A systematic review of the association between coping strategies and quality of life among caregivers of children with chronic illness and/or disability

Validation of the Family Integration Experience Scale: Chronic Illness for the Portuguese language spoken in Brazil

OBJECTIVE

to conduct the cross-cultural adaptation and psychometric validation of the Family Integration Experience Scale: Chronic Illness in Brazilian Portuguese.

METHOD

a methodological study divided into two stages. In the first stage, the Family Integration Experience Scale: Chronic Illness was cross-culturally adapted for Brazilian culture, when the scale was subjected to translations, back-translations, and a committee of judges - to verify the semantic, linguistic, and contextual equivalence between the original and translated items. The second step was to validate the scale in a sample of families of children and adolescents with chronic illnesses. The participants were 230 families of children with chronic illnesses attending the outpatient clinic of a tertiary public hospital with teaching and research characteristics.

RESULTS

internal consistency was tested using Cronbach's alpha (0.81) and McDonald's omega (0.81). Confirmatory factor analysis was also tested, and the model's fit was acceptable for validation standards.

CONCLUSION

the version of the Family Integration Experience Scale: Chronic Illness showed evidence of validation and can be considered a valid and reliable instrument in Brazilian culture. The Brazilian Portuguese version of the Family Integration Experience Scale: Chronic Illness can be used to measure the experience of family integration in chronic illness.

Evaluation of fear and stress levels and methods of coping with stress among parents having children with chronic diseases during the COVID-19 pandemic

PURPOSE

The aim of this study is to evaluate the fear and stress levels of parents having children with chronic disease and their methods to cope with stress during the COVID-19 pandemic.

DESIGN AND METHODS

This descriptive and correlation study was conducted with the participation of 390 parents with and without children suffering from chronic diseases. Fear of COVID-19 Scale (FCS), Parenting Stress Index (PSI-SF), and Coping Response Inventory (CRI) were used to collect data. In the data analysis, Kurtosis and Skewness coefficients were used to check the assumption of normal distribution, t-test was used to compare two independent groups and Pearson correlation analysis was used to make relational inferences.

RESULT

It was found that 84.9% (n = 331) of the parents were mothers and 15.1% (n = 59) were fathers. The FCS mean score of the parents having children with chronic diseases was 21.52 ± 5.07, their PSI-SF mean score was 68.27 ± 25.56, and their CRI mean score was 96.97 ± 15.12. For the parents having children without chronic diseases, the FCS mean score was 18.10 ± 5.80, the PSI-SF mean score was 68.75 ± 23.43, and the CRI mean score was 94.77 ± 15.08.

CONCLUSION

It was determined that parents having children with chronic diseases had higher levels of COVID-19 fear during the pandemic than parents having child without chronic diseases, but their stress levels and CRI mean scores were similar.

PRACTICAL IMPLICATIONS

It is important for nurses to take into account the feelings of fear and stress experienced by parents due to the COVID-19 pandemic and provide coping methods.

Type D Personality, Stress Levels, and Coping Strategies in Women with Androgenetic Alopecia and Polycystic Ovary Syndrome

BACKGROUND The study was aimed to determine level of stress and using of coping strategies and frequency of type D personality in women with androgenetic alopecia with polycystic ovary syndrome (PCOS), to correlate personality type with level of stress and coping strategies, and to correlate severity of alopecia with personality type, level of stress, and coping strategies. MATERIAL AND METHODS The study was conducted in 2023 and included 146 Polish women aged 18 to 45 years with androgenetic alopecia and PCOS. A questionnaire containing social-demographic data, gynecological and obstetric history, health history, history of diagnosis, and treatment of PCOS in the past and present. Three standardized questionnaires were used: the Type-D Scale (DS)-14, Perceived Stress Scale (PSS)-10, and Coping Orientation to Problems Experienced (COPE) inventory. RESULTS Type D personality was found in 45% of patients. Most patients perceived high levels of stress (44%) and most frequently used active and supportive strategies, with avoidance strategies being less frequent. Women with type D personality experienced significantly higher levels of stress, used active strategies less often, and used avoidant strategies more often. Stages of androgenetic alopecia did not correlate with type D personality or levels of perceived stress. CONCLUSIONS In women with androgenetic alopecia, type D personality is determinative of a high level of perceived stress and more frequent use of dysfunctional coping strategies. The severity of the condition did not correlate with personality type and level of stress, while it was related to certain coping strategies.

Quality of life in children at different stages of chronic kidney disease in a developing country

BACKGROUND

Children with chronic kidney disease (CKD) require comprehensive assessments, including medical and quality of life (QoL) evaluations. Few studies have been conducted in developing countries.

METHODS

This cross-sectional study included 2-18-year-old patients who were categorized into 4 groups: the CKD stage 2-3, stage 4-5, stage 5 with dialysis (D), and kidney transplantation (KT) groups. QoL was measured using the Pediatric Quality of Life Inventory™ (PedsQL™) version 4.0; relationships between different factors and QoL were determined using multivariable linear regression analysis.

