whose children received treatment with epilepsy surgery or medical therapy over two years. METHODS This multi-center study recruited parents whose children were evaluated for epilepsy surgery. Parents completed measures of care-related QOL (CarerQOL) at the time of their children's surgical evaluation, 6 months, 1 year, and 2 years later. Additional measures included parent anxiety and depression, satisfaction with family relationships, family resources and demands, and child clinical variables. A linear mixed model was used to compare the trajectories of parent HRQOL of surgical and medical patients, adjusting for baseline clinical, parent, and family characteristics. RESULTS There were 111 children treated with surgery and 154 with medical therapy. The trajectory of parent HRQOL was similar among parents of surgical and medical patients over the two-year follow-up. However, HRQOL of parents of surgical patients was 3.0 points higher (95%CI - 0.1, 6.1) across the follow-up period compared to parents of medical patients. Parents of seizure-free children reported 2.3 points (95%CI 0.2, 4.4) higher HRQOL relative to parents of non-seizure-free children across the two-year follow-up. CONCLUSION Parent HRQOL did not improve after their children were treated with epilepsy surgery, possibly related to ongoing comorbidities in children.
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Affiliation(s)
- Elysa Widjaja
- Department of Medical Imaging, Ann and Robert H. Lurie Children's Hospital, 225 E Chicago Ave, Chicago, IL, 60611, USA.
- Neuroscience and Mental Health Program, The Hospital for Sick Children, Toronto, ON, Canada.
| | - Klajdi Puka
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Mary Lou Smith
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON, Canada
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Malcolm C, Hoddinott P, King E, Dick S, Kyle R, Wilson P, France E, Aucott L, Turner SW. Short-stay urgent hospital admissions of children with convulsions: A mixed methods exploratory study to inform out of hospital care pathways. PLoS One 2024; 19:e0301071. [PMID: 38557817 PMCID: PMC10984513 DOI: 10.1371/journal.pone.0301071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/09/2024] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVE To inform interventions focused on safely reducing urgent paediatric short stay admissions (SSAs) for convulsions. METHODS Routinely acquired administrative data from hospital admissions in Scotland between 2015-2017 investigated characteristics of unscheduled SSAs (an urgent admission where admission and discharge occur on the same day) for a diagnosis of febrile and/or afebrile convulsions. Semi-structured interviews to explore perspectives of health professionals (n = 19) making referral or admission decisions about convulsions were undertaken. Interpretation of mixed methods findings was complemented by interviews with four parents with experience of unscheduled SSAs of children with convulsion. RESULTS Most SSAs for convulsions present initially at hospital emergency departments (ED). In a subset of 10,588 (11%) of all cause SSAs with linked general practice data available, 72 (37%) children with a convulsion contacted both the GP and ED pre-admission. Within 30 days of discharge, 10% (n = 141) of children admitted with afebrile convulsions had been readmitted to hospital with a further convulsion. Interview data suggest that panic and anxiety, through fear that the situation is life threatening, was a primary factor driving hospital attendance and admission. Lengthy waits to speak to appropriate professionals exacerbate parental anxiety and can trigger direct attendance at ED, whereas some children with complex needs had direct access to convulsion professionals. CONCLUSIONS SSAs for convulsions are different to SSAs for other conditions and our findings could inform new efficient convulsion-specific pre and post hospital pathways designed to improve family experiences and reduce admissions and readmissions.
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Affiliation(s)
- Cari Malcolm
- School of Health Sciences, University of Dundee, Dundee, United Kingdom
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, United Kingdom
| | - Emma King
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, United Kingdom
| | - Smita Dick
- Child Health, University of Aberdeen, Aberdeen, United Kingdom
| | - Richard Kyle
- Academy of Nursing, Department of Health and Care Professions, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
| | - Philip Wilson
- Centre for Rural Health, University of Aberdeen, Aberdeen, United Kingdom
- Centre for Research and Education in General Practice, University of Copenhagen, København, Denmark
| | - Emma France
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, United Kingdom
| | - Lorna Aucott
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Stephen W. Turner
- Child Health, University of Aberdeen, Aberdeen, United Kingdom
- Women and Children Division, NHS Grampian, Aberdeen, United Kingdom
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Marshall KH, Pincus HA, Tesson S, Lingam R, Woolfenden SR, Kasparian NA. Integrated psychological care in pediatric hospital settings for children with complex chronic illness and their families: a systematic review. Psychol Health 2024; 39:452-478. [PMID: 35635028 DOI: 10.1080/08870446.2022.2072843] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 03/07/2022] [Accepted: 04/27/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To synthesize and critically evaluate evidence on the effectiveness of integrated psychological care models for children with complex chronic illness within pediatric hospital settings and provide recommendations for successful implementation. DESIGN Six electronic databases (Medline, Cochrane, Embase, PsycINFO, Scopus, CINAHL) were systematically searched for English language studies including families of children aged 0-17 years with complex chronic illness. Eligible studies reported on psychology or neuropsychology screening, assessment, intervention, or services provided within a pediatric hospital setting. RESULTS Fifteen studies were identified for review; nine assessed a psychological service, five examined psychosocial screening, and one examined a neuropsychology service. Three studies demonstrated the effectiveness of integrated psychological services in improving child or parent physical, psychological, or behavioral health outcomes. Uptake of psychosocial screening was high (84-96%), but only 25-37% of children or families identified as 'at-risk' engaged with on-site psychology services. Integrated psychological services offering consultations at the same time and location as the child's medical visit reported the highest rates of uptake (77-100%). CONCLUSIONS The available evidence supports co-location of child medical and psychological services. A more consistent and comprehensive approach to the assessment of patient- and caregiver-reported outcomes and implementation effectiveness is recommended.
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Affiliation(s)
- Kate H Marshall
- Heart Centre for Children, The Sydney Children's Hospitals Network, Sydney, NSW, Australia
- Population Child Health Clinical Research Group, School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Harold A Pincus
- Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, New York, NY, USA
- Irving Institute for Clinical and Translational Research, Columbia University and New York‑Presbyterian Hospital, New York, NY, USA
| | - Stephanie Tesson
- Heart Centre for Children, The Sydney Children's Hospitals Network, Sydney, NSW, Australia
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Raghu Lingam
- Population Child Health Clinical Research Group, School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Susan R Woolfenden
- Population Child Health Clinical Research Group, School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
- Sydney Institute for Women, Children and their Families, Sydney local health District, Sydney, NSW, Australia
| | - Nadine A Kasparian
- Cincinnati Children's Center for Heart Disease and Mental Health, Heart Institute and Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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10
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Yücel G, Kadir Arslan A, Özgör B, Güngör S. Sleep quality and depression in mothers of children with epilepsy and its relation to their children's sleep. Epilepsy Behav 2023; 149:109493. [PMID: 37992428 DOI: 10.1016/j.yebeh.2023.109493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/28/2023] [Accepted: 10/13/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVE This study aimed to evaluate the relationship between sleep disturbances in children with epilepsy (CWE) and maternal sleep quality and depression severity. METHODS A Cross-sectional study was conducted in pediatric sleep disturbances using questionnaires on mother-reported sleep of CWE [Children's Sleep Habits Questionnaire (CSHQ)], maternal sleep quality [Pittsburgh Sleep Quality Index (PSQI)], and maternal depression status [Self-Rating Depression Scale (SDS)]. 114 dyads consisting of CWE and their mothers were included in this study. RESULTS Over three-quarters (78.9 %) of mothers reported poor sleep quality (total PSQI score ≥ 5), and nearly a third (29.8 %) met clinical criteria for moderate or severe depression levels. The mothers' total PSQI scores were between 5.93 ± 2.44 (range: 2-16 points). The most affected PSQI subcomponents were sleep latency (AUC = 0.826p < 0.001) and daytime dysfunction (AUC = 0.800p < 0.001). The majority of children (88.6 %) were stated by their mothers to have sleep-related problems. The total CSHQ scores of the children were between 49.06 ± 9.20 (range: 33-86 points). The most affected CSHQ subcomponents were detected sleep anxiety (AUC = 0.856, p < 0.001), bedtime resistance (AUC = 0.818, p < 0.001) and daytime sleepiness (AUC = 0.807, p < 0.001). There was a statistically significant positive correlation between maternal sleep quality and depression severity (rho = 0.842; p < 0.001). A statistically significant positive moderate correlation was detected between sleep problems in CWE and maternal sleep quality and depression severity (rho = 0.406; p < 0.001, rho = 0.399; p < 0.001, respectively). As a result of multiple stepwise logistic regression analysis, the presence of seizures during sleep and generalized epileptiform discharges on electroencephalography were associated risk factors with poor maternal sleep quality (OR:6.6, p = 0.014; OR:11.5, p = 0.018, respectively). A borderline insignificant relationship was observed between a less than 50 % decrease in seizure frequency and the poor maternal sleep quality (OR:20.59p = 0.059). Seizures during sleep was associated risk factor with children's sleep disturbances (OR:7.2, p = 0.02). CONCLUSIONS Sleep problems in CWE may lead to negative consequences such as sleep quality and/or depression in mothers. Interventions planned to correct sleep disturbances in mothers suggest that children's sleep problems should be optimally managed.
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Affiliation(s)
- Gül Yücel
- Department of Pediatric Neurology, Faculty of Medicine, Inönü University, Malatya, Turkey.
| | - Ahmet Kadir Arslan
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Inönü University, Malatya, Turkey.
| | - Bilge Özgör
- Department of Pediatric Neurology, Faculty of Medicine, Inönü University, Malatya, Turkey.
| | - Serdal Güngör
- Department of Pediatric Neurology, Faculty of Medicine, Inönü University, Malatya, Turkey.
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11
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Smith ML, Puka K, Speechley KN, Ferro MA, Connolly MB, Major P, Gallagher A, Almubarak S, Hasal S, Ramachandrannair R, Andrade A, Xu Q, Leung E, Snead OC, Widjaja E. Trajectories of parent well-being in children with drug-resistant epilepsy. Epilepsia 2023; 64:3342-3353. [PMID: 37828819 DOI: 10.1111/epi.17797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVE This longitudinal cohort study aimed to identify trajectories of parent well-being over the first 2 years after their child's evaluation for candidacy for epilepsy surgery, and to identify the baseline clinical and demographic characteristics associated with these trajectories. Parent well-being was based on parent depressive and anxiety symptoms and family resources (i.e., family mastery and social support). METHODS Parents of 259 children with drug-resistant epilepsy (105 of whom eventually had surgery) were recruited from eight epilepsy centers across Canada at the time of their evaluation for epilepsy surgery candidacy. Participants were assessed at baseline and 6-month, 1-year, and 2-year follow-up. The trajectories of parents' depressive symptoms, anxiety symptoms, and family resources were jointly estimated using multigroup latent class growth models. RESULTS The analyses identified three trajectories: an optimal-stable group with no/minimal depressive or anxiety symptoms, and high family resources that remained stable over time; a mild-decreasing-plateau group with mild depressive and anxiety symptoms that decreased over time then plateaued, and intermediate family resources that remained stable; and a moderate-decreasing group with moderate depressive and anxiety symptoms that decreased slightly, and low family resources that remained stable over time. Parents of children with higher health-related quality of life, fathers, and parents who had higher household income were more likely to have better trajectories of well-being. Treatment type was not associated with the trajectory groups, but parents whose children were seizure-free at the time of the last follow-up were more likely to have better trajectories (optimal-stable or mild-decreasing-plateau trajectories). SIGNIFICANCE This study documented distinct trajectories of parent well-being, from the time of the child's evaluation for epilepsy surgery. Parents who present with anxiety and depressive symptoms and low family resources do not do well over time. They should be identified and offered supportive services early in their child's epilepsy treatment history.
