The psychosomatic approach in paediatrics

Medical manageability and psychosocial factors in childhood asthma

Five psychosocial factors were empirically derived from a questionnaire administered to 175 asthmatic children who were taken from three subsamples representing hospitalized inpatients, outpatients and private practice patients. The scales included three measures of anxiety labeled Despair Over Social Debilitation, Quality of Life, and Dread of Illness, one attitude scale labeled Orientation Towards Compliance, and one scale labeled Family Communication. These scales correlated with measures of debilitation during the 6 month period prior to treatment, which included the number of asthma attacks, emergency room visits, days hospitalized, days of school missed and parental ratings of interference in physically strenuous activities. Two groups of children were defined for each psychosocial factor by a mean split of the scores. The incidence of children with relatively much anxiety as defined by three of these scales and a poor attitude about compliance was greatest in the inpatient subsample and least in the private practice subsample. Inpatients also experienced the most debilitation during the 6 month period before testing. Follow-up measures of debilitation were recorded for the 6 month period post discharge. The relationship between the debilitation experienced by the children and their anxiety was evaluated. Patient groups with much and little anxiety both showed comparable and significant reductions in debilitation post hospital treatment. The results were interpreted to indicate that the anxiety assessed upon admission was the consequence of a history of poor medical manageability. The anxiety assessed did not appear to contribute to poor control of this illness.