Mothers' depression and health-related quality of life in neuromuscular diseases: role of functional independence level of the children

Predictors of overload in parents of children with neuromuscular diseases

Introduction

Parents of children with neuromuscular diseases experience multiple difficulties in their daily lives that affect their physical and psychological health. The risk factors for these health issues have not been sufficiently investigated. Therefore, the aim of this study was to analyze the potential predictors of overload in these parents, including QoL, somatic symptomatology, life satisfaction, psychological adjustment and certain sociodemographic variables.

Methods

A cross-sectional research study was conducted among parents who are caregivers for children with NMD in Spain. A convenience sample of 110 parents who were contacted by associations and hospitals was used. Variables were evaluated using the sociodemographic questionnaire, CarerQol-7D, PHQ-15, Barthel Index, Psychological Adaptation Scale, Zarit Overload Scale and Satisfaction with Life Scale.

Results

One of the most relevant findings of the present study is the identification of 3 overload groups (mild to moderate, moderate to severe, and severe overload) based on life satisfaction and somatic symptom scores within the predictive model of the discriminate analysis. Wilk's lambda of the discriminant function was 0.568, χ2 (2, n = 55) = 8.815, p < 0.001.

Discussion

This study presents a model that reveals the influence of unemployment, having a child with a severe level of dependency, the presence of somatic symptomatology and life satisfaction on caregiver overload. Likewise, the caregiver's self-esteem could be a protective factor against overload.

The Role of Associations in Reducing the Emotional and Financial Impact on Parents Caring for Children with Duchenne Muscular Dystrophy: A Cross-Cultural Study

Caregivers' emotions and finances are affected by the deterioration of functional capacity of patients with Duchenne muscular dystrophy (DMD), both in Mexico and Spain. Patient associations may reduce this impact on caregivers. This study aims to study the role of two models of associations, inspired by two different cultural models, in how the services they provide can help decrease the emotional and financial impact on the caregivers of children with DMD. The sample consisted of 34 caregivers from Mexico and 40 from Spain recruited from Spanish hospitals and rare disease organizations in Spain and Mexico. The instruments used consisted of a sociodemographic and socioeconomic questionnaire, the CarerQol-7D, the PHQ-15, the Zarit Caregiver's Burden Scale and the SWLS. The results showed that caregivers in Mexico are in better physical and psychological health than caregivers in Spain. They also receive more subsidies than those in Spain. Caregivers in Mexico have a greater well-being and are less affected by the economic impact of the disease due to the associations' day-to-day work and the fact that they generate a network of health services that they make available to the patient free of charge. These differences may also be attributable to cultural issues and to the fact that Mexico has a deeply established culture of support.

Duchenne muscular dystrophy

Duchenne muscular dystrophy is a severe, progressive, muscle-wasting disease that leads to difficulties with movement and, eventually, to the need for assisted ventilation and premature death. The disease is caused by mutations in DMD (encoding dystrophin) that abolish the production of dystrophin in muscle. Muscles without dystrophin are more sensitive to damage, resulting in progressive loss of muscle tissue and function, in addition to cardiomyopathy. Recent studies have greatly deepened our understanding of the primary and secondary pathogenetic mechanisms. Guidelines for the multidisciplinary care for Duchenne muscular dystrophy that address obtaining a genetic diagnosis and managing the various aspects of the disease have been established. In addition, a number of therapies that aim to restore the missing dystrophin protein or address secondary pathology have received regulatory approval and many others are in clinical development.

Understanding carer resilience in Duchenne muscular dystrophy: A systematic narrative review

Objectives

This review synthesizes recent research on resilience in those who care for a family member with Duchenne muscular dystrophy, identifying the challenges and potential factors moderating resilience.

Methods

This systematic narrative review is informed by searches on six bibliographic databases between January and June 2016. Forty-one articles were identified to meet the inclusion criteria, and findings were synthesised around three key themes.

Results

Those who care for someone with Duchenne muscular dystrophy have been described as resilient through building strength in facing the adversity of caring. The main predictors of carer resilience were the child’s level of disability, perception of the caring experience and family functioning. The outcomes of resilience were identified as better psychological and physical health as well as psychological adaption. Coping abilities and social support, influenced by individual and environmental factors contribute to resilience.

Discussion

Research suggested that some carers have the ability to build resilience over time, although limited understanding of coping with the emotional experience of Duchenne muscular dystrophy is conveyed. Social support appears to be a protective factor for Duchenne muscular dystrophy carers but further research is required on its relationship with resilience.