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Affiliation(s)
- Mary Lou Smith
- Department of Psychology, University of Toronto Mississauga, Mississauga, Ontario, Canada
- Neurosciences and Mental Health Program, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Klajdi Puka
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Kathy N Speechley
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Mark A Ferro
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Mary B Connolly
- Division of Neurology, Department of Pediatrics, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Philippe Major
- Division of Neurology, Department of Neurosciences, CHU Sainte-Justine Hospital, University of Montreal, Montreal, Quebec, Canada
| | - Anne Gallagher
- Centre de Recherche, CHU Sainte-Justine Hospital, University of Montreal, Montreal, Quebec, Canada
| | - Salah Almubarak
- Division of Pediatric Neurology, Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Qatif Central Hospital, Qatif, Saudi Arabia
| | - Simona Hasal
- Division of Pediatric Neurology, Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Andrea Andrade
- Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Qi Xu
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Edward Leung
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - O Carter Snead
- Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elysa Widjaja
- Neurosciences and Mental Health Program, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Medical Imaging, Lurie Children's Hospital, Chicago, Illinois, USA
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12
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Lou VWQ, Chung HF, Leung WCY, Chang RSK, Tsaw M, Lo CNR, Chiu ATG. Prevalence and predictors of depressive symptoms among caregivers of patients with epilepsy in Hong Kong. Epilepsy Behav 2023; 147:109411. [PMID: 37672823 DOI: 10.1016/j.yebeh.2023.109411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/13/2023] [Accepted: 08/19/2023] [Indexed: 09/08/2023]
Abstract
STUDY AIM To estimate the prevalence of high caregiving burden and depressive symptoms among caregivers (CG) of patients with epilepsy (PWEs) in Hong Kong and identify risk and protective factors for both outcomes after the Model of Stress and Carer Burden (MSCB). METHODS This cross-sectional study recruited participants from local epilepsy clinics to complete a 15-minute survey on a tablet. Caregiving burden (CB) was assessed using the 4-item Zarit Caregiver Burden Interview. Depressive symptoms were assessed using the 2-item Patient Health Questionnaire. Family functioning was assessed using the Short-Form Family Assessment Device General Functioning Subscale. Sociodemographic data of the caregivers and clinical data of the PWE they cared for were described. Hierarchical logistic regression models were used to analyze the factors associated with the outcomes. RESULTS A hundred and fifty-one CGs of PWEs were recruited for this study. The prevalence of high caregiving burden (ZBI-4 > 7) for CGs of PWEs was 58.9% (n = 89), whereas the prevalence of high depressive symptoms (PHQ2 > 2) was 23.8% (n = 36). Hierarchical logistic regression analysis revealed that entering patient characteristics and care situations did not enhance the model's predictability. In the full model, a high perceived CB was a risk factor for elevated depressive symptoms. Good physical health protects against depressive symptoms. CONCLUSIONS Among caregivers of PWE in Hong Kong, a high perceived caregiving burden was a risk factor for elevated depressive symptoms; however, the clinical characteristics of the PWEs were not. Self-reported physical health is a protective factor against increased depressive symptoms.
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Affiliation(s)
- Vivian W Q Lou
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong; Sau Po Centre of Ageing, University of Hong Kong, Hong Kong.
| | - Ho-Fung Chung
- Sau Po Centre of Ageing, University of Hong Kong, Hong Kong
| | - William C Y Leung
- Division of Neurology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong
| | - Richard Shek-Kwan Chang
- Division of Neurology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong
| | - Meagan Tsaw
- Division of Neurology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong
| | - Cheuk Nam Rachel Lo
- Division of Neurology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong
| | - Annie Ting-Gee Chiu
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong
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13
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Wu Y, Zhang R, Tang J, Li X, Wang Y, Li T, Wu F, Dou X, Wang D, Jiang L. Multi-dimensional influence of pediatric epilepsy on children and their families: A cross-sectional study. Epilepsy Behav 2023; 146:109360. [PMID: 37499581 DOI: 10.1016/j.yebeh.2023.109360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 07/11/2023] [Accepted: 07/13/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVE In this study, we aimed to evaluate the effects of pediatric epilepsy on family burden, parental anxiety, depression states, and quality of life of both parents and children. METHODS The study was undertaken between March and December 2021 using an online questionnaire that included the Family Burden Scale of Disease, the 7-item Generalized Anxiety Disorder scale, the 9-item Patient Health Questionnaire, the WHO Quality of Life Scale (WHOQOL-BREF), and the PedsQL 4.0 Generic Core Scales (parent-proxy report). RESULTS A total of 288 parents of children aged 2-18 years were included. Overall, 94.8% of the participating families experienced high levels of disease burden, 67.0% of parents suffered from anxiety states, 57.0% suffered from depression states, and 56.2% of children with epilepsy suffered from comorbid neuropsychiatric symptoms. The mean WHOQOL-BREF score for parental quality of life was 53.7 ± 12.8, while the median PedsQL score for children's quality of life was 65.4 (49.6-81.7). Parental depression states contributed the most to family burden and parental quality of life, whereas comorbidities of epilepsy contributed the most to children's quality of life. Seizure frequency significantly influenced parental anxiety states, and family burden was the most significant predictor of parental depression states. CONCLUSION Heavy disease burden, anxiety states, and depression states are prevalent in families with children suffering from epilepsy, and most have a poor quality of life. There is a need for greater focus on the quality of life of this patient population and their caregivers, as well as increased resources to help combat anxiety, depression, and poor quality of life.
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Affiliation(s)
- You Wu
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China; Department of Neurology, Xi'an Children's Hospital, the Affiliated Children's Hospital of Xi'an Jiaotong University, Shannxi, China
| | - Rui Zhang
- Department of Neurology, Xi'an Children's Hospital, the Affiliated Children's Hospital of Xi'an Jiaotong University, Shannxi, China
| | - Jianyong Tang
- Department of Laboratory Medicine, Xi'an Children's Hospital, the Affiliated Children's Hospital of Xi'an Jiaotong University, Shaanxi, China
| | - Xia Li
- Department of Neurology, Xi'an Children's Hospital, the Affiliated Children's Hospital of Xi'an Jiaotong University, Shannxi, China
| | - Yan Wang
- Department of Neurology, Xi'an Children's Hospital, the Affiliated Children's Hospital of Xi'an Jiaotong University, Shannxi, China
| | - Taoli Li
- Department of Neurology, Xi'an Children's Hospital, the Affiliated Children's Hospital of Xi'an Jiaotong University, Shannxi, China
| | - Fang Wu
- Department of Neurology, Xi'an Children's Hospital, the Affiliated Children's Hospital of Xi'an Jiaotong University, Shannxi, China
| | - Xiangjun Dou
- Department of Neurology, Xi'an Children's Hospital, the Affiliated Children's Hospital of Xi'an Jiaotong University, Shannxi, China
| | - Dong Wang
- Department of Neurology, Xi'an Children's Hospital, the Affiliated Children's Hospital of Xi'an Jiaotong University, Shannxi, China.
| | - Li Jiang
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China.
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14
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van Westrhenen A, Lazeron RHC, van Dijk JP, Leijten FSS, Thijs RD. Multimodal nocturnal seizure detection in children with epilepsy: A prospective, multicenter, long-term, in-home trial. Epilepsia 2023; 64:2137-2152. [PMID: 37195144 DOI: 10.1111/epi.17654] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/14/2023] [Accepted: 05/15/2023] [Indexed: 05/18/2023]
Abstract
OBJECTIVE There is a pressing need for reliable automated seizure detection in epilepsy care. Performance evidence on ambulatory non-electroencephalography-based seizure detection devices is low, and evidence on their effect on caregiver's stress, sleep, and quality of life (QoL) is still lacking. We aimed to determine the performance of NightWatch, a wearable nocturnal seizure detection device, in children with epilepsy in the family home setting and to assess its impact on caregiver burden. METHODS We conducted a phase 4, multicenter, prospective, video-controlled, in-home NightWatch implementation study (NCT03909984). We included children aged 4-16 years, with ≥1 weekly nocturnal major motor seizure, living at home. We compared a 2-month baseline period with a 2-month NightWatch intervention. The primary outcome was the detection performance of NightWatch for major motor seizures (focal to bilateral or generalized tonic-clonic [TC] seizures, focal to bilateral or generalized tonic seizures lasting >30 s, hyperkinetic seizures, and a remainder category of focal to bilateral or generalized clonic seizures and "TC-like" seizures). Secondary outcomes included caregivers' stress (Caregiver Strain Index [CSI]), sleep (Pittsburgh Quality of Sleep Index), and QoL (EuroQol five-dimension five-level scale). RESULTS We included 53 children (55% male, mean age = 9.7 ± 3.6 years, 68% learning disability) and analyzed 2310 nights (28 173 h), including 552 major motor seizures. Nineteen participants did not experience any episode of interest during the trial. The median detection sensitivity per participant was 100% (range = 46%-100%), and the median individual false alarm rate was .04 per hour (range = 0-.53). Caregiver's stress decreased significantly (mean total CSI score = 8.0 vs. 7.1, p = .032), whereas caregiver's sleep and QoL did not change significantly during the trial. SIGNIFICANCE The NightWatch system demonstrated high sensitivity for detecting nocturnal major motor seizures in children in a family home setting and reduced caregiver stress.
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Affiliation(s)
- Anouk van Westrhenen
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede and Zwolle, the Netherlands
- Department of Neurology and Clinical Neurophysiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Richard H C Lazeron
- Academic Center of Epileptology Kempenhaeghe, Heeze, the Netherlands
- Faculty of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Johannes P van Dijk
- Academic Center of Epileptology Kempenhaeghe, Heeze, the Netherlands
- Faculty of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
- Department of Orthodontics, Ulm University, Ulm, Germany
| | - Frans S S Leijten
- Brain Center, Department of Neurology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Roland D Thijs
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede and Zwolle, the Netherlands
- Department of Neurology and Clinical Neurophysiology, Leiden University Medical Center, Leiden, the Netherlands
- UCL Queen Square Institute of Neurology, London, UK
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15
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Tschamper MK, Larsen MH, Wahl AK, Jakobsen R. Developing and maintaining health literacy: A continuous emotional, cognitive, and social process for parents of children with epilepsy-A qualitative study. Epilepsy Behav 2023; 142:109222. [PMID: 37088063 DOI: 10.1016/j.yebeh.2023.109222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/23/2023] [Accepted: 04/07/2023] [Indexed: 04/25/2023]
Abstract
Childhood epilepsy is often complicated by neurobehavioral comorbidities, and parents are expected to actively engage in managing the condition. Insufficient parental health literacy (HL) has been associated with reduced health outcomes for children with epilepsy. Little is known about the parents' experiences of information seeking, social support, navigating the healthcare system, and interactions with healthcare professionals and how these skills may contribute to the development of sufficient HL. This study explored parents' experiences of their caregiver responsibility and the development of their HL in relation to caring for their child with epilepsy. Ten parents of children under 12 years of age with epilepsy were purposedly sampled and interviewed individually, using semi-structured interviews. The interviews were analyzed using qualitative content analysis, in line with Graneheim & Lundman. The analyses resulted in three themes, each comprising two sub-themes. The themes were: (1) Alone with the responsibility, (2) The combat for information and support, and (3) Developing vigilance and distrust in system competence. Lack of flexibility in healthcare services, insufficient multidisciplinary collaboration, and unclear treatment provider responsibility made the parents feel alone in the caregiver's responsibility. Poor local provider competence related to childhood epilepsy was a barrier to developing sufficient HL. A trusting relationship with professionals and timely access to competent health services were facilitators for developing HL. Higher HL made the parents more critical for the healthcare services, which triggered vigilance and reduced their trust in the professionals' information. For the parents, developing and maintaining HL was a continuous emotional, cognitive, and social process. Health information and care support need to be adjusted to the severity of the child's condition, the resources are available, and the parent's HL. The results of this study may contribute to the development of future interventions for strengthening parental HL in the childhood epilepsy context.
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Affiliation(s)
- Merete K Tschamper
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Norway; National Centre for Epilepsy, Department of Neurology, Oslo University Hospital, Norway.
| | | | - Astrid K Wahl
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Norway.
| | - Rita Jakobsen
- Lovisenberg Diaconal University College, Oslo, Norway.
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16
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Lahmini W, Gyamfi SO, Bourrous M. Survey on the management of childhood epilepsy among general practitioners in the area of Marrakech. BMC Pediatr 2023; 23:159. [PMID: 37016344 PMCID: PMC10071602 DOI: 10.1186/s12887-023-03947-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/04/2022] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Epilepsy is a common chronic neurological disorder in the pediatric population and its evolution can be fatal. It represents a major public health problem as well as an economic burden for the families of affected children, health systems and the overall economies of countries. This further accentuates the role that general practitioners can play in the management of childhood epilepsy in the face of the persistent lack of neurologists and neuro-pediatricians in our country. METHODS In order to assess the knowledge and therapeutic habits of general practitioners, we carried out a descriptive and cross-sectional study with general practitioners practicing in the two healthcare sectors: public and private, and in two settings: urban and rural, during the year 2018. The data was collected through a pre-established survey. RESULTS In total, 155 general practitioners responded to the survey. For 85.2% of physicians, the diagnosis of childhood epilepsy was based on interrogation, physical examination, and EEG. While brain imaging would be systematic regardless of the type of epilepsy for 45.2% of doctors. Only 6 doctors (3.9%) had knowledge of the latest classifications of the "ILAE". For treatment, the majority of physicians (65.5%) adopted first-line monotherapy with valproate in leading position. Almost half of the doctors (48.4%) found that education of parents and children was always necessary. None of the GPs interviewed in our series assessed the academic impact of epilepsy. Only 32% of doctors had received continuing education on epilepsy. CONCLUSION The data from our study demonstrates that continuing education on the management of childhood epilepsy and the greater involvement of general practitioners were essential elements in improving care.
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Affiliation(s)
- Widad Lahmini
- Department of Paediatric Emergency, Mohamed VI UHC, Cadi Ayyad University, Faculty of Medicine and Pharmacy, PO Box: 7010, Sidi Abbad Street, 40000, Marrakech, Morocco
| | - Samuel Opoku Gyamfi
- Department of Paediatric Emergency, Mohamed VI UHC, Cadi Ayyad University, Faculty of Medicine and Pharmacy, PO Box: 7010, Sidi Abbad Street, 40000, Marrakech, Morocco
| | - Mounir Bourrous
- Department of Paediatric Emergency, Mohamed VI UHC, Cadi Ayyad University, Faculty of Medicine and Pharmacy, PO Box: 7010, Sidi Abbad Street, 40000, Marrakech, Morocco.