RESULTS

Eighty-seven patients (mean age: 13.3 (4.1) years) were included. The self-reported total scores were 77.5 (12.5), 78.9 (11.2), 77.4 (16.2), and 76.1 (10.9) in the stage 2-3, stage 4-5, stage 5D and KT groups, respectively. Parent-reported scores showed a weak-to-moderate correlation with self-reported scores (r = 0.12-0.42), with total scores of 71.8 (12.7), 69.5 (14.9), 63.4 (14.8), and 70.8 (18.1) in the stage 2-3, 4-5, 5D and KT groups, respectively. Multivariable linear regression revealed that the parent-reported score in the stage 5D group was 15.92 points lower than that in the stage 2-3 group (p = 0.02); the score in the low maternal education group was 10.13 points lower than that in the high maternal education group (p = 0.04).

CONCLUSIONS

Parent-reported scores showed weak-to-moderate correlation with self-reported scores. Patients with CKD stage 5D and patients with low maternal education had lower QoL. Regular QoL assessment is recommended for patients with advanced CKD and those with socioeconomic vulnerabilities.

Perceived stress and posttraumatic growth in caregivers of pediatric burn patients undergoing mHealth-enhanced outpatient burn care: A pilot study

Approximately 120,000 children in the United States are evaluated in the emergency department annually due to burn injuries. Studies have consistently documented that pediatric burns are among the most stressful events for caregivers, resulting in a wide range of emotions, including guilt, anxiety, grief, depression, and posttraumatic stress symptoms, as well as positive psychological changes, a phenomenon known as posttraumatic growth. The present pilot study aimed to explore the prevalence of elevated perceived stress as well as posttraumatic growth among caregivers of pediatric burn patients receiving outpatient burn care and using an mHealth burn platform to administer burn treatment. Our results demonstrated that, on average, caregivers endorsed similar or lower levels of perceived stress over the past 30 days compared to the general population of 30-44-year-old adults and only a third of caregivers reported elevated levels of perceived stress in the past 30 days. However, during the treatment phase, two-thirds of caregivers reported elevated levels of stress. Further, approximately half of the caregiver sample reported moderate to high levels of posttraumatic growth following their child's burn injury. This pilot study clarifies the level of the perceived stress that caregivers of burn-injured children experience, particularly during the treatment phase when they are responsible for their children's outpatient burn care (e.g., dressing changes). Additionally, the results shed light on the high prevalence of moderate to high posttraumatic growth in caregivers, with a prevalence rate similar to other trauma survivors.

Listening to the voices of mothers in Indonesia: Qualitative content analysis of experiences in parenting children with down syndrome

INTRODUCTION

Generally, mothers provide the majority of caring for children who have Down syndrome. They pose challenges not only with regard to the acceptability of the child situation but also with regard to the provision of care for children with DS.

AIM

To explore the experiences of mothers parenting children with DS in Indonesia, to give a better understanding of their needs, which is necessary for the delivery of treatment.

METHODS

A descriptive qualitative research with content analysis was used. Study participants (15 mothers) were purposively sampled from attendees of a State Special School for students with disabilities. Data was collected via semi-structure interviews and were audio recorded. Participant's statements underwent content analysis, and the principle of trustworthiness was subsequently applied.

RESULTS

Five main themes describing participants' experiences were identified: (1) parenting experiences - the impacts, (2) special needs, (3) parenting barriers, (4) parenting facilitators, and (5) mothers' expectations.

CONCLUSIONS

The study findings showed that the mothers viewed their situation in both positive and negative ways. Despite the limited sample size in this exploratory study, the results offer new insights into raising a child with DS in a particular cultural setting.

IMPLICATIONS FOR PRACTICE

This study offers important information to families and healthcare providers to improve awareness of the disorder and its appropriate management methods. It is important that an exploration of the experiences of mothers will provide healthcare professionals and families with an understanding of the situation. This understanding is essential for the effective management and delivery of treatment.

'I'm proud of my son with CP': Cerebral palsy caregivers' experiences, Gauteng province

Background

Caregivers of children with cerebral palsy (CP) are critical in the survival and well-being of their children. Despite the caregivers' particularly demanding responsibilities, literature on their experiences is limited.

Objectives

This study explored the caregivers' experiences of providing care to children with CP.

Method

An explorative qualitative study design using semi-structured interviews was employed. All interviews were audio-recorded, transcribed verbatim and analysed guided by Colaizzi's seven-step methodology.

Results

Two themes emerged: the challenges in caregiving and positive experiences of providing care. Caregivers faced financial, psychological, social and physical challenges such as stigmatisation, a lack of work accommodations, time constraints due to demands of providing care, strained family relations, isolation, exclusion, emotional and physical exhaustion in their caregiving role. Despite the challenges, they also had fulfilling, positive experiences. Caregivers became more resilient, some relationships were strengthened and awareness of the CP condition increased over time.