Association Between Health-Related Quality of Life and Motor Function in Ambulant and Nonambulant Duchenne Muscular Dystrophy Patients

This cross-sectional study assessed health-related quality of life (HRQOL) in ambulant and nonambulant patients with Duchenne muscular dystrophy, and explored the association between health-related quality of life and clinically assessed motor function. The Pediatric Quality of Life Inventory (PedsQL) Generic Core Scale and PedsQL Neuromuscular module were completed by 34 parent-child dyads. Association between PedsQL scores and overall motor abilities and the transfers and standing posture domain measured by the Motor Function Measure were examined. Child self-reported and parent proxy-reported mean PedsQL scores for children with Duchenne muscular dystrophy were lower than those for healthy children for the physical and psychosocial health-related quality of life. Fifty-six percent of patients reported clinically impaired psychosocial health-related quality of life scores. Several aspects of the generic and disease-specific health-related quality of life in patients with Duchenne muscular dystrophy were positively associated to overall motor function and transfers and standing posture domain. Associations remained stable when adjusted for age and corticosteroid use. The Motor Function Measure is clinically meaningful in the context of a patient's day-to-day life.

A critical review of patient and parent caregiver oriented tools to assess health-related quality of life, activity of daily living and caregiver burden in spinal muscular atrophy

The positive outcome of different therapeutic approaches for spinal muscular atrophy (SMA) in clinical trials and in clinical practice have highlighted the need to establish if functional changes are associated with possible changes of patient health-related quality of life or have an effect on activities of daily living and caregiver burden. The aim of this paper is to provide a critical review of the tools previously or currently used to measure quality of life, activity of daily living, and caregiver burden in SMA. We identified 36 measures. Only 6 tools were specifically developed for SMA while the others had been used and at least partially validated in wider groups of neuromuscular disorders including SMA. Twelve of the 36 focused on health-related quality of life, 5 on activities of daily living and 9 on caregiver burden. Ten included a combination of items. The review provides a roadmap of the different tools indicating their suitability for different SMA types or age groups. Scales assessing activities of daily living and care burden can provide patients and carers perspective on functional changes over time that should be added to the observer rated scales used in clinic.

Health-related quality of life in Chinese boys with Duchenne muscular dystrophy and their families

This study aims to assess the family functioning and health-related quality of life (HRQOL) in Chinese boys with Duchenne muscular dystrophy (DMD) and their parents using Pediatric Quality-of-Life Family Impact Module (PedsQL FIM) and Pediatric Quality-of-Life Inventory (PedsQL) 4.0. Findings from 15 families with DMD were compared with 15 unaffected families. The HRQOL, as measured by the mean PedsQL 4.0 Generic Core Scale scores for the boys with DMD were significantly lower than those of age-matched healthy boys, for overall (p < 0.05, parent-report; p <0.001, self-report), physical (p < 0.001, parent-report and self-report), and social (p < 0.05, parent-report) functioning, but the emotional functioning is not affected. The parent-child concordance of our affected DMD families was generally in the moderate-to-good agreement range (intraclass correlation coefficients from 0.51 to 0.73), except for emotional (0.28) and social (0.31) functioning. The PedsQL FIM total score showed an inverse relationship with the affected child's age (correlation coefficient: -0.55; p < 0.01) and the disease stage (correlation coefficient: -0.63; p < 0.01) confirming that parental HRQOL and overall family functioning worsened as the child increased in age with advancing disease stage.

Factors Associated with Caregiver Burden in Primary Caregivers of Patients with Adolescent Scoliosis: A Descriptive Cross-Sectional Study

Background

Primary caregivers for patients with scoliosis suffer from considerable distress and burden. However, a few studies have examined the factors related to burden of caregivers of patients with adolescent scoliosis, particularly in China. Therefore, the present study aimed to identify patient and caregiver characteristics associated with caregiver burden.

Material/Methods

A cross-sectional study was conducted in a sample comprising 87 pairs of patients with adolescent scoliosis and their primary caregivers from July 2014 to October 2016 in Xi’an, China. Patients and their primary caregivers were administered a sociodemographic questionnaire. The caregiver burden, social support, and self-efficacy were assessed using the Chinese version of the Zarit Burden Interview (ZBI), Social Support Rating Scale (SSRS), and General Self-Efficacy Scale (GSE). A multivariate analysis was used to evaluate the factors associated with caregiver burden.