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17
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Beesley RE, Lew AR, Hindley D, Jameson H, Panwar N, Walton C. Carer's perceptions of paediatric epilepsy services with and without epilepsy specialist nurses: A thematic analysis. Seizure 2022; 103:26-31. [DOI: 10.1016/j.seizure.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/20/2022] [Accepted: 10/08/2022] [Indexed: 11/07/2022] Open
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18
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Kelada L, Wakefield CE, Drew D, Ooi CY, Palmer EE, Bye A, De Marchi S, Jaffe A, Kennedy S. Siblings of young people with chronic illness: Caring responsibilities and psychosocial functioning. J Child Health Care 2022; 26:581-596. [PMID: 34271837 DOI: 10.1177/13674935211033466] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Siblings of young people with chronic illness commonly undertake caring responsibilities for their affected brother/sister, which may encourage maturation, yet may also be perceived as a burden. Our study determined (1) siblings' caring responsibilities, (2) siblings' current emotional distress and psychosocial functioning, and (3) how siblings' caring responsibilities and psychosocial functioning related to familial relationships and coping strategies. Siblings completed questionnaires which contained Sibling Inventory of Behavior, Sibling Inventory of Differential Experiences, PedsQL, emotion thermometers, Brief COPE, and a checklist of caregiving responsibilities. We analyzed the data with t-tests and multi-level models. Forty-five siblings (mean age = 15.40 years, SD = 3.31 years; 60.0% female) participated. Siblings who had caring responsibilities (n = 26, 57.8%) reported lower anxiety symptoms, lower need for help, greater use of problem-focused coping, and more companionship and teaching/directiveness with their affected brother/sister than siblings without caring responsibilities. Siblings reported lower psychosocial and physical functioning when they perceived their parents provided them with less affection than their affected brother/sister. Family-based psychosocial interventions may aim to improve the sibling-parent relationship (including expressing affection) and the sibling-sibling relationship. Future interventions may also focus on increasing siblings' use of problem-focused coping strategies.
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Affiliation(s)
- Lauren Kelada
- School of Women's and Children's Health, 146817UNSW Sydney, Kensington, NSW, Australia.,Kids Cancer Centre, 63623Sydney Children's Hospital, Randwick, NSW, Australia
| | - Claire E Wakefield
- School of Women's and Children's Health, 146817UNSW Sydney, Kensington, NSW, Australia.,Kids Cancer Centre, 63623Sydney Children's Hospital, Randwick, NSW, Australia
| | - Donna Drew
- Kids Cancer Centre, 63623Sydney Children's Hospital, Randwick, NSW, Australia
| | - Chee Y Ooi
- School of Women's and Children's Health, 146817UNSW Sydney, Kensington, NSW, Australia.,MiCF Research Centre, 63623Sydney Children's Hospital, Randwick, NSW, Australia.,Department of Gastroenterology, 63623Sydney Children's Hospital, Randwick, NSW, Australia
| | - Elizabeth E Palmer
- School of Women's and Children's Health, 146817UNSW Sydney, Kensington, NSW, Australia.,Centre for Clinical Genetics, 63623Sydney Children's Hospital, Randwick, NSW, Australia
| | - Ann Bye
- School of Women's and Children's Health, 146817UNSW Sydney, Kensington, NSW, Australia.,Department of Neurology, 63623Sydney Children's Hospital, Randwick, NSW, Australia
| | - Sandra De Marchi
- Tumbatin Clinic, 63623Sydney Children's Hospital, Randwick, NSW, Australia
| | - Adam Jaffe
- School of Women's and Children's Health, 146817UNSW Sydney, Kensington, NSW, Australia.,Respiratory Department, 63623Sydney Children's Hospital, Randwick, NSW, Australia
| | - Sean Kennedy
- School of Women's and Children's Health, 146817UNSW Sydney, Kensington, NSW, Australia.,Department of Neurology, 63623Sydney Children's Hospital, Randwick, NSW, Australia
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19
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Robertson EG, Kelada L, Best S, Goranitis I, Grainger N, Le Marne F, Pierce K, Nevin SM, Macintosh R, Beavis E, Sachdev R, Bye A, Palmer EE. Acceptability and feasibility of an online information linker service for caregivers who have a child with genetic epilepsy: a mixed-method pilot study protocol. BMJ Open 2022; 12:e063249. [PMID: 36288836 PMCID: PMC9615979 DOI: 10.1136/bmjopen-2022-063249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 09/22/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Developmental and epileptic encephalopathies (DEEs) are rare epilepsy conditions that collectively impact 1 in 2000 children. They are highly genetically heterogeneous, resulting in significant barriers to accurate and adequate information for caregivers. This can lead to increased distress and dissatisfaction with the healthcare system. To address this gap, we developed 'GenE Compass' to provide caregivers with the highest-quality possible, understandable and relevant information in response to specific questions about their child's DEE. Using a mixed-method design, we will now pilot GenE Compass to evaluate the acceptability to caregivers and clinicians, feasibility and impact to caregivers. METHODS AND ANALYSIS We will recruit 88 caregivers (estimated final sample of 50 at follow-up) who have a child under 18 years of age with a suspected or confirmed DEE diagnosis. Following consent and a baseline questionnaire (questionnaire 1 (Q1)), participants will be able to submit questions to GenE Compass over a 3-month period. After 3 months, participants will complete a follow-up questionnaire (Q2) and an optional telephone interview to answer the research questions. Primary outcomes are acceptability of GenE Compass and feasibility of delivering the intervention (eg, cost of the intervention, number of questions submitted and time taken to respond to questions). Secondary outcomes include the impact of GenE Compass on caregivers' quality of life, information searching behaviours, perceptions of their child's illness and activation. ETHICS AND DISCUSSION The study protocol (V.2, dated 16 September 2021) has been approved by the Sydney Children's Hospitals Network Human Research Ethics Committee (ETH11277). The results will be disseminated in peer-reviewed journals and at scientific conferences. A lay summary will be disseminated to all participants. TRIAL REGISTRATION NUMBER ACTRN12621001544864.
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Affiliation(s)
- Eden G Robertson
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW, Randwick, New South Wales, Australia
| | - Lauren Kelada
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW, Randwick, New South Wales, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia
| | - Stephanie Best
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Sydney, New South Wales, Australia
- Australian Genomics Health Alliance, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - I Goranitis
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Natalie Grainger
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW, Randwick, New South Wales, Australia
| | - Fleur Le Marne
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW, Randwick, New South Wales, Australia
- Department of Neurology, Sydney Children's Hospitals Network Randwick, Randwick, New South Wales, Australia
| | - Kristine Pierce
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW, Randwick, New South Wales, Australia
- Epilepsy Foundation, Melbourne, Victoria, Australia
| | - Suzanne M Nevin
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW, Randwick, New South Wales, Australia
| | - Rebecca Macintosh
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW, Randwick, New South Wales, Australia
- Centre for Clinical Genetics, Sydney Children's Hospitals Network Randwick, Randwick, New South Wales, Australia
| | - Erin Beavis
- Department of Neurology, Sydney Children's Hospitals Network Randwick, Randwick, New South Wales, Australia
| | - Rani Sachdev
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW, Randwick, New South Wales, Australia
- Centre for Clinical Genetics, Sydney Children's Hospitals Network Randwick, Randwick, New South Wales, Australia
| | - Annie Bye
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW, Randwick, New South Wales, Australia
- Department of Neurology, Sydney Children's Hospitals Network Randwick, Randwick, New South Wales, Australia
| | - Elizabeth E Palmer
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine & Health, UNSW, Randwick, New South Wales, Australia
- Centre for Clinical Genetics, Sydney Children's Hospitals Network Randwick, Randwick, New South Wales, Australia
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Parents’/caregivers’ fears and concerns about their child’s epilepsy: A scoping review. PLoS One 2022; 17:e0274001. [PMID: 36067199 PMCID: PMC9447888 DOI: 10.1371/journal.pone.0274001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 08/20/2022] [Indexed: 11/19/2022] Open
Abstract
Background Childhood epilepsy is a serious and common neurological condition and can have life-long consequences and its impact can pervade all aspects of family life. Whilst the medical management of seizures is important, much of the day-to-day home management of epilepsy is invisible to people external to the family, including health care professionals, and parents’/caregivers’ fears and concerns can go unacknowledged and unaddressed by health care professionals. Objective This objective of this review was to examine parents’/caregivers’ fears and concerns regarding their child’s epilepsy, the impact of these fears and concerns on family life, the social and emotional well-being of parents/caregivers and any factors which mitigate these fears and concerns. Design Scoping review using a modified version of Arksey and O’Malley’s framework. Data sources Relevant studies were identified using key search terms in Scopus, Medline, CINAHL and PsychInfo databases in March 2021 with hand checking of reference lists. Search terms were developed using population (parents/caregivers of children aged ≤ 18 years with epilepsy, families); concept (parents’/caregivers’ fears, concerns, anxiety about their child’s epilepsy); and context (any setting). A further search was run in April 2022. Other inclusion criteria: English language empirical studies, 2010–2021. Study appraisal methods A minimum of two reviewers independently screened articles and undertook data extraction and decisions were consensually made. Methodological quality appraisal was undertaken using the Mixed Methods Appraisal Tool v2018. A data extraction table was created to chart all studies. The conduct and reporting of this study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) (S1 Table). There is no published copy of the review protocol. Main findings The search identified a total of 4077 papers (after duplicates were removed) of which 110 were assessed for eligibility. Twenty-four papers published between 2010–2021 were included in the review and each paper was treated as a separate study. The review findings indicate that parents’/caregivers’ fears and concerns stem from more than their child’s seizures and relate to many wider aspects of family life. These fears and concerns had far-reaching influences on their parenting/caregiving, and on the lifestyle and activities of their child and their family. What was less evident was what parents/caregivers wanted in terms of support or how they thought health professionals could acknowledge and/or allay their fears and concerns. The discussion is framed within the compassion-focused therapy model as a basis for generating new thinking about the impact of these fears and concerns and the need for a new agenda for clinical consultations in childhood epilepsy. Conclusions The review concludes with a proposal that a more compassionate agenda underpins the dialogue between parents/caregivers and clinicians to encompass and mitigate the wider emotional, psychosocial, and societal threats that impact on the parent/caregivers of children with epilepsy.
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21
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Ren Z, Yang C, Yu D. Cognitive deficiency, parental relationship, and coping strategies are related with anxiety and depression among parents of children with epilepsy. Chronic Dis Transl Med 2022; 8:229-237. [PMID: 36161201 PMCID: PMC9481879 DOI: 10.1002/cdt3.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 03/19/2022] [Accepted: 03/22/2022] [Indexed: 11/11/2022] Open
Abstract
Background The diagnosis of epilepsy in a child often and understandably causes psychological adjustment difficulties in the parents. To help parents of children with epilepsy cope with stress, it is important to understand how parents cope with the sickness of their child. The objective of this study was to assess factors related to the state of anxiety and depression among parents of children with epilepsy. Methods The present study was a cross-sectional study, and the data were collected through an anonymous, Internet-based survey platform between October 2018 and October 2019 from 250 participants aged 22-65 years. Participants were invited to fill questionnaires include socioeconomic questionnaire, anxiety, depression, and coping strategies scale. Result Among the parents of children with epilepsy, 48.8% (122/250) had depressive symptoms (Patient Health Questionnaire-9 [PHQ-9] score >4) and 46.4% (116/250) had anxiety symptoms (7-item Generalized Anxiety Disorder [GAD-7] score >5). Depression among parents of children with epilepsy was significantly associated with comorbidity (odds ratio [OR] = 0.392, 95% CI = 0.182-0.846), a poor parental relationship (OR = 0.283, 95% CI = 0.130-0.614), positive coping (OR = 0.947, 95% CI = 0.903-0.992), and negative coping (OR = 1.287, 95% CI = 1.179-1.405). Anxiety among parents of children with epilepsy was significantly associated with a poor parental relationship (OR = 0.416, 95% CI = 0.207-0.835) and negative coping (OR = 1.155, 95% CI = 1.087-1.228). Conclusions The present study indicates the importance of couple support and providing effective coping to make parents of children with epilepsy more resilient in the presence of negative life events, especially for parents of children with comorbidity with cognitive deficiency.