Conclusion

Caring for a child with CP is challenging. Cerebral palsy is a permanent disability; therefore, a holistic, long-term perspective to supporting caregivers is necessary to ensure they can care for their children adequately.

Contribution

There is a need for various support structures for caregivers to lessen the burden of care. It is necessary to establish the relationships between the support structures available and the way that these structures are viewed and consequently utilised by the caregivers. This study highlights the experiences and needs of caregivers to inform stakeholders on intervention strategies.

Development and validation of a supportive programme for family caregivers of children suffering from cystic fibrosis: protocol for a sequential exploratory mixed-methods study

INTRODUCTION

Families with children who have cystic fibrosis (CF) face a multitude of challenges. They require complex and time-consuming daily care, various forms of knowledge and intricate care responsibilities. One of the most critical challenges that Iranian families of children with CF face is the lack of adequate support from health teams in the early stages of diagnosis, frequent hospitalisation and the postdischarge process. Unfortunately, limited studies have been conducted in this field, and the Iranian society lacks a comprehensive support programme for these families after leaving treatment centres or home care teams. Therefore, it is necessary to identify and redefine the needs of these families for better care and support in Iran.

METHODS AND ANALYSIS

A mixed-method research design with an exploratory sequential approach will be used in this study. The study consists of three stages: stage (1) the qualitative phase (conventional content analysis and scoping review); stage (2) the programme design phase (development of a support programme) and stage (3) the quantitative phase (validation of the programme through the Delphi method). In the first stage, data will be collected through interviews. Key concepts, evidence and gaps in research will also be identified, collected and analysed through a scoping review. In the second stage, a support programme will be designed based on the results of the content analysis of interviews and the findings from the scoping review. In the final phase, the study will aim to validate the designed programme through a Delphi study.

ETHICS AND DISSEMINATION

This study formed part of a Ph.D. degree and was approved by the ethics committee of Tabriz University of Medical Sciences (IR.TBZMED.REC.1402.395). Informed consent will be obtained from all study participants. Findings will be published in a peer-reviewed journal.

Stress Coping Strategies in Parents of Newborns and Infants with Congenital Cyanotic Heart Disease with Regard to Stress Levels and Negative Emotions

BACKGROUND

Parents of children suffering from congenital heart disease experience high levels of stress and negative emotions. Therefore, recognition of parents' emotional states and their ways of coping with it is becoming more and more important.

METHODS

The study group consisted of 154 parents of newborns and infants with cyanotic congenital heart disease, before and after cardiac surgery (partial or full). To assess parental negative emotions, the level of stress, and strategies of coping with it, standardized questionnaires, such as HADS-M, PSS-10, and COPE, were used.

RESULTS

Stress levels in parents were high and associated with negative emotions (anxiety, depression, irritability), as well as the choice of non-constructive coping strategies, which was observed especially in younger parents.

CONCLUSIONS

Assessing parents' stress levels and ways of coping with stress can improve family functioning and provide better development conditions for the child.

Disease Burden and Coping Strategies of Spouses of Patients with Psoriasis: A Qualitative Study

Background

Psoriasis is a chronic autoimmune inflammatory skin condition characterized by erythema, papules, and scales. It imposes a heavy psychological and social strain on both patients and their families. Surprisingly, there's limited research delving into the disease burden and coping strategies of spouses contending with psoriasis.

Objective

The objective is to explore the disease burden faced and coping strategies utilized by spouses of individuals living with psoriasis. This exploration aims to offer insights crucial for devising mental health support and intervention strategies.

Methods

The research methodology employed in this study was phenomenological, a qualitative approach. A total of fifteen spouses of patients with psoriasis were selected using an objective sampling method for in-depth, semi-structured interviews. Thematic analysis was then applied to the recorded interview data to derive meaningful themes.

Results

This study has identified and analyzed three core themes concerning the disease burden and coping strategies of spouses of patients with psoriasis: Overwhelming disease burden; Lack of support system; Coping strategies (Problem - centered coping strategies: Proactive acquisition of disease knowledge; Active confrontation of illness - related issues; Behavioral habit alteration; and Emotional - centered coping strategies: Active acceptance and normalization; Passive acceptance and internalized stigma; Avoidance of disease - related problems).

Conclusion

This study adds valuable insights into comprehending the disease burden encountered by spouses of patients with psoriasis and sheds light on the coping strategies they employ. Healthcare providers should proactively recognize and address the burden experienced by spouses early on. Establishing a robust support network is crucial, and promoting adaptive coping strategies can significantly aid spouses in effectively navigating and managing the complexities associated with psoriasis.

A sense of coherence (SOC) among the fathers of children with chronic illnesses

AIM

This study focuses on the fathers of children with chronic illnesses in an effort to clarify how the stressor and the father's sense of coherence (SOC) influence their mental health and how the father's SOC is associated with the social support.