Results

Most primary caregivers observed in this study were female (65.5%), with mothers of the patients accounting for 58.6% of all the caregivers. The ZBI score of primary caregivers was 36.83±13.30, and most caregivers (88.5%) had moderate or severe burden. The factors associated with caregiver burden were Cobb angle of patients, SSRS scores, GSE scores, and monthly household income per capita of the caregiver (R²=0.556; P<0.001). The identified significant factors explained nearly 56% of the variance in the caregiver burden.

Conclusions

The data indicated that most primary caregivers for patients with scoliosis had a considerable caregiver burden, and intervention of social support and self-efficacy might be helpful in reducing caregiver burden.

Burden and quality of life of mothers of children and adolescents with chronic illnesses: an integrative review

Objective:

to identify and analyze the evidence available regarding evaluation of burden and quality of life of mothers who are caregivers for children and adolescents with chronic illnesses.

Method:

an integrative review, undertaken in the electronic sources MEDLINE; Academic Search Premier; CINAHL; LILACS; SciELO and PubMed, between 2010 and 2014.

Results:

among the 22 documents selected, there was a predominance of convenience samples and non-experimental transversal designs, at the levels IV and III2. The caregiver burden scales used were the Zarit Burden Interview and Montgomery-Borgatta Caregiver Burden Scale-Revised along with the following instruments for evaluating quality of life: The World Health Organization Quality of Life-BREF Scale; Self-report questionnaires; The Ulm Quality of Life Inventory for Parents of chronically ill children; Asthma Caregiver Quality of Life Questionnaire; and the Nottingham Health Profile. Quality-of-life appears to be influenced in a complex and interrelated way by the physical and mental health of the mothers who are caregivers, in accordance with their level of independence, social relationships, environment, and the extent to which they see themselves as burdened.

Conclusion:

the revealing of the results for the evaluation of burden and quality of life of mothers who are caregivers has implications for the planning and implementation of effective interventions, by the multidisciplinary team, if they are to relieve the burden.

Postoperative quality of life in patients with progressive neuromuscular scoliosis and their parents

BACKGROUND CONTEXT

The functional level of children with progressive neuromuscular disease is a major factor that affects the quality of life (QOL) of parents. However, only a few publications have reported changes in the QOL of parents after correctional spinal surgery.

PURPOSE

The purpose was to compare changes in QOL for both patients and parents after spinal correctional surgery for better sitting balance and to analyze correlation among radiographic parameters, functional outcome, and QOL questionnaires. Finally, the QOL of patients and parents was compared with the population norm.

STUDY DESIGN

This study is a retrospective analysis of prospectively gathered data.

PATIENT SAMPLE

From 2008 to 2011, 58 patients who underwent correctional surgery for progressive neuromuscular scoliosis and their parents were enrolled.

OUTCOME MEASURES

A Muscular Dystrophy Spine Questionnaire (MDSQ) and short-form questionnaire 36 (SF-36) were used.

METHODS

The gathered functional outcome and QOL data using MDSQ and SF-36 for both enrolled patients and parents were compared preoperatively, postoperatively at 3 months, and at 1-year follow-up.

RESULTS

Mean age was 15.0±4.1 years. Forty male and 18 female patients were enrolled. Mean follow-up was 38.4±13.7 months. Cobb angle was 61.5°±23.5° preoperatively, 39.0°±20.1° immediately postoperative, and 40.0°±20.2° at the final follow-up. Cobb angle, pelvic obliquity, and lumbar lordosis were significantly improved after surgery (p<.001). Among sitting-related questions, answers to questions 15 (sitting comfortably), 16 (change weight in wheelchair), 22 (sit all day), 24 (sit at table for meal), 26 (keep balance while sitting in wheelchair), and 27 (look good while sitting in wheelchair) were significantly improved after correctional surgery (p<.001). Regarding the SF-36 scales for patients, bodily pain and social functioning significantly improved postoperatively (p<.001).

CONCLUSIONS

Muscular Dystrophy Spine Questionnaire results indicated that patients had significantly improved sitting balance-related outcomes, whereas the SF-36 indicated improvements only in bodily pain and social functioning scales. For parents, no SF-36 scales improved significantly postoperatively. Accordingly, improved sitting balance and QOL for neuromuscular scoliosis patients after surgery do not necessarily increase parent QOL.

Impact of obstetrical brachial plexus injury on parents

BACKGROUND

The aim of this study was to describe the impact of obstetrical brachial plexus palsy (OBPP) on parents and to investigate the effect of the severity of OBPP and the age of the children on parents.