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Affiliation(s)
- Zhengjia Ren
- Department of Clinical PsychologyThe Third Affiliated Hospital of Chongqing Medical UniversityChongqing401120China
| | - Chunsong Yang
- Department of Pharmacy, Evidence‐based Pharmacy Center, West China Second HospitalSichuan UniversityChengduSichuan610041China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of EducationSichuan UniversityChengduSichuan610041China
| | - Dan Yu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of EducationSichuan UniversityChengduSichuan610041China
- Department of Medical Genetics, West China Second HospitalSichuan UniversityChengduSichuan610041China
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22
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Depression and anxiety and their associated factors among caregivers of children and adolescents with epilepsy in three selected hospitals in Amhara region, Ethiopia: A cross-sectional study. PLoS One 2022; 17:e0271885. [PMID: 35877780 PMCID: PMC9312431 DOI: 10.1371/journal.pone.0271885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/07/2022] [Indexed: 11/30/2022] Open
Abstract
Background The prevalence rates of depression and anxiety are unforeseen among primary caregivers of patients with epilepsy. Little attention is being given to the problem in Ethiopia. Objectives This study aimed to assess the prevalence and associated factors of depression and anxiety among caregivers of children and adolescents with epilepsy in three selected hospitals in Amhara region, Ethiopia. Methods Institution-based cross-sectional study was conducted in Ethiopia from January 1-30/2021. Systematic sampling technique was used. The Public Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) questionnaires were used to measure depression and anxiety respectively. Binary logistic regression model was employed independently for both depression and anxiety. Variables with P-values <0.2 were taken to multivariate analyses. Variables with P-value <0.05 in the multivariate analyses were considered to have a statistical association with depression and anxiety. Result A total of 383 participants involved yielding a response rate of 90.5%. The prevalence of depression and anxiety were found to be 13.7% and 10.4% respectively. Being female (Adjusted Odds Ratio (AOR) = 1.21: 95% Confidence Interval (CI): 1.00, 3.82), being unmarried (AOR = 1.31; 95%CI: 0.32, 5.023), having history of chronic medical illness (AOR = 1.46; 95%CI: 1.07, 1.98), current seizure attack (AOR = 4.19; 95%CI: 1.36, 12.97), duration of care 6-11years (AOR = 1.80; 95%CI: 1.11, 7.58), duration of care > 11years (AOR = 6.90; 95%CI: 1.56, 30.49), moderate social support (AOR = 0.37; 95%CI: 0.13, 0.81), strong social support (AOR = 0.61; 95%CI: 0.22, 1.67) and currently use substance (AOR = 2.01;95%CI: 1.63, 6.46) were factors associated with depression. On the other hand, being unmarried (AOR = 1.47; 95%CI: 1.12, 1.93), current seizure attack (AOR = 1.81 with 95% CI = 1.28–2.54), able to read and write (AOR = 0.33; 95%CI: 0.14, 0.77), completed primary and secondary education (AOR = 0.54; 95%CI: 0.39, 0.76), current substance use (AOR = 1.466; 95%CI: 1.12, 1.93), being parent (AOR = 2.55; 95%CI: 1.31, 4.96), rural (AOR = 3.75; 95%CI: 1.40, 10.04) and grand mal type (AOR = 2.21; 95%CI: 1.68, 2.91) were factors associated with anxiety. Conclusions In our study, approximately one in fifteen and more than one in ten caregivers had depression and anxiety respectively. The result of this study suggested that healthcare providers need to pay more attention to the psychological well-being of all caregivers of children and adolescents with epilepsy.
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Tschamper MK, Wahl AK, Hermansen Å, Jakobsen R, Larsen MH. Parents of children with epilepsy: Characteristics associated with high and low levels of health literacy. Epilepsy Behav 2022; 130:108658. [PMID: 35358855 DOI: 10.1016/j.yebeh.2022.108658] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/24/2022] [Accepted: 02/28/2022] [Indexed: 11/26/2022]
Abstract
Parents of children with epilepsy play a key role in the management of their child's condition. Their level of health literacy (HL), which refers to their ability to seek, understand, assess, remember, and utilize health information, is essential for handling the child optimally. The aim of this study was to investigate characteristics associated with high and low levels of different dimensions of HL in parents. HL was assessed with the multidimensional Health Literacy Questionnaire (parents' version) and the electronic Health Literacy Scale, using data from a cohort of 254 parents of children <12 years. Bivariate correlation and multiple hierarchal linear regression (STATA version 16 SE) were used to investigate variables associated with HL. Self-efficacy (St. β = 0.14-0.34) was the only variable that predicted higher scores on every HL scale. Being older than 35 years (St. β = 0.18-0.21), level of education (St. β = 0.16-0.27), and the child having a coordinator of services (St. β = 0.16-0.28) were associated with higher scores, while sick leave due to the child's epilepsy (St. β = -0.13 to -0.16), child comorbidities (St. β = -0.15 to -0.19), and higher levels of mental distress (St. β = -0.13 to -0.19) were associated with lower scores in several of the different HL dimensions. A total of 44.8% of the parents scored over the cutoff (≥1.85) predicting a mental disorder on the Hopkins symptom checklist. This is the first study to investigate multidimensional parental HL in a childhood epilepsy context. Our results highlight the need to investigate multiple variables, especially mental distress, to determine characteristics that may predict low parental HL. Further qualitative studies are needed to explore the underlying reasons for the parents' HL scores and to develop inventions tailored to meet different HL needs.
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Affiliation(s)
- Merete K Tschamper
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Norway.
| | - Astrid K Wahl
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Norway
| | - Åsmund Hermansen
- Faculty of Social Sciences, Oslo Metropolitan University, Norway
| | - Rita Jakobsen
- Lovisenberg Diaconal University College, Oslo, Norway
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24
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Piloting positive psychology resources for caregivers of a child with a genetic developmental and epileptic encephalopathy. Eur J Paediatr Neurol 2022; 37:129-138. [PMID: 35240556 DOI: 10.1016/j.ejpn.2022.01.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 11/24/2021] [Accepted: 01/31/2022] [Indexed: 11/22/2022]
Abstract
UNLABELLED Developmental and epileptic encephalopathies (DEEs) are chronic and life-threatening conditions, frequently with a genetic basis and infantile-onset. Caregivers often experience enduring distress adapting to their child's diagnosis and report a deficit of accessible psychological supports. We aimed to pilot a novel, empirically-driven suite of audio-visual positive psychology resources tailored for caregivers of children with a DEE, called 'Finding a Way'. METHODS We recruited caregivers through two paediatric hospital databases, and we also shared an invitation to the online questionnaire via genetic epilepsy advocacy organisations. The online questionnaire included a combination of validated, purpose-designed, and open-ended questions to assess the acceptability, relevance, and emotional impact of the resources among caregivers. RESULTS 167 caregivers from 18 countries reviewed the resources, with 56 caregivers completing over 85% of the evaluation. Caregivers rated the resources as highly acceptable and relevant to their experiences. In both the quantitative and qualitative data, caregivers reported that the resources normalised their emotional experiences and provided helpful suggestions about managing their personal relationships, seeking support and accepting help from others. Frequently reported emotional responses after viewing the resources included feeling "comforted", "hopeful", "connected" and "reassured". Suggestions for improvement included, expanding the suite of resources and embedding the resources with links to specialised psychological services. CONCLUSION 'Finding a Way' is a novel codesigned suite of audio-visual positive psychology resources tailored for caregivers of children with DEEs. Our results suggest that 'Finding a Way' is acceptable to caregivers and may contribute towards enhanced emotional adaptation and coping.
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Tsamakis K, Teagarden DL, Villarreal HK, Morton ML, Janocko NJ, Groover O, Loring DW, Drane DL, Karakis I. Depression and Anxiety in Adult Persons With Epilepsy and Their Caregivers: A Survey-Based Study at a Tertiary Care Center. J Nerv Ment Dis 2022; 210:212-218. [PMID: 34719659 DOI: 10.1097/nmd.0000000000001436] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT This study evaluated the rates of depression and anxiety and their determinants in adult persons with epilepsy and their caregivers. Both completed surveys about demographic, disease-related, and psychosocial characteristics. One hundred patients and caregivers participated. A mood disorder was present in 89% of patients and 56% of caregivers. In the univariate analysis, the presence of mood disorder in the patient was associated with being unmarried, unemployed, frequent hospitalizations, side effects from polypharmacy, patient stigma, patient quality of life, caregiver anxiety, and caregiver burden. In the multivariate analysis, medication side effects sustained as an important determinant. In the univariate analysis, the presence of mood disorder in the caregiver was associated with seizure frequency, patient anxiety, patient quality of life, caregiver stigma, and caregiver burden. In the multivariate analysis, patient anxiety level and caregiver burden sustained as important determinants. Adult persons with epilepsy and their caregivers experience high rates of mood disorders, explained by certain clinical factors.
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26
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Ouattara A, Resseguier N, Cano A, De Lonlay P, Arnoux JB, Brassier A, Schiff M, Pichard S, Fabre A, Hoebeke C, Guffon N, Fouilhoux A, Broué P, Touati G, Dobbelaere D, Mention K, Labarthe F, Tardieu M, De Parscau L, Feillet F, Bonnemains C, Kuster A, Labrune P, Barth M, Damaj L, Lamireau D, Berbis J, Auquier P, Chabrol B. Determinants of Quality of Life in Children with Inborn Errors of Metabolism Receiving a Restricted Diet. J Pediatr 2022; 242:192-200.e3. [PMID: 34788681 DOI: 10.1016/j.jpeds.2021.11.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To investigate the determinants of quality of life (QoL) in children with inborn errors of metabolism with restricted diet (IEMRDs) using a single theory-based multidimensional model. STUDY DESIGN In this multicenter cross-sectional study, data from children aged 8-17 years with IEMRDs (except phenylketonuria) and their parents were collected from January 2015 to December 2017. Measurements included a child's self-reported QoL, self-rated behavioral problems and anxiety, and parental anxiety. Based on hypotheses from a literature-built theoretical model linking demographic, clinical, family environment, and psychosocial characteristics to QoL either directly or indirectly, associations of these factors with a child's self-rated QoL were examined using a structural equation modeling approach. RESULTS A total of 312 children (mean [SD] age, 12.2 [2.6] years; 51% boys [n = 160]) were included. Higher levels of trait anxiety and behavioral problems in children were the most important factors associated with poorer QoL (standardized path coefficients, -0.71 and -0.23, respectively). In addition, higher parent trait anxiety, younger age at diagnosis, and a disease requiring an emergency diet were associated with poorer QoL in these children. The final model fit the data closely according to conventional goodness-of-fit statistics and explained 86% of the QoL variance. CONCLUSIONS Psychosocial factors appear to be major determinants of QoL impairment in children with IEMRDs. These factors should be addressed in clinical practice as part of the global treatment plan for a child with IEMRD. Future studies based on a longitudinal design should consider coping strategies when exploring potential predictive factors of QoL.
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Affiliation(s)
- Abdoulaye Ouattara
- Department of Epidemiology and Health Economics, AP-HM/EA 3279, Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, Aix-Marseille University, Marseille, France
| | - Noemie Resseguier
- Department of Epidemiology and Health Economics, AP-HM/EA 3279, Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, Aix-Marseille University, Marseille, France.