DESIGN

Cross-sectional study.

METHODS

We conducted a self-reported questionnaire survey of 137 respondents (51 fathers of children with chronic illnesses, 86 fathers of healthy children) were statistically using ANOVA.

RESULTS

The fathers' stressor was significantly related to their SOC. Furthermore, the SOC of the fathers majorly influenced their mental health, while having a buffering effect on the stressor with respect to depression. And their SOC was significantly positively associated with the social support. Our findings underscore that father's SOC has a buffering effect on self-mental health and is important for maintaining mental health and enhancing SOC to reduce the stressors of these fathers with respect to depression.

Alignment of Canada's COVID-19 policy response with barriers and facilitators for coping reported by caregivers of youth with developmental delays, disorders, and disabilities

Introduction

The UNICEF-WHO Global Report on Developmental Delays, Disorders, and Disabilities is an ongoing initiative aimed at increasing awareness, compiling data, providing guidance on strengthening health systems, and engaging country-level partners. Data from its caregiver survey assessing impacts of the COVID-19 pandemic showed that half of youths with developmental delays and disabilities (DDDs) and their caregivers struggled to cope, with a significant portion reporting a lack of supports and difficulty managing the worsening of the child's symptoms in isolation. Governments created service strategies supporting vulnerable groups. Little is known about the alignment between COVID-19 policies for persons with disabilities and their lived experiences. Contextualizing caregivers' experiences can promote the development of tailored public supports for these families following a public health crisis.

Methods

Online survey data were collected from June-July 2020, leading to a convenience sample of caregivers of youth with DDDs across Canada. Respondents answered two open-ended questions regarding challenges and coping strategies during the pandemic. We conducted a thematic analysis of responses using inductive coding on NVivo software. Overarching codes derived from the dataset were contextualized using an analysis of provincial policies published during the pandemic. Parallels with these policies supported the exploration of families' and youths' experiences during the same period.

Results

Five hundred and seventy-six (N = 576) participants answered open-ended questions. Barriers to coping included family mental health issues, concerns about the youths' regression, challenges in online schooling, limited play spaces, and managing physical health during quarantine. Environmental barriers encompassed deteriorating family finances, loss of public services, and a lack of accessible information and supports. In contrast, caregivers reported coping facilitators, such as family time, outdoor activities, and their child's resilience. Environmental facilitators included community resources, public financial supports, and access to telehealth services. Few COVID-19 policies effectively addressed caregiver-identified barriers, while some restrictions hindered access to facilitators.

Conclusion

Prioritizing needs of families of youths with DDDs during public health emergencies can significantly impact their experiences and mental health. Enhancing financial benefits, providing telehealth services, and creating inclusive public play spaces are priority areas as we navigate the post-pandemic landscape.

Stress and Coping Factors Affecting Health-Related Quality of Life in Parents of Children with Congenital Heart Disease: An Integrative Review

Parents of children with congenital heart disease experience unique stressors that affect their psychological well-being and health-related quality of life. A parent's ability to cope effectively influences how they adjust to stressful situations. The purpose of this review is to synthesize the factors influencing HRQoL in parents of children with congenital heart disease under the lens of the Transactional Model of Stress and Coping framework to identify areas for intervention and future research. An integrative literature review was conducted by keyword search of online databases PubMed, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and Medline from 2011 to 2022. Inclusion and exclusion criteria were applied to search results and studies were assessed for quality using the Mixed Method Appraisal Tool. The initial search yielded 1026 unique papers, and 24 were included based on the predefined criteria. The Transactional Model of Stress and Coping was applied to organize results and generate themes. Results showed a child's hospitalization is a time of uncertainty and distress for parents of children with congenital heart disease. Effective problem-focused and emotion-focused coping strategies can lead to reduced stress and improved health-related quality of life for parents. Additionally, multiple variables moderate the relationship between a parent's perceived stress and adjustment. Health care teams should focus on targeted education, faith, coping, and social support interventions. Further research is needed that examines the effect of mental health factors, cultural differences, and socioeconomic variables on the health-related quality of life of parents of children with congenital heart disease.

Psychological aspects of being a parent of an individual with Rett syndrome: A scoping review

BACKGROUND

Rett syndrome (RTT) causes multiple disabilities with a lifelong need for substantial care, placing a tremendous lifelong responsibility on the parents. Parenting an individual with RTT can therefore be challenging. Research on the psychological aspects of parenting individuals with RTT is limited and unclear. We aimed to identify and map the existing literature on this subject.

METHOD

A scoping review was conducted with systematic searches in PubMed, PsycINFO and CINAHL.

RESULTS

Eighteen studies were included. Negative and positive psychological aspects were described with the majority focusing on the negative. Three factors seemed to especially affect the parents: severity of the diagnosis, time (increasing age of parents or individual with RTT; years of caretaking), work-status of the mother.