METHODS

A total of 106 parents (with a mean age of 30.14 ± 5.01 years) of children with OBPP were included in the study. The functional level of the children was assessed by the Active Movement Scale, whereas the impact of OBPP on the parents was assessed by the Turkish version of the Impact on Family Scale.

RESULTS

The parents appeared to be moderately affected by their child's disorder. Financial, social, personal, mastery parameters and total impact values were 52% (27-77%), 65% (46-114%), 49% (31-67%), 51% (28-74%) and 56% (40-72%), respectively. Root involvement and the age of the children did not make a statistically significant difference in the level of impact.

CONCLUSIONS

Detailed knowledge of the impact of OBPP on families might provide a chance to support affected families in coping with the situation and decrease their burden in providing care for the children. It is crucial to evaluate and provide social support to parents of children with OBPP.

Health-Related Quality of Life in Children with Developmental Coordination Disorder and Their Parents

This study measured health-related quality of life (HRQOL) in children with developmental coordination disorder (DCD) and their parents. A convenience sample of 369 children with DCD (144 girls; mean age: 11.2 ± 3.66 years) and 360 children with typical development (146 girls; mean age: 11.4 ± 4.09 years) was enrolled. The Bruininks—Oseretsky Test of Motor Proficiency-Second Edition was used to classify the DCD group into five levels of motor abilities. The HRQOL of the children was assessed with the Child Health Questionnaire-Parent Form 50, and the HRQOL of the parents was assessed with the 12-Item Short Form Health Survey (SF-12), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). Although the two groups had comparable physical health, the DCD group had significantly lower HRQOL in all psychosocial domains. The degree to which HRQOL is reduced is related to motor proficiency. Compared to parents of typically developing children, parents of children with DCD had significantly lower HRQOL ( p < .05 for both SF-12 and BAI). HRQOL of the parents was unassociated with the motor proficiency of the children. DCD significantly affects multiple HRQOL domains in both the child with DCD and the parents.

Quality of life in mothers of children with obstetrical brachial plexus palsy

BACKGROUND

The aim of this study was to explore impairment in quality of life (QOL) of the mothers who were primarily responsible for taking care of children with obstetrical brachial plexus palsy (OBPP) and to state its association with the age, sex and functional status of the child with OBPP.

METHODS

Ninety-three mothers of children with OBPP and 88 mothers of children without any health problems were included in the study. Children's demographic characteristics were recorded and the functional status of the upper extremity was determined with the active movement scale. The QOL of the mothers was assessed with the Turkish version of the Nottingham Health Profile (NHP).

RESULTS

There were significant differences between mothers of children with OBPP and the control group in total, physical activity, energy expenditure, and pain score of the NHP. A decrease in energy expenditure and physical activity levels were found to be related to children's active movement scale results in elbow flexion and extension, and forearm supination. A statistically meaningful difference was found between mothers of children aged 0-2 and mothers of children aged 2-7 years in emotional reaction, social isolation and total score of NHP.

CONCLUSIONS

The results of this study revealed that mothers of children with OBPP have poor QOL compared with mothers of healthy children. The limitation in elbow joint movements was found to be important for the mothers. The strongest impact of the illness is on the emotional reactions and social isolation of the mothers. Professionals involved in the care of children with OBPP should also help parents to cope with the burden of caregiving.

Child asthma and change in elevated depressive symptoms among mothers of children of a birth cohort from Quebec

The authors examined the association between maternal reports of child asthma attacks since birth and occurrence of elevated maternal depressive symptoms at seventeen months postpartum in the present study. The modifying role of poverty in this association was also examined. Data from n = 1,696 mother-child dyads from the Quebec Longitudinal Study of Child Development, a birth cohort of children born in 1998, were used. Maternal depressive symptoms were measured with an abridged and validated twelve-item version of the Center for Epidemiologic Studies Depression Scale. Maternal reports of child asthma attacks since birth in relation to the occurrence of maternal depressive symptoms at 17 months postpartum and the potential modifying role of poverty were tested using multiple logistic regression models. When mothers reported child asthma attacks, those without elevated depressive symptoms at 5 months postpartum had lower odds of elevated depressive symptoms one year later (OR = 0.2, 95% CI: 0.1-0.7). Poverty was associated with increased odds of elevated maternal depressive symptoms (OR = 2.4, 95% CI: 1.5-3.9), without interacting with child asthma. Through this study, the authors suggest that in mothers without elevated symptoms at 5 months, reported child asthma attacks since birth did not contribute one year later to new occurrence of depressive symptoms.