| | - Aline Cano
- Reference Center of Inherited Metabolic Disorders, Timone Enfants Hospital, Marseille, France
| | - Pascale De Lonlay
- Reference Center of Inherited Metabolic Disorders, Necker Hospital, Paris, France
| | - Jean-Baptiste Arnoux
- Reference Center of Inherited Metabolic Disorders, Necker Hospital, Paris, France
| | - Anais Brassier
- Reference Center of Inherited Metabolic Disorders, Necker Hospital, Paris, France
| | - Manuel Schiff
- Reference Center of Inherited Metabolic Disorders, Necker Hospital, Paris, France
| | - Samia Pichard
- Reference Center of Inherited Metabolic Disorders, Robert Debré Hospital, Paris, France
| | - Alexandre Fabre
- Reference Center of Inherited Metabolic Disorders, Timone Enfants Hospital, Marseille, France
| | - Celia Hoebeke
- Reference Center of Inherited Metabolic Disorders, Timone Enfants Hospital, Marseille, France
| | - Nathalie Guffon
- Reference Center of Inherited Metabolic Disorders, Femme Mère Enfant Hospital, Lyon, France
| | - Alain Fouilhoux
- Reference Center of Inherited Metabolic Disorders, Femme Mère Enfant Hospital, Lyon, France
| | - Pierre Broué
- Reference Center of Inherited Metabolic Disorders, Purpan Hospital, Toulouse, France
| | - Guy Touati
- Reference Center of Inherited Metabolic Disorders, Purpan Hospital, Toulouse, France
| | - Dries Dobbelaere
- Reference Center of Inherited Metabolic Disorders, Jeanne de Flandres Hospital, Lille, France
| | - Karine Mention
- Reference Center of Inherited Metabolic Disorders, Jeanne de Flandres Hospital, Lille, France
| | - Francois Labarthe
- Reference Center of Inherited Metabolic Disorders, Clocheville Hospital, Tours, France
| | - Marine Tardieu
- Reference Center of Inherited Metabolic Disorders, Clocheville Hospital, Tours, France
| | - Loïc De Parscau
- Competence Center of Inherited Metabolic Disorders, Brest Hospital, Brest, France
| | - Francois Feillet
- Reference Center of Inherited Metabolic Disorders, Brabois Hospital, Nancy, France
| | - Chrystèle Bonnemains
- Reference Center of Inherited Metabolic Disorders, Brabois Hospital, Nancy, France
| | - Alice Kuster
- Pediatric Intensive Care Unit, Nantes Hospital, Nantes, France
| | - Philippe Labrune
- Reference Center of Rare Liver Disease, Antoine Beclere Hospital, Clamart, France
| | - Magalie Barth
- Competence Center of Inherited Metabolic Disorders, Angers Hospital, Angers, France
| | - Lena Damaj
- Competence Center of Inherited Metabolic Disorders, Rennes Hospital, Rennes, France
| | - Delphine Lamireau
- Competence Center of Inherited Metabolic Disorders, Pellegrin Hospital, Bordeaux, France
| | - Julie Berbis
- Department of Epidemiology and Health Economics, AP-HM/EA 3279, Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, Aix-Marseille University, Marseille, France
| | - Pascal Auquier
- Department of Epidemiology and Health Economics, AP-HM/EA 3279, Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, Aix-Marseille University, Marseille, France
| | - Brigitte Chabrol
- Reference Center of Inherited Metabolic Disorders, Timone Enfants Hospital, Marseille, France
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Wauters A, Vervoort T, Dhondt K, Soenens B, Vansteenkiste M, Morbée S, Waterschoot J, Haerynck F, Vandekerckhove K, Verhelst H, Van Aken S, Raes A, Schelstraete P, Walle JV, Van Hoecke E. Mental Health Outcomes Among Parents of Children With a Chronic Disease During the COVID-19 Pandemic: The Role of Parental Burn-Out. J Pediatr Psychol 2021; 47:420-431. [PMID: 34915562 PMCID: PMC8754736 DOI: 10.1093/jpepsy/jsab129] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 11/29/2021] [Accepted: 12/01/2021] [Indexed: 11/30/2022] Open
Abstract
Objective The COVID-19 pandemic and associated quarantine measures highly impacted parental psychological well-being. Parents of children with chronic diseases might be specifically vulnerable as they already face multiple challenges to provide adequate care for their child. The research questions of the current study were twofold: (a) to examine whether parents of children with a chronic disease experienced more anxiety and depression compared to parents of healthy children and (b) to examine a series of risk factors for worsened well-being (i.e., depression, anxiety, and sleep problems), such as sociodemographic variables, COVID-19-specific variables (i.e., financial worries, living space, and perceived quality of health care), and parental psychological experiences (i.e., parental burn-out and less positive parenting experiences). Methods Parents of children with a chronic disease (i.e., the clinical sample; N = 599 and 507 for Research Questions 1 and 2, respectively) and parents of healthy children (i.e., the reference sample: N = 417) filled out an online survey. Results Findings demonstrated that the parents in the clinical sample reported higher levels of anxiety than parents in the reference sample. Analyses within the clinical sample indicated that COVID-19-specific stressors and parental psychological experiences were associated with higher levels of anxiety, depression, and sleep problems. Mediation analyses furthermore indicated that the association of COVID-19-specific stressors with all outcome measures was mediated by parental burn-out. Conclusions Parents of children with a chronic disease constitute a vulnerable group for worse well-being during the current pandemic. Findings suggest interventions directly targeting parental burn-out are warranted.
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Affiliation(s)
- Aline Wauters
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Tine Vervoort
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Karlien Dhondt
- Department of Child & Adolescent Psychiatry, Ghent University Hospital, Ghent, Belgium
| | - Bart Soenens
- Department of Developmental, Personality, and Social Psychology, Ghent University, Ghent, Belgium
| | - Maarten Vansteenkiste
- Department of Developmental, Personality, and Social Psychology, Ghent University, Ghent, Belgium
| | - Sofie Morbée
- Department of Developmental, Personality, and Social Psychology, Ghent University, Ghent, Belgium
| | - Joachim Waterschoot
- Department of Developmental, Personality, and Social Psychology, Ghent University, Ghent, Belgium
| | | | | | - Helene Verhelst
- Department of Pediatrics, Ghent University Hospital, Ghent, Belgium
| | - Sara Van Aken
- Department of Pediatrics, Ghent University Hospital, Ghent, Belgium
| | - Ann Raes
- Department of Pediatrics, Ghent University Hospital, Ghent, Belgium
| | | | | | - Eline Van Hoecke
- Pediatric Psychology, Department of Pediatrics, Ghent University Hospital, Ghent, Belgium
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Omri S, Zouari L, Mejdoub Y, Smaoui N, Mâalej Bouali M, Ben Nsir S, Feki R, Ben Thabet J, Triki C, Damak J, Charfi N, Mâalej M. [Post-traumatic stress disorder, depression and anxiety in parents of children with epilepsy]. Encephale 2021; 48:530-537. [PMID: 34649710 DOI: 10.1016/j.encep.2021.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/04/2021] [Accepted: 05/21/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Post-traumatic Stress Disorder (PTSD), depression and anxiety are the most common psychiatric consequences among parents of children with epilepsy. OBJECTIVES We aimed to investigate the prevalence and predictors of PTSD, depression and anxiety in a sample of parents of children with epilepsy. METHODS A survey of 135 parents of children with epilepsy, treated in the pediatric neurology department at the Sfax Teaching Hospital in Tunisia, was conducted in the last quarter of 2019. The PTSD Checklist for DSM-5 and the Hospital Anxiety and Depression Scale (HADS) were used to assess, respectively, PTSD, depression and anxiety in parents. Associations with clinical and demographic variables with PTSD, depression and anxiety were evaluated in a logistic regression model. RESULTS Results revealed PTSD rates of 20.7%, depression rates of 28.9% and anxiety rates of 55.6%. The main factors associated with PTSD on multivariable analysis were female gender (P=0.026, ORa=13.1), insufficient involvement of partner in disease management (P<10-3, ORa=12.1) and duration of epilepsy less than 12 months (P=0.001; ORa=0.1). Female gender (P=0.006, ORa=18.1) and restriction of social life (P=0.006, ORa=4.1) were associated with depression. Factors associated with anxiety were insufficient involvement of partner in disease management (P=0.03, ORa=4.6) and PTSD (P=0.005, ORa=9.1). CONCLUSION These findings suggest that clinicians should pay more attention to psychological health of parents of children with epilepsy and help healthcare providers to develop preventive and intervention strategies for parents of such children.
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Affiliation(s)
- S Omri
- Service de psychiatrie « C », faculté de médecine de Sfax, CHU de Hédi Chaker, Université de Sfax, 3029 Sfax, Tunisie.
| | - L Zouari
- Service de psychiatrie « C », faculté de médecine de Sfax, CHU de Hédi Chaker, Université de Sfax, 3029 Sfax, Tunisie
| | - Y Mejdoub
- Service de médecine communautaire et d'épidémiologie, faculté de médecine de Sfax, CHU de Hédi-Chaker, Université de Sfax, Sfax, Tunisie
| | - N Smaoui
- Service de psychiatrie « C », faculté de médecine de Sfax, CHU de Hédi Chaker, Université de Sfax, 3029 Sfax, Tunisie
| | - M Mâalej Bouali
- Service de psychiatrie « C », faculté de médecine de Sfax, CHU de Hédi Chaker, Université de Sfax, 3029 Sfax, Tunisie
| | - S Ben Nsir
- Service de neuropédiatrie, faculté de médecine de Sfax, CHU Hédi Chaker, Université de Sfax, Sfax, Tunisie
| | - R Feki
- Service de psychiatrie « C », faculté de médecine de Sfax, CHU de Hédi Chaker, Université de Sfax, 3029 Sfax, Tunisie
| | - J Ben Thabet
- Service de psychiatrie « C », faculté de médecine de Sfax, CHU de Hédi Chaker, Université de Sfax, 3029 Sfax, Tunisie
| | - Ch Triki
- Service de neuropédiatrie, faculté de médecine de Sfax, CHU Hédi Chaker, Université de Sfax, Sfax, Tunisie
| | - J Damak
- Service de médecine communautaire et d'épidémiologie, faculté de médecine de Sfax, CHU de Hédi-Chaker, Université de Sfax, Sfax, Tunisie
| | - N Charfi
- Service de psychiatrie « C », faculté de médecine de Sfax, CHU de Hédi Chaker, Université de Sfax, 3029 Sfax, Tunisie
| | - M Mâalej
- Service de psychiatrie « C », faculté de médecine de Sfax, CHU de Hédi Chaker, Université de Sfax, 3029 Sfax, Tunisie
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van Westrhenen A, de Lange WFM, Hagebeuk EEO, Lazeron RHC, Thijs RD, Kars MC. Parental experiences and perspectives on the value of seizure detection while caring for a child with epilepsy: A qualitative study. Epilepsy Behav 2021; 124:108323. [PMID: 34598099 DOI: 10.1016/j.yebeh.2021.108323] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/03/2021] [Accepted: 09/03/2021] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Caring for a child with epilepsy has a significant impact on parental quality of life. Seizure unpredictability and complications, including sudden unexpected death in epilepsy (SUDEP), may cause high parental stress and increased anxiety. Nocturnal supervision with seizure detection devices may lower SUDEP risk and decrease parental burden of seizure monitoring, but little is known about their added value in family homes. METHODS We conducted semi-structured in-depth interviews with parents of children with refractory epilepsy participating in the PROMISE trial (NCT03909984) to explore the value of seizure detection in the daily care of their child. Children were aged 4-16 years, treated at a tertiary epilepsy center, had at least one nocturnal major motor seizure per week, and used a wearable seizure detection device (NightWatch) for two months at home. Data were analyzed using inductive thematic analysis. RESULTS Twenty three parents of nineteen children with refractory epilepsy were interviewed. All parents expressed their fear of missing a large seizure and the possible consequences of not intervening in time. Some parents felt the threat of child loss during every seizure, while others thought about it from time to time. The fear could fluctuate over time, mainly associated with fluctuations of seizure frequency. Most parents described how they developed a protective behavior, driven by this fear. The way parents handled the care of their child and experienced the burden of care influenced their perceptions on the added value of NightWatch. The experienced value of NightWatch depended on the amount of assurance it could offer to reduce their fear and the associated protective behavior as well as their resilience to handle the potential extra burden of care, due to false alarms or technical problems. CONCLUSION Healthcare professionals and device companies should be aware of parental protective behavior and the high parental burden of care and develop tailored strategies to optimize seizure detection device care.
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Affiliation(s)
- Anouk van Westrhenen
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede and Zwolle, The Netherlands; Department of Neurology, Leiden University Medical Center (LUMC), Leiden, The Netherlands.
| | - Wendela F M de Lange
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Eveline E O Hagebeuk
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede and Zwolle, The Netherlands.
| | - Richard H C Lazeron
- Academic Center of Epileptology Kempenhaeghe, Heeze, The Netherlands; Faculty of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
| | - Roland D Thijs
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede and Zwolle, The Netherlands; Department of Neurology, Leiden University Medical Center (LUMC), Leiden, The Netherlands; UCL Queen Square Institute of Neurology, London, United Kingdom.
| | - Marijke C Kars
- Center of Expertise in Palliative Care, Julius Center Research Program Cancer, University Medical Center Utrecht, Utrecht, The Netherlands.
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Post-traumatic stress disorder (PTSD) symptoms in children with severe epilepsy. Epilepsy Behav 2021; 122:108217. [PMID: 34352664 DOI: 10.1016/j.yebeh.2021.108217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/30/2021] [Accepted: 07/09/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To assess symptoms of post-traumatic stress disorder (PTSD) in children with severe epilepsy and the associations of trauma symptoms across age, comorbid symptoms, epilepsy-specific factors, parental resources, and psychopathology. METHODS Fifty children with severe epilepsy across three different age groups (0-5 yrs., 6-12 yrs., 13-18 yrs.) were assessed with developmental-sensitive and standardized PTSD assessment tools when hospitalized at the tertiary epilepsy center Filadelfia, Denmark. The Diagnostic Infant and Preschool Assessment (DIPA), the Darryl test, and the ITQ questionnaire were used to assess the three age groups, respectively. RESULTS Twenty-two percent of the overall sample met the criteria for PTSD, with a prevalence of symptoms increasing with age (6%, 28%, and 40%). Comorbid psychiatric symptoms in preschoolers were present in 81% of the children witnessing a high level of distress in this group. Behavioral difficulties were elevated across all three age groups, and 40% of the children with trauma symptoms had a parent with concurrent psychopathology. CONCLUSION To the authors' knowledge, this study is the first to assess trauma symptoms with standardized tests in children with more complicated epilepsies. Trauma symptoms in the group are high; however, there is a need for larger scale studies and research into trauma symptoms in children with more severe epilepsy than those assessable with the included assessment tools. The trauma perspective in severe childhood epilepsy might further clarify the complex associations of biological and contextual variables that affect the children's life quality and enable better preventative treatment options for this group.