CONCLUSIONS

Seemingly, parents are highly affected; however, the literature is scarce and has several gaps. Future research should include older parents, fathers, parents of individuals living in group homes, and positive aspects.

Resilience and adolescence-transition in youth with developmental disabilities and their families: a scoping review

Background

Children with neurodevelopmental disabilities (NDDs, e.g., cerebral palsy) and their caregivers face lifelong and impactful challenges, particularly during life-transition periods such as adolescence. One's resilience emerges as an essential ability to navigate this vulnerable phase. Resilience is a complex concept that embeds multiple factors on various levels. Little is known about what resilience factors are pivotal in youth with NDDs and their families as they transition into adolescence and how these are addressed as part of existing targeted interventions.

Objectives

This review explored the concept of resilience in youth with NDDs and their families. Specific aims included describing salient resilience factors in adolescents with NDDs and their families and to describe how resilience is addressed as part of targeted interventions.

Methods

Using the Arskey and O'Malley framework, six steps were undertaken, including a comprehensive literature search (n = 5 databases), transparent study selection, detailed data extraction with a coding scheme (n = 46 factors), results' collating with numerical and inductive content analysis, and consultation with three key stakeholders.

Results

The study screened 1,191 publications, selecting fifty-eight (n = 58; n = 52 observational and n = 6 intervention) studies. Findings revealed that resilience in this context is closely linked to more than forty factors across four levels (individual; family; school/peers; and community). Pivotal factors include social and emotional competence, optimism, and family/peer relationships. While existing interventions targeting resilience show promising results, few programs are available and generalizable to different NDDs. Stakeholders highlighted the importance of addressing resilience factors that are not targeted in existing interventions: caregivers' self-efficacy and self-esteem, as well as youth's and caregiver's confidence. Preferences for and advantages of online delivery for support programs and individual/group features also emerged.

Conclusion

The review emphasizes the need for a holistic approach to support youth with NDDs and their families during adolescence transition. To enhance their resilience, recognizing caregivers' roles, customizing interventions, and exploring new implementation formats are avenues that align with the current evidence and opportunities for practical development in this field.

Cross-Cultural Adaptation and Psychometric Testing of the Portuguese Version of the Iceland-Family Illness Beliefs Questionnaire

Illness beliefs have a role in the adaptation, coping, well-being, healing, and recovery in families of children/adolescents with chronic illness. The assessment of family illness beliefs can support family nursing interventions that address the suffering of family members when illness arises. The purpose of this study was to translate, cross-culturally adapt, and psychometrically test the Portuguese version of the Iceland-Family Illness Beliefs Questionnaire. A sample of 237 parents of children/adolescents who experienced chronic health conditions completed the online questionnaire. The original factor model was tested through confirmatory factorial analysis. The results showed satisfactory model fit indices (χ2/gl = 3.004; comparative fit index [CFI] = 0.90; root mean square error of approximation [RMSEA] = 0.092) and internal consistency (Cronbach's α = 0.74). The instrument showed good psychometric characteristics of validity and reliability, suggesting it may be useful in the assessment of illness beliefs in families experiencing a pediatric chronic illness.

Effectiveness of a supportive care program via a smartphone application on the quality of life and care burden among family caregivers of patients with major depressive disorder: a randomized controlled trial

BACKGROUND

The majority of patients with major depressive disorder require care that has generally affected caregivers' lives. Providing care could cause negative experiences as a care burden and deteriorate quality of life. However, there is a lack of evidence about caregiver training-based informatics and its impact on the caregiver's life.

METHODS

This experimental study was carried out in Mashhad, Iran. A total of 60 primary family caregivers of patients with major depressive disorder were included in the study between February and July 2021. The quadruple block randomization method was used to allocate the participants into control and intervention groups. In the intervention group, family caregivers used the application with weekly phone calls for one month. The app contains the most important points of patient care and has the possibility of communicating with the nurse. The Novak and Guest Care Burden Inventory and the short form of the World Health Organization Quality of Life Questionnaire were completed before and after the intervention. Data analysis was performed using chi-squared tests, independent sample t tests, and analysis of covariance.

RESULTS

At baseline, the mean scores of care burden and quality of life were homogeneous between the two groups. After the intervention, the mean scores of care burden and quality of life were significantly reduced and improved in the intervention group compared with the control group (p < 0.001).

CONCLUSIONS

Using the application with the ability to communicate with the caregiver, along with educational support, helps to strengthen the relationship between the family caregiver and the nurse. Despite the effectiveness of the present intervention, before including this form of implementation of support in care programs, it is necessary to evaluate its other positive aspects in future studies.

TRIAL REGISTRATION

Iranian Registry of Clinical Trials (IRCT), IRCT20210202050222N1. Registered on 05/02/2022.

Comparing Physical Activity and Quality of Life of Caregivers of Children With Physical Disabilities and Typically Developing Children

There are conflicting reports of the level of physical activity (PA) and its relationship to quality of life (QoL) among caregivers of children with physical disabilities (CwPD). In this cross-sectional study, we aimed to compare the PA levels and QoL of two groups of caregivers - a CwPD group and caregivers of typically developing children (CwTD). We included 32 family caregivers in the CwPD group (22 women, 10 men; M age = 42.1, SD = 6.2 years) and 32 caregivers in the CwTD group (24 women, 8 men; M age = 42.3, SD = 6.1 years). We assessed PA with the International Physical Activity Scale-Short Form (IPAQ-SF) and self-reported activity diaries, and we assessed QoL with the Short-Form 36 (SF-36) questionnaire. Although the IPAQ scores and sitting times of caregivers in these two groups were not statistically different (p > .05), many parameters of self-reported activity diary data and total energy expenditure were significantly higher in the CwPD than the CwTD group (p < .05, effect size = .53-1.10). The CwPD group reported a lower QoL according to the SF-36 and its sub-scores (p < .05, effect size = .54-.77), and higher PA levels than those in the CwTD group. In the CwPD group, moderate, vigorous, and total PA scores were mildly to moderately associated with the total Qol score, and many of its subscores (r = .36 to .60, p < .05). The lower quality of life observed in CwPD, despite high-intensity physical activity levels, suggested that investigators and care providers should consider QoL in the CwPD group to be multifactorial and that here is a need for caregiver interventions to enhance QoL in this underserved population.

Coping Factors for Caregivers of Children With Medical Complexity During Hospitalization

OBJECTIVES

This study aimed to identify coping factors for caregivers of children with medical complexity (CMC) to manage the stressors and experience associated with their child's hospitalization.

METHODS

We conducted semistructured interviews with CMC caregivers over a video-conferencing platform to examine factors that they perceive impact their coping while their children are hospitalized. Interviews were audio-recorded, transcribed, and imported into a qualitative coding software (MAXQDA). Using a modified grounded theory approach, we assigned process and in vivo codes to the transcripts and conducted interpretive analysis to identify themes. Once we reached thematic saturation, we finalized themes by discussing them to achieve group consensus and processed themes through triangulation with our institution's pediatric family advisory council.

RESULTS

We interviewed 14 caregivers (11 mothers and 3 fathers) and identified 3 major themes. The factors that contributed to CMC caregiver coping with their child's hospitalizations included caregivers: feeling that they are prioritizing their child's needs over their own, feeling trust in their child's interdisciplinary healthcare team, and feeling their self-care practices are well adjusted to the hospital setting.

CONCLUSIONS

Our study found 3 coping factors for caregivers of CMC during their child's hospitalization. Development and testing of interventions that enhance these coping practices may better support CMC caregivers during their child's hospitalizations. Potential interventions could include developing structured processes to establish caregiver involvement in their child's hospital care and helping caregivers modify their existing coping mechanisms to the hospital setting.

Caregiver's Quality of Life Among Children with Cerebral Palsy in the Kingdom of Saudi Arabia, and Various Influencing Factors: A Single Cohort Study

Purpose

Quality of life (QOL) among disabled children and their caregivers is an important concern in healthcare. We aim to evaluate the quality of life among caregivers of children with cerebral palsy and to observe the effects of various demographic factors and affected child-related factors on caregivers' quality of life.

Patients and Methods

After ethical approval and written consent was obtained from the participants. One hundred six caregivers of children with cerebral palsy from the Asir region were recruited for the study. Caregivers provided details, including their demographic characteristics, social factors, and information regarding their affected children regarding age, gender, mobility levels, etc. They also completed the Arabic version of the World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaire for assessing their QOL.

Results

All the caregivers were women; their mean age was 40.38 years and SD7.09, and the overall QOL mean and standard deviations were 66.38 ± 12.88. There was a moderately significant correlation between total QOL in comparison with caregivers' educational level and mobility capacity, with R values of 0.54 (p<0.001) and 0.62 (p<0.001), respectively.

Conclusion

All the subdomains of WHOQOL-BREF were found to be very closely related to the total scores for QOL. The caregivers of children with cerebral palsy had better QOL scores than the cutoff scores proposed in the WHOQOL-BREF scale. Factors such as increased mobility and education of the affected child contributed to better total QOL scores.