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Jakobsen AV, Elklit A. Self-control and coping responses are mediating factors between child behavior difficulties and parental stress and family impact in caregivers of children with severe epilepsy. Epilepsy Behav 2021; 122:108224. [PMID: 34352665 DOI: 10.1016/j.yebeh.2021.108224] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/10/2021] [Accepted: 07/10/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To gain a better understanding of parental support needs by assessing parental individual psychological factors as mediating factors between child behavior difficulties and parental perceived stress and family impact of severe childhood epilepsy. METHODS One-hundred and sixty two parents of children with severe epilepsy were enrolled in the survey during the hospitalization of their child at the Danish Epilepsy Center. Questionnaires targeted the impact on the family, coping style responses, sense of control, and the level of parental perceived stress. RESULTS Serial mediation models demonstrated a mediating effect of self-control and emotional coping (EMCOP) response between child behavioral difficulties and both parental stress (F(4, 127) = 56.371, p < 0.001, R2 = 0.64) and family impact (F(3, 134) = 32.202, p < 0.001, R2 = 0.42). Low level of control was associated with a higher level of EMCOP response, and a high EMCOP response was associated with greater perceived stress and family impact. Social support ceased to be a protective factor for parental stress in the presence of decreased self-control and higher levels of EMCOP response. CONCLUSION Individual caregiver psychological factors influence the degree to which sequelae of epilepsy impact family life and perceived stress in parents. Coping interventions should direct awareness toward the life-control aspect, coping response styles, and illness-specific factors to ensure that appropriate support is provided. Maintaining parental resources is essential, and the parents' capacities to handle the child's behavioral difficulties should be considered.
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Affiliation(s)
- Anne Vagner Jakobsen
- Department of Neuropediatrics, The Danish Epilepsy Center, Filadelfia, Dianalund, Denmark.
| | - Ask Elklit
- Danish National Center of Psychotraumatology, Department of Psychology, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark
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Dravet syndrome: Effects on informal caregivers' mental health and quality of life - A systematic review. Epilepsy Behav 2021; 122:108206. [PMID: 34280725 DOI: 10.1016/j.yebeh.2021.108206] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/27/2021] [Accepted: 06/29/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Dravet syndrome (DS) is a severe developmental and epileptic encephalopathy, with predictable negative consequences for informal caregivers' mental health. This systematic review aimed to evaluate the representativeness of depression, anxiety, and burden in these caregivers and assess their quality of life. METHODS The PRISMA recommendations were followed, and a comprehensive search was conducted on PubMed/MEDLINE, WoS and Scopus databases, without date or language limits. Only observational quantitative studies on adult informal caregivers of patients with DS were considered. RESULTS Of 876 records found, 21 full-text articles were assessed and only 6 met the inclusion criteria. The latter have mostly a cross-sectional design and include samples composed by 19 to 742 caregivers, mainly mothers/females. Most of the study participants had a Bachelor's degree/higher educational level and were married. An important incidence of depression and anxiety on DS caregivers was reported, with significantly higher levels compared with population norms and with carers of other patients with epilepsy. Depression/anxiety were shown to be significantly associated with caregivers' fatigue and compromised sleep quality. Other important aspects of burden have been identified; however, comparisons between studies were not possible as different scales were used. Caregivers' health-related quality of life is also affected, with mothers reporting a worse perception on this domain. CONCLUSIONS Mental health and quality of life of DS caregivers are compromised, with mothers bearing an apparently greater burden. Studies using validated instruments for this population to assess the previously considered outcomes are needed, in order to inform the development of preventive strategies and problem-oriented interventions.
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Klotz KA, Özcan J, Sag Y, Schönberger J, Kaier K, Jacobs J. Anxiety of families after first unprovoked or first febrile seizure - A prospective, randomized pilot study. Epilepsy Behav 2021; 122:108120. [PMID: 34144460 DOI: 10.1016/j.yebeh.2021.108120] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/28/2021] [Accepted: 05/28/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Parents of children with a first unprovoked seizure report high levels of stress and anxiety. Little is known however about interventions that might help to reduce anxiety. We aimed to evaluate anxiety of parents and children after a first unprovoked seizure and assess the anxiety-reducing effect of a semi-structured follow-up in a first seizure clinic (FSC). In comparison, parents of children with febrile seizures are also evaluated, as an example of anxiety evolution without follow-up intervention after provoked seizures. STUDY DESIGN In this prospective, interventional study, patients presenting with a first unprovoked seizure were randomized to early care (EC) with follow-up in FSC within 3 weeks and late care (LC), follow-up in FSC after 4 months. Anxiety levels of parents and patients were scored with the State Trait Anxiety Inventory (STAI) after the initial seizure (T0), 3 and 12 months (T1, T2). To assess the effect of the semi-structured follow-up, anxiety scores were compared between the two groups at baseline, at T1 (i.e., after intervention in EC but prior to intervention in LC) and at T2. Parents of children with febrile seizures (FS) were prospectively followed up without intervention. RESULTS Fifty two patients were included (EC n = 18, LC n = 18, FS n = 15). Initial state anxiety in parents was high in all groups. At T1 (i. e. after intervention in EC but not LC) state anxiety was significantly higher in LC (52.2 (16.7) vs. 33.3 (5.3), p < 0.01). This effect persisted after 12 months, despite intervention in LC in the meantime (39.0 (11.7) vs. 28.8 (6.2); p < 0.01)). The effect in children was similar (T1: 40.6 (8.3) vs. 29.8 (5.1); p < 0.05 and T2: 33.5 (4.7) vs. 24.7 (3.6); p < 0.01). State anxiety in FS decreased within 3 months without intervention (50.0 (14.5) to 33.7 (9.2)). CONCLUSIONS A timely and structured follow-up in a FSC offers effective and sustained reduction of anxiety-levels after first unprovoked seizure in children. In contrast, anxiety after a first febrile seizure decreases over time without additional intervention.
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Affiliation(s)
- Kerstin Alexandra Klotz
- Department of Neuropediatrics and Muscle Disorders, Center for Pediatrics, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Mathildenstraße 1, 79106 Freiburg, Germany; Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, Breisacher Straße 153, 79106 Freiburg, Germany; Epilepsy Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 64, 79106 Freiburg, Germany.
| | - Jasmin Özcan
- Department of Neuropediatrics and Muscle Disorders, Center for Pediatrics, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Mathildenstraße 1, 79106 Freiburg, Germany
| | - Yusuf Sag
- Department of Neuropediatrics and Muscle Disorders, Center for Pediatrics, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Mathildenstraße 1, 79106 Freiburg, Germany
| | - Jan Schönberger
- Department of Neuropediatrics and Muscle Disorders, Center for Pediatrics, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Mathildenstraße 1, 79106 Freiburg, Germany; Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, Breisacher Straße 153, 79106 Freiburg, Germany; Epilepsy Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 64, 79106 Freiburg, Germany.
| | - Klaus Kaier
- Institute of Medical Biometry and Medical Informatics, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Stefan-Meier-Straße 26, 79104 Freiburg, Germany.
| | - Julia Jacobs
- Alberta Children's Hospital, Alberta Children's Research Institute, Hodgekiss Brain Institute, University of Calgary, Section of Pediatric Neurology, Alberta, Canada; Department of Neuropediatrics and Muscle Disorders, Center for Pediatrics, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Mathildenstraße 1, 79106 Freiburg, Germany.
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Bagherian B, Nematollahi M, Mehdipour-Rabori R. How Parents Cope with the Care of a Child with Epilepsy: Based upon Grounded Theory. Ethiop J Health Sci 2021; 31:329-338. [PMID: 34158785 PMCID: PMC8188076 DOI: 10.4314/ejhs.v31i2.16] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Parents of children with seizure face the complicated health issues of their children. Adaptation strategies of parents as major care providers impact not only their handling of stresses on themselves but also children's quality of life. This study investigated the adaptation processes of parents of children with seizure at two educational hospitals affiliated with Kerman University of Medical Sciences in Iran. Methods Twenty parents (15 mothers and 5 fathers), and three nurses were selected using purposive sampling method. Data was collected using qualitative semi-structured interviews and analyzed using the method suggested by Corbin and Strauss version 2008. The interviews were conducted until thematic saturation was achieved. Results The adaptation process had five phases: “Disbelief, Patience on what happened, change to preserve, acceptance of the current situation, and self- empowerment.” In summary, the parents of children with seizure had a 5-phase adaptation strategy. The core category achieved was “continued efforts of parents to restore calm.” Conclusion Properly assessing the stresses' resources on parents of children with seizure is necessary. Informing their adaptation strategies may help medical staff and social services to provide more targeted support and promote the balance of the family function.
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Affiliation(s)
- Behnaz Bagherian
- Assistant Professor, Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Monirsadat Nematollahi
- Assistant Professor, Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran
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Holmes H, Sawer F, Clark M. Autism spectrum disorders and epilepsy in children: A commentary on the occurrence of autism in epilepsy; how it can present differently and the challenges associated with diagnosis. Epilepsy Behav 2021; 117:107813. [PMID: 33642176 DOI: 10.1016/j.yebeh.2021.107813] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/17/2021] [Accepted: 01/20/2021] [Indexed: 01/02/2023]
Abstract
Autism occurs more frequently in epilepsy, but is often not diagnosed. This could be due to a focus on medical issues, or because it presents differently from classic autism in its timing, phenotype, fluctuating profiles, and high level of comorbidity. Without a diagnosis, these children miss out on interventions that could modify outcome and their families and local teams will struggle to understand and support them. They also become a hidden group that does not participate in or benefit from research. This paper examined the issues and challenges of diagnosing autism in a population with a high-risk of epilepsy, drawing on more than 20 years' experience of a specialist multi-disciplinary Developmental Epilepsy Clinic (DEC).
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Affiliation(s)
- Harriet Holmes
- Developmental Epilepsy Clinic, Great Ormond Street Hospital, London WC1N3JH, UK
| | - Francesca Sawer
- Developmental Epilepsy Clinic, Great Ormond Street Hospital, London WC1N3JH, UK
| | - Maria Clark
- Developmental Epilepsy Clinic, Great Ormond Street Hospital, London WC1N3JH, UK.
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Executive function and depressed mood are independently disruptive to health-related quality of life in pediatric temporal lobe epilepsy. Epilepsy Behav 2021; 115:107681. [PMID: 33360405 DOI: 10.1016/j.yebeh.2020.107681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/21/2020] [Accepted: 11/28/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Youth with temporal lobe epilepsy (TLE) are at increased risk of depressive features and diminished health-related quality of life (HRQOL). To assist in the development of future behavioral interventions for youth with TLE, the current study explored potential pathways by which executive functioning (EF) and depressive features impinge upon HRQOL in the context of psychosocial and seizure-specific factors. METHODS Data included parental ratings on the Behavior Assessment System for Children (BASC-2), Behavior Rating Inventory of Executive Function (BRIEF), and the Quality of Life in Childhood Epilepsy (QOLCE) questionnaires for 82 children (Age = 11.99, SD = 3.80) with TLE. Observed path analysis was used to simultaneously investigate the determinants of HRQOL in pediatric TLE. Indirect effects were evaluated with bootstrap analyses. RESULTS Both executive dysfunction and depressive features were negatively linked to child HRQOL, and, furthermore, EF and HRQOL were indirectly connected by depressive features. In addition, depressive features were linked to lower EF, current antiepileptic drug (AED) regimen, and the presence of hippocampal sclerosis. Diminished EF was linked to parental psychiatric history and family stress; EF mediated the relationship of parental psychiatric history and family stress on both depressive features and diminished HRQOL. Finally, a more complicated AED regimen and higher HRQOL were indirectly connected by depressive features. CONCLUSION This study underscores the importance of child depressive features and EF along with environmental and epilepsy-specific factors on HRQOL in pediatric TLE.
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Kelada L, Wakefield CE, Muppavaram N, Lingappa L, Chittem M. Psychological outcomes, coping and illness perceptions among parents of children with neurological disorders. Psychol Health 2020; 36:1480-1496. [DOI: 10.1080/08870446.2020.1859113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Lauren Kelada
- School of Women’s and Children’s Health, UNSW Sydney, Kensington, Australia
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick, Australia
| | - Claire E. Wakefield
- School of Women’s and Children’s Health, UNSW Sydney, Kensington, Australia
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick, Australia
| | - Nagesh Muppavaram
- Department of Liberal Arts, Indian Institute of Technology Hyderabad, Hyderabad, India
| | - Lokesh Lingappa
- Department of Neurology, Rainbow Children’s Hospital, Hyderabad, India
| | - Mahati Chittem
- Department of Liberal Arts, Indian Institute of Technology Hyderabad, Hyderabad, India
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Ketogenic Diet Therapy for Intractable Epilepsy in Infantile Alexander Disease: A Small Case Series and Analyses of Astroglial Chemokines and Proinflammatory Cytokines. Epilepsy Res 2020; 170:106519. [PMID: 33395615 DOI: 10.1016/j.eplepsyres.2020.106519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/23/2020] [Accepted: 11/29/2020] [Indexed: 11/20/2022]
Abstract
In infantile Alexander disease (iAxD), one of the serious symptoms is intractable epilepsy, and some reports have suggested that neuroinflammation may be involved in the pathophysiology of the disease. Drug-resistant seizures adversely affect not only the quality of life of the caregivers and patients, but also patients' lifespan. Thus, controlling epilepsy is clinically important. For intractable childhood epilepsy, ketogenic diet therapy (KDT) is well-established, but its effects on iAxD have not been characterized. Here, we describe the use of KDT in three iAxD patients experiencing drug-resistant seizures. In all three cases, the formerly intractable epilepsies were well controlled by KDT. However, the brain magnetic resonance imaging findings deteriorated even after the epilepsy was controlled. In addition, the concentrations of monocyte chemotactic protein-1 and proinflammatory cytokines in the cerebrospinal fluid of the patients remained still high. KDT is effective in controlling epilepsy in iAxD. Our results clinically support previous reports arguing the involvement of neuroinflammation in the pathophysiology of iAxD. Although KDT cannot prevent disease progression, earlier initiation might contribute to a better prognosis.