Caregiver Burden, Stress, and Relationship Cohesion Among Self-Identified Caregivers of Children with Pediatric Acute-Onset Neuropsychiatric Syndrome

Objective: Children with Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) experience sudden onset neuropsychiatric symptoms after infection or other triggers. Symptoms range from mild to severe, potentially lasting days, weeks, months, or longer. Exacerbation-related functional decline presents in many aspects of daily life, generally accompanied by family stress and caregiver burden. We sought to investigate the relationship between severity of PANS symptoms and caregiver burden/stress and the relationship between severity of PANS symptoms and degree of caregiver/child cohesion. Methods: This cross-sectional online study surveyed caregivers recruited from PANS-related social media support sites. The Pediatric Acute Neuropsychiatric Symptom Scale - Parent Version (PNSS) measured current severity. Caregiver Burden Inventory (CBI) and Caregiver Self-Assessment Questionnaire (CSAQ) assessed caregiver burden/stress. Inclusion of Other in the Self (IOS) scale determined caregiver-perceived current and desired cohesion with their child(ren) with PANS. Results: Of the 216 respondents 79.6% exceeded CBI threshold indicating need for respite in adult care receiver populations. On the CSAQ, 72.9% expressed high distress, 80.5% reported feeling overwhelmed, and 58.1% reported crying spells, meeting cutoffs for support/respite used in adult care receiver populations. Most caregivers reported not having the desired degree of cohesion with their child on the IOS (85.5%). Parents of children with more severe PNSS symptoms fared significantly worse on all measures (CBI: H = 57.83; CSAQ: F = 29.26; IOS: H = 38.04; p < 0.001 for all). Content analysis of comments revealed five themes: (1) severe caregiver and/or family emotional distress and trauma; (2) caregivers wondering what happened to their child; (3) lack of awareness and support among health and education professionals; (4) relationship strain with family, friends, and significant others; and (5) financial and/or legal struggles because of their child's diagnosis. Conclusion: There is strong need for support and respite for children with PANS and their families. Long-term effects including posttraumatic stress symptoms among family members should be studied.

Understanding School Anxiety in Italian Adolescence through an Artificial Neural Network: Influence of Social Skills and Coping Strategies

School anxiety depends on multiple factors that occur directly or indirectly in the teaching-learning process, such as going to the blackboard in class or reporting low grades at home. Other factors that influence school climate are social skills and coping strategies. That said, the aim of this research was to analyze the sources of school anxiety, coping strategies, and social skills in Italian secondary school students through an artificial neural network. For this purpose, a quantitative and ex post facto design was used in which the Inventory of School Anxiety (IAES), the Coping Scale for Children (EAN), and the Questionnaire for the Evaluation of Social Skills student version (EHS-A) were administered. The results showed that cognitive avoidance and behavioral avoidance coping strategies, together with the lack of social skills in students, are the variables that contributed the most to school anxiety scores in the artificial neural network. The conclusions revolve around the need to develop primary prevention programs.

Parental reflective functioning and coping among parents of toddlers with severe developmental disabilities: An early integrative bio-psycho-social rehabilitative intervention in daycare facilities

BACKGROUND

Parental reflective functioning has a positive effect on parents' wellbeing. It is associated with positive outcomes for their children. However, there is little research on it among parents of toddlers with severe developmental disabilities.

AIMS

We examined an early bio-psycho-social rehabilitative intervention with parents of toddlers with severe developmental disabilities in daycare programs and its contribution to their parental reflective functioning and coping.

METHODS AND PROCEDURES

Seventy parents of children (ages 3 months to two and half years) responded to measures before and after the intervention in their children's daycare programs. Structural equation modeling of the mediation model revealed that the therapeutic inputs were associated with more adaptive coping strategies by increasing parental reflective functioning.

OUTCOMES AND RESULTS

Parents who participated in an intervention of 13 sessions or more significantly increased their reflective functioning. The path analysis showed that parental reflective functioning after the intervention mediated the association between its prior level and the therapeutic inputs, and the parents' proactivity and search for support.

CONCLUSIONS AND IMPLICATIONS

Parental reflective functioning positively affects parents' adaptive coping styles. A bio-psycho-social intervention targeting parental reflective functioning benefits parents of toddlers with severe developmental disabilities.

Stress, Coping, and Physical Health in Caregiving

Informal caregivers experience a great deal of stress due to care-related duties and responsibilities. Caregiving stress has the ability to impact caregivers' physical health, but has been largely understudied in caregivers of children with a chronic illness. In this study, we examine the associations of stress to both caregiver self-rated health and biomarkers of the hypothalamic-pituitary-adrenal (HPA) axis and immune systems (arginine vasopressin, c-reactive protein, tumor necrosis factor alpha). We also examine whether coping style (proactive, avoidant, support coping) buffers the links of stress to health across two different stressor contexts: caregiving for a child with a rare or undiagnosed disease (n = 101) and caregiving for a typically developing child (n = 69). Results indicated perceived stress was linked to worse self-rated health, however, stress was only linked to biological markers of health for caregivers of typically developing children. Results also suggest that coping style may moderate some of the links of stress to health, as proactive coping was linked to lower arginine vasopressin. However, models also suggested the role of coping style may differ based on caregiving context, as support coping was linked to better health only for caregivers of typically developing children, and more proactive coping overall was observed in the rare disease context. Future research should continue to examine how stress and coping interact within different caregiving contexts to protect caregiver health and well-being.

Feeling stretched: Parents' narratives about challenges to resilience when their child has a tracheostomy

This study aimed to examine how parents develop personal resilience when facing the challenges of caring for a child with tracheostomy. This study employed a longitudinal qualitative design. Unstructured narrative interviews with 12 parents (from nine families) whose child had a new tracheostomy were undertaken at three time points over 12 months. Data were analysed using a socio-narratology method. Findings reveal the journey parents experienced, how their feelings changed and the processes involved in developing resilience over the first 12 months of their child having a tracheostomy. Stories told by parents early in their journey revealed emotional upheaval, negative emotions, stress and shock. Due to medical need, parents had little or no choice for their child to have a tracheostomy. Once their child's life was out of danger, parents started to reframe their experiences and beliefs. Resilience played a major part in how parents perceived and faced their situation, allowing them to deal with what came their way and to move forward with their lives. Different aspects of resilience such as self-awareness, grit, gratitude, internal locus of control and reframing came to the fore at different time points. Parents talked feeling stretched by the challenges they faced and how they reframed their perspectives about their child's tracheostomy. Parents' resilience and reframing is discussed in relation to the ABC-X model. This study identifies a theoretical model that explains this process of change, this results in transferable knowledge, useful for understanding and explaining the experience of other parents and families.

Coping strategies following the diagnosis of a fetal anomaly: A scoping review

Introduction

Many women experience severe emotional distress (such as grief, depression, and anxiety) following a diagnosis of fetal anomaly. The ability to cope with stressful events and regulate emotions across diverse situations may play a primary role in psychological wellbeing. This study aims to present coping strategies after disclosing a fetal anomaly to pregnant women.

Methods

This is a scoping review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews (PRISMA-ScR). Electronic databases, including Web of Science (WOS, BCI, KJD, MEDLINE, RSCI, SCIELO), CINAHL, and EBSCO PsycARTICLES, were used to search for primary studies from the inception of each database to 2021. The keywords were determined by existing literature and included: "fetal anomaly," "fetal abnormality," "fetal anomaly," "fetal abnormality" AND "cope," "coping," "deal," "manage," "adapt*," "emotion* regulate*," with the use of Boolean operators AND/OR. A total of 16 articles were reviewed, followed by advancing scoping review methodology of Arksey and O'Malley's framework.

Results

In this review, we identified 52 coping strategies using five questionnaires in seven quantitative studies and one mixed-method study. The relationship between coping strategies and mental distress was explored. However, the results were inconsistent and incomparable. We synthesized four coping categories from qualitative studies and presented them in an intersection.

Conclusion

This scoping review identified the coping strategies of women with a diagnosis of a fetal anomaly during pregnancy. The relationship between coping strategies and mental distress was uncertain and needs more exploration. We considered an appropriate measurement should be necessary for the research of coping in women diagnosed with fetal anomaly pregnancy.

Youth-Onset Type 2 Diabetes: Burden of Complications and Socioeconomic Cost

PURPOSE OF REVIEW

With the rise in prevalence of youth-onset type 2 diabetes (T2DM), it is imperative to understand the clinical burden of the disease and the socioeconomic burden this disease imposes. We review the most recent data on youth-onset T2DM, including its pathophysiology, complications, and treatment. We also review existing data to determine the socioeconomic burden of youth-onset T2DM.

RECENT FINDINGS

The incidence of youth-onset T2DM is rising, and significantly accelerated following the COVID-19 pandemic. Youth with T2DM are more frequently from families of racial/ethnic minorities and lower socioeconomic status. Youth-onset T2DM has more rapid disease progression compared to adult-onset type 2 diabetes. It results in earlier and more severe microvascular and macrovascular complications compared to both adult-onset T2DM and youth-onset type 1 diabetes (T1DM). While there is a lack of data describing the socioeconomic cost of youth-onset T2DM, based on extrapolation from analyses of the burden of T2DM in adults and T1DM in youth, we propose that youth-onset T2DM has higher direct and indirect costs than adult-onset T2DM. Youth-onset T2DM presents a significant clinical and socioeconomic burden due to its aggressive presentation and earlier appearance of complications. Additional research is needed regarding the cost of illness in this population.

Brief Assessment of Adaptive and Maladaptive Coping Strategies During Pandemic

This study aimed to analyse the internal structure, internal consistency, and convergent and divergent validity for the Coping Strategies Scale. We found a two-factor solution (maladaptive coping; adaptative coping) with a second-order general factor (coping strategies) that demonstrated adequate factorial structure and internal consistency for a brief nine items instrument in a sample of 211 economically active Brazilians (M_age = 37.07; SD = 13.03). The adaptive strategies factor converged with quality of life and work. It also diverged from phobia, stress, and anxiety. Maladaptive coping strategies converged with phobia, stress, and anxiety and diverged from the quality of work and life. According to the results, we found that coping strategies are a vital personal resource to overcome daily adversity, including those from the current pandemic