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The impact of severe pediatric epilepsy on experienced stress and psychopathology in parents. Epilepsy Behav 2020; 113:107538. [PMID: 33238238 DOI: 10.1016/j.yebeh.2020.107538] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/12/2020] [Accepted: 10/12/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To assess the prevalence of psychopathology and the level of stress in parents of children with severe epilepsy to gain a better understanding of parental support needs. METHODS Questionnaires were completed by parents of children with severe epilepsy during the hospitalization of their child at the Danish Epilepsy Center. The questions targeted symptoms of post-traumatic stress disorder (PTSD), complex PTSD (CPTSD), depression, and anxiety, and the level of perceived stress. RESULTS A total of 162 caregivers of 140 children with epilepsy participated in the survey. Mothers were more often unemployed than fathers (38% vs. 11%, p < 0.01), and nearly half of the children (47%) attended special needs classes. Psychopathology symptoms were found in 43.5% of parents, fulfilling criteria for one or more diagnoses, and an additional 11% showed symptoms of sub-clinical PTSD. Parent-rated child difficulties were significantly associated with PTSD (Mdiff = 5.51, p = 0.001), depression (Mdiff = 4.50, p < 0.000), and anxiety (Mdiff = 4.61, p = 0.01), and with higher levels of perceived stress (p < 0.001). CONCLUSION Caring for a child with severe epilepsy has a significant psychopathological impact on caregivers. Caregivers' resources and the degree of behavioral difficulties in the child, rather than epilepsy-related factors, are highly correlated with distress and psychopathological symptoms in caregivers.
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Puka K, Bax K, Andrade A, Devries-Rizzo M, Gangam H, Levin S, Nouri MN, Prasad AN, Secco M, Zou G, Speechley KN. A live-online mindfulness-based intervention for children living with epilepsy and their families: protocol for a randomized controlled trial of Making Mindfulness Matter©. Trials 2020; 21:922. [PMID: 33176853 PMCID: PMC7657360 DOI: 10.1186/s13063-020-04792-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/05/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Epilepsy extends far beyond seizures; up to 80% of children with epilepsy (CWE) may have comorbid cognitive or mental health problems, and up to 50% of parents of CWE are at risk for major depression. Past research has also shown that family environment has a greater influence on children's and parents' health-related quality of life (HRQOL) and mental health than epilepsy-related factors. There is a pressing need for low-cost, innovative interventions to improve HRQOL and mental health for CWE and their parents. The aim of this randomized controlled trial (RCT) is to evaluate whether an interactive online mindfulness-based intervention program, Making Mindfulness Matter (M3), can be feasibly implemented and whether it positively affects CWE's and parents' HRQOL and mental health (specifically, stress, behavioral, depressive, and anxiety symptoms). METHODS This parallel RCT was planned to recruit 100 child-parent dyads to be randomized 1:1 to the 8-week intervention or waitlist control and followed over 20 weeks. The intervention, M3, will be delivered online and separately to parents and children (ages 4-10 years) in groups of 4-8 by non-clinician staff of a local community epilepsy agency. The intervention incorporates mindful awareness, social-emotional learning skills, and positive psychology. It is modeled after the validated school-based MindUP program and adapted for provision online and to include a parent component. DISCUSSION This RCT will determine whether this online mindfulness-based intervention is feasible and effective for CWE and their parents. The proposed intervention may be an ideal vector to significantly improve HRQOL and mental health for CWE and their parents given its low cost and implementation by community epilepsy agencies. TRIAL REGISTRATION ClinicalTrials.gov NCT04020484 . Registered on July 16, 2019.
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Affiliation(s)
- Klajdi Puka
- Department of Epidemiology & Biostatistics, Western University, Kresge Building, Room K201, 1151 Richmond Street, London, ON, N6A 5C1, Canada. .,Children's Health Research Institute, Lawson Health Research Institute, London, Ontario, Canada.
| | - Karen Bax
- Children's Health Research Institute, Lawson Health Research Institute, London, Ontario, Canada.,The Mary J. Wright Research and Education Centre, Western University, London, Ontario, Canada
| | - Andrea Andrade
- Children's Health Research Institute, Lawson Health Research Institute, London, Ontario, Canada.,Paediatrics, Western University, London, Ontario, Canada.,Children's Hospital at London Health Sciences Centre, London, Ontario, Canada
| | - Margo Devries-Rizzo
- Children's Hospital at London Health Sciences Centre, London, Ontario, Canada.,Health Sciences, Western University, London, Ontario, Canada
| | - Hema Gangam
- Paediatrics, Western University, London, Ontario, Canada
| | - Simon Levin
- Children's Health Research Institute, Lawson Health Research Institute, London, Ontario, Canada.,Paediatrics, Western University, London, Ontario, Canada.,Children's Hospital at London Health Sciences Centre, London, Ontario, Canada
| | - Maryam N Nouri
- Children's Health Research Institute, Lawson Health Research Institute, London, Ontario, Canada.,Paediatrics, Western University, London, Ontario, Canada.,Children's Hospital at London Health Sciences Centre, London, Ontario, Canada
| | - Asuri N Prasad
- Children's Health Research Institute, Lawson Health Research Institute, London, Ontario, Canada.,Paediatrics, Western University, London, Ontario, Canada.,Children's Hospital at London Health Sciences Centre, London, Ontario, Canada
| | - Mary Secco
- Epilepsy Southwestern Ontario, London, Ontario, Canada
| | - Guangyong Zou
- Department of Epidemiology & Biostatistics, Western University, Kresge Building, Room K201, 1151 Richmond Street, London, ON, N6A 5C1, Canada.,Robarts Research Institute, London, Ontario, Canada
| | - Kathy N Speechley
- Department of Epidemiology & Biostatistics, Western University, Kresge Building, Room K201, 1151 Richmond Street, London, ON, N6A 5C1, Canada.,Children's Health Research Institute, Lawson Health Research Institute, London, Ontario, Canada.,Paediatrics, Western University, London, Ontario, Canada
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Lemmon M, Glass H, Shellhaas RA, Barks MC, Bailey B, Grant K, Grossbauer L, Pawlowski K, Wusthoff CJ, Chang T, Soul J, Chu CJ, Thomas C, Massey SL, Abend NS, Rogers EE, Franck LS. Parent experience of caring for neonates with seizures. Arch Dis Child Fetal Neonatal Ed 2020; 105:634-639. [PMID: 32503792 PMCID: PMC7581607 DOI: 10.1136/archdischild-2019-318612] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 03/10/2020] [Accepted: 03/19/2020] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Neonates with seizures have a high risk of mortality and neurological morbidity. We aimed to describe the experience of parents caring for neonates with seizures. DESIGN This prospective, observational and multicentre (Neonatal Seizure Registry) study enrolled parents of neonates with acute symptomatic seizures. At the time of hospital discharge, parents answered six open-ended response questions that targeted their experience. Responses were analysed using a conventional content analysis approach. RESULTS 144 parents completed the open-ended questions (732 total comments). Four themes were identified. Sources of strength: families valued medical team consensus, opportunities to contribute to their child's care and bonding with their infant. Uncertainty: parents reported three primary types of uncertainty, all of which caused distress: (1) the daily uncertainty of the intensive care experience; (2) concerns about their child's uncertain future and (3) lack of consensus between members of the medical team. Adapting family life: parents described the many ways in which they anticipated their infant's condition would lead to adaptations in their family life, including adjusting their family's lifestyle, parenting approach and routine. Many parents described financial and work challenges due to caring for a child with medical needs. Emotional and physical toll: parents reported experiencing anxiety, fear, stress, helplessness and loss of sleep. CONCLUSIONS Parents of neonates with seizures face challenges as they adapt to and find meaning in their role as a parent of a child with medical needs. Future interventions should target facilitating parent involvement in clinical and developmental care, improving team consensus and reducing the burden associated with prognostic uncertainty.
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Affiliation(s)
- Monica Lemmon
- Pediatrics and Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Hannah Glass
- Neurology and Pediatrics, University of California San Francisco, San Francisco, California, USA,Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Renee A Shellhaas
- Pediatrics (Neurology Division), University of Michigan, Ann Arbor, Michigan, USA
| | - Mary Carol Barks
- Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina, USA
| | - Bria Bailey
- Neurology and Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Katie Grant
- Parent Partner, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Lisa Grossbauer
- Parent Partner, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kamil Pawlowski
- Parent Partner, UCSF Benioff Children’s Hospital Oakland, Oakland, California, USA
| | | | - Taeun Chang
- Neurology, Children’s National Medical Center, Washington, District of Columbia, USA
| | - Janet Soul
- Neurology, Children’s Hospital, Boston, Massachusetts, USA
| | - Catherine J Chu
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Cameron Thomas
- Pediatrics, Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Shavonne L Massey
- Departments of Neurology and Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Nicholas S Abend
- Neurology, Pediatrics, Anesthesia and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Elizabeth E Rogers
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Linda S Franck
- Family Health Care Nursing, University of California San Francisco School of Nursing, San Francisco, California, USA
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Yang H, Feng Y, Zhu Z, Qiao Z, Xiao B, Feng L. Evaluation of anxiety, depression, and sleep quality among parents of children with epilepsy in Southern China. Epilepsy Behav 2020; 112:107340. [PMID: 32861027 DOI: 10.1016/j.yebeh.2020.107340] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/10/2020] [Accepted: 07/11/2020] [Indexed: 01/14/2023]
Abstract
PURPOSE The purpose of the study was to evaluate sleep quality in the parents of children with epilepsy (CWE) as well as their symptoms of anxiety and depression in Southern China. METHOD A structured questionnaire, comprised of The State-Trait Anxiety Inventory (STAI), Center for Epidemiologic Studies Depression Scale (CES-D), and the Pittsburgh Sleep Quality Index (PSQI), was administered to parents of CWE (n = 234) in Xiangya Hospital and parents of healthy children (n = 230) during 2019-2020. RESULTS The scores (Mean ± SD) of State Anxiety Inventory (S-AI) and Trait Anxiety Inventory (T-AI) among parents of CWE were 51.850 ± 11.380 and 48.201 ± 9.526, respectively, which were significantly higher than those of control group (37.172 ± 8.047 and 37.478 ± 7.314, respectively) (p < 0.001). Compared with 10.84% in parents of healthy children, 23.51% of parents of CWE had symptoms of depression (p < 0.001). The mean score of total PSQI among parents of CWE (6.944 ± 3.814) was statistically higher than that of parents of healthy children (5.039 ± 3.390) (p < 0.001). Moreover, anxiety and depression subscores among parents of infants with epilepsy were significantly higher than in other groups. The T-AI and CES-D could explain 43.9% of the variance (R2 = 0.444, F = 92.215, p < 0.001) on the PSQI. CONCLUSIONS Our study showed more severe symptoms of anxiety and depression as well as poorer sleep quality among parents of CWE, especially in the infants group. In light of this information, more attention should be paid to early identification and intervention of symptoms of anxiety and depression in susceptible parents who are the main caregivers of their CWE.
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Affiliation(s)
- Haojun Yang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha 410008, PR China
| | - Yanyan Feng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha 410008, PR China
| | - Ziqing Zhu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha 410008, PR China
| | - Zhihua Qiao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha 410008, PR China
| | - Bo Xiao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha 410008, PR China
| | - Li Feng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha 410008, PR China.
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Phillips NL, Widjaja E, Smith ML. Changes in caregiver depression, anxiety, and satisfaction with family relationships in families of children who did and did not undergo resective epilepsy surgery. Epilepsia 2020; 61:2265-2276. [PMID: 32944931 DOI: 10.1111/epi.16672] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/07/2020] [Accepted: 08/08/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate longitudinal changes in caregiver depression, anxiety, and family relationships following resective surgery for pediatric drug-resistant epilepsy (DRE). METHODS This multicenter cohort study involved 177 caregivers of children with DRE aged 4-18 years (63 surgical and 114 nonsurgical). Caregivers completed measures of depression (Quick Inventory of Depressive Symptomatology), anxiety (Generalized Anxiety Disorder 7-item scale), and satisfaction with family relationships (Family Adaptability, Partnership, Growth, Affective, and Resolve scale) at baseline, 6 months, and 1 year. Additional data collected at baseline included child, caregiver, and family sociodemographic and clinical factors as well as family environment (demands and resources). RESULTS At 1 year, 64% and 27% of surgical and nonsurgical patients were seizure-free, respectively. Linear mixed-effects models found a reduction in caregiver depression (b = -0.85, P = .004) and anxiety (b = -1.09, P = .003), but not family satisfaction (b = 0.18, P = .31) over time. There was no effect of treatment. When seizure outcome was added to the model, seizure freedom was associated with fewer depressive symptoms (b = -1.15, P = .005) and greater family satisfaction (b = 0.65, P = .006), but not anxiety (b = -0.41, P = .42). A greater proportion of caregivers of patients who achieved seizure freedom (32%) versus continued seizures (18%) reported clinically meaningful improvement in depression at 1 year (P = .03). Lower baseline depression (β = 0.42, P < .001), greater family resources (β = -0.18, P = .04), and male caregiver (β = 0.15, P = .02) predicted lower caregiver depression, and lower baseline anxiety (β = 0.47, P < .001), greater family resources (β = -0.24, P = .01), and higher education (β = -0.13, P = .04) predicted lower caregiver anxiety at 1 year. Baseline functioning was the only predictor of family relationships at 1 year (β = 0.49, P < .001). SIGNIFICANCE Caregivers of children who achieved seizure freedom, irrespective of surgical treatment, report fewer depressive symptoms and greater satisfaction with family relationships. Baseline functioning is the strongest predictor of outcome; however, caregivers of families with fewer resources and supports are also at risk of poor psychosocial outcomes.
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Affiliation(s)
- Natalie L Phillips
- Neurosciences and Mental Health Program, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elysa Widjaja
- Neurosciences and Mental Health Program, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mary Lou Smith
- Neurosciences and Mental Health Program, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Psychology, University of Toronto Mississauga, Toronto, Ontario, Canada
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A Gluten Free Diet in the Management of Epilepsy in People with Coeliac Disease or Gluten Sensitivity. GASTROINTESTINAL DISORDERS 2020. [DOI: 10.3390/gidisord2030026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The aim of this review was to assess the effects of a gluten free diet (GFD) in the management of epilepsy in people with coeliac disease (CD) or gluten sensitivity (GS). A systematic approach was used to undertake a literature review. Five electronic databases (PubMed; Scopus; Google Scholar; Cochrane Epilepsy Group specialised register; Cochrane Register of Controlled Trails (CENTRAL) via the Cochrane Register of Online Trials) were searched using predetermined relevant search terms. In total, 668 articles were identified. Duplicates were removed and predefined inclusion and exclusion criteria were applied, and a PRISMA flow chart was produced. Data was extracted using Covidence software. Twelve studies on Epilepsy and CD involving a total of 70 participants were selected for analysis; narrative synthesis was used owing to the small sample sizes in the selected studies. None of the 12 studies meeting inclusion criteria investigated gluten sensitivity and epilepsy. All the included studies support a link between epilepsy and CD. GFD was effective in 44 out of 70 participants across the studies in terms of a reduction of seizures, reduction of antiepileptic drugs (AEDs) or normalisation of EEG pattern. A total of 44 participants showed a reduction in seizures (across eight studies) and complete cessation of seizures was reported in 22 participants. In general, the earlier the GFD is implemented after the onset of seizures, the better the likelihood of the GFD being successful in supporting control of seizures. Mechanisms linking gluten with epilepsy are not fully understood; possible hypotheses include gluten mediated toxicity, immune-induced cortical damage and malabsorption. Evidence suggests the effectiveness of a GFD in supporting the management of epilepsy in patients with CD, although the quality of evidence is low. There appears to be a growing number of neurologists who are prepared to advocate the use of a GFD. A multidisciplinary approaches and further research are recommended. It could be argued that when balancing potential treatments such as AEDs or surgery, a GFD has a low likelihood of harm.
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Sylvén I, Olsson I, Hallböök T, Rydenhag B, Reilly C. 'In the best case seizure-free' - Parental hopes and worries before and satisfaction after their child's epilepsy surgery. Epilepsy Behav 2020; 110:107153. [PMID: 32480305 DOI: 10.1016/j.yebeh.2020.107153] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The objective of this study was to gain a better understanding of parental hopes and worries before and subsequent experiences two years after their child had undergone epilepsy surgery. METHODS The parents of 107 children and young people who underwent epilepsy surgery at a single center completed surveys focusing on hopes and concerns before surgery and subsequent experiences at two-year follow-up. Responses were analyzed by thematic analysis. RESULTS Before surgery, parental hopes focus on not only seizure freedom or reduction but also potential improvements in child development and emotional-behavioral functioning. Worries before surgery include not only potential injury or loss of skills but also a concern that the surgical procedure would not lead to an improvement in the child's seizures. The vast majority of parents experienced positive aspects at the two-year follow-up including seizure freedom or reduction but also perceived improvements in behavior, development, and sleep. This suggests that for many, expectations for the surgery were met. A small number of parents reported negative effects of surgery including loss of skills, worsening/lack of improvement in seizure frequency, or negative impact on development. SIGNIFICANCE For the majority of parents whose children undergo surgery, expectations are met, and fears are not realized. Knowledge of parental hopes and worries before surgery as well as experiences after the operation is useful for improving pre- and postsurgical counseling.
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Affiliation(s)
- Isabelle Sylvén
- Dept. of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ingrid Olsson
- Dept. of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Tove Hallböök
- Dept. of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Bertil Rydenhag
- Institute of Nuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Sweden; Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Colin Reilly
- Dept. of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.
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Importance of prompt diagnosis in pediatric epilepsy outcomes. Seizure 2020; 80:24-30. [DOI: 10.1016/j.seizure.2020.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 03/02/2020] [Accepted: 03/23/2020] [Indexed: 11/19/2022] Open
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Pinquart M. Meta-Analysis of Anxiety in Parents of Young People with Chronic Health Conditions. J Pediatr Psychol 2020; 44:959-969. [PMID: 31220871 DOI: 10.1093/jpepsy/jsz024] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 03/22/2019] [Accepted: 03/26/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Chronic health conditions are often associated with uncertainty and threats which may cause anxiety in the family members. The present meta-analysis analyzed whether parents of children with chronic physical diseases and/or sensory/physical disabilities show higher anxiety levels than parents of healthy/nondisabled children or test norms. METHODS The databases PSYCINFO, MEDLINE, Google Scholar, CINAHL, and PSYNDEX were searched for relevant studies. In total, 486 studies were identified that fulfilled the inclusion criteria. RESULTS We found moderate elevations of anxiety symptoms in parents of young people with chronic conditions (g = .54 standard deviation units). About 16% of the parents fulfilled the criteria for an anxiety disorder. Parents of young people with neuromuscular disorders, HIV-infection/AIDS, and cancer during active treatment showed large elevations of anxiety symptoms. Elevations of anxiety symptoms were smaller in the cases of longer lasting chronic conditions, longer time since the end of active treatment, in families of older children, in samples with lower percentages of mothers, and in studies from economically developed countries compared to less developed countries. CONCLUSION Measures for preventing and reducing anxiety symptoms in parents of young people with neuromuscular disorders, HIV-infection/AIDS, and those undergoing cancer treatments are particularly needed.
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Franck LS, Shellhaas RA, Lemmon M, Sturza J, Soul JS, Chang T, Wusthoff CJ, Chu CJ, Massey SL, Abend NS, Thomas C, Rogers EE, McCulloch CE, Grant K, Grossbauer L, Pawlowski K, Glass HC. Associations between Infant and Parent Characteristics and Measures of Family Well-Being in Neonates with Seizures: A Cohort Study. J Pediatr 2020; 221:64-71.e4. [PMID: 32446494 PMCID: PMC7336525 DOI: 10.1016/j.jpeds.2020.02.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/29/2020] [Accepted: 02/12/2020] [Indexed: 12/14/2022]
Abstract
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.
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Affiliation(s)
- Linda S Franck
- Department of Family Health Care Nursing, University of California San Francisco, San Francisco, CA.
| | | | - Monica Lemmon
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Julie Sturza
- Department of Pediatrics, University of Michigan, Ann Arbor, MI
| | - Janet S Soul
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Taeun Chang
- Department of Neurology, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC
| | | | - Catherine J Chu
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Shavonne L Massey
- Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Nicholas S Abend
- Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Departments of Anesthesia and Critical Care Medicine, Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Cameron Thomas
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH; Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Elizabeth E Rogers
- Department of Pediatrics, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, CA
| | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
| | - Katie Grant
- NSR Parent Partner, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Lisa Grossbauer
- NSR Parent Partner, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Kamil Pawlowski
- NSR Parent Partner, UCSF Benioff Children's Hospital, San Francisco, CA
| | - Hannah C Glass
- Departments of Neurology and Pediatrics, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, CA
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Clinical application of the PedsQL Epilepsy Module (PedsQL-EM) in an ambulatory pediatric epilepsy setting. Epilepsy Behav 2020; 106:107005. [PMID: 32199347 DOI: 10.1016/j.yebeh.2020.107005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/24/2020] [Accepted: 02/24/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Children with epilepsy report lower health-related quality of life (QOL) compared with healthy children and those with other chronic disorders. This study piloted the recently published Pediatric Quality of Life Inventory (PedsQL) Epilepsy Module (PedsQL-EM) in an ambulatory setting and studied epilepsy-related factors contributing to QOL in children with epilepsy. METHODS Children with epilepsy aged 8-18 years who were ambulant and verbal were recruited from pediatric neurology clinics. Children and their caregivers completed age-appropriate versions of the PedsQL-EM (8-12 or 13-18 years) in the clinic waiting area. Treating neurologists completed medical questionnaires about their patients' epilepsy. RESULTS We collected 151 parent-report and 127 self-report PedsQL-EMs. Administration time was 5-10 min with some children receiving assistance from the researcher. Mean age of children was 12.9+/-3.0, with 77 females (51%). Parents reported lower mean QOL scores across all subdomains compared with their children. Parents reported significantly lower QOL for children with earlier age at epilepsy onset, longer epilepsy duration, presence of seizures during the last month, more severe epilepsy, increased number of antiepileptic drugs (AEDs), and cognitive comorbidity. The same factors impacted on child self-reporting, but with more variability across subdomains. CONCLUSIONS The PedsQL-EM is an epilepsy-specific measure of QOL that is quick and easy to administer and is sensitive to the clinical factors reported to impact on QOL in pediatric epilepsy.
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Yang C, Kang B, Mao Y, Xu Q, Yu D, Zhang L. Anxiety among caregivers of children with epilepsy from western China: A cross-sectional survey. Medicine (Baltimore) 2020; 99:e19237. [PMID: 32080126 PMCID: PMC7034634 DOI: 10.1097/md.0000000000019237] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The current study aimed to evaluate the status of anxiety among caregivers of children with epilepsy and examine the associated factors.A cross-sectional study was conducted in western China, which consecutively recruited children with epilepsy in 2018. The self-rating anxiety scale (SAS) was used to assess the status of anxiety among caregivers of children with epilepsy. We collected information about aspects of sociodemographic data, disease status, attitude of caregivers towards the disease and family conditions as independent variables, using multiple linear regression to analyze factors related to the status of anxiety among caregivers.A total of 334 participants were included in the study with a response rate of 95.4% (334/350). The mean age of children with epilepsy was 6.05 ± 4.11 years. 7.2% (24/334) of patients were newly diagnosed and 55.4% (185/334) of patients presented with generalized epilepsy. A total of 25.7% (86/334) of caregivers among children with epilepsy presented the symptom of anxiety, with the scores of SAS 44.31 ± 10.558. SAS scores were negatively correlated with the children's age (B = -0.141; standard error = 0.135; P = .008), attitude towards seizures (B = -0.153; standard error = 1.192; P = .004) and medical expenses payment (B = -0.169; standard error = 1.703; P = .002).Symptoms of anxiety are common among caregivers of children with epilepsy in western China. Healthcare providers should pay more attention to caregivers with younger children, difficult financial situation, and greater fear of seizures. Exploring mental health interventions for caregivers is important.
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Affiliation(s)
- Chunsong Yang
- Department of Pharmacy, Evidence-based Pharmacy Center, West China Second Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, China
- Department of Epidemiology, West China School of Public Health, and West China Fourth Hospital
| | - BingYao Kang
- Department of Pediatric Clinic, West China Second Hospital
| | | | - Qunfen Xu
- Department of Pharmacy, Evidence-based Pharmacy Center, West China Second Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, China
- Department of Epidemiology, West China School of Public Health, and West China Fourth Hospital
| | - Dan Yu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, China
- Department of Children's Genetic Endocrinology and Metabolism, West China Second Hospital, Sichuan University, China
| | - Lingli Zhang
- Department of Epidemiology, West China School of Public Health, and West China Fourth Hospital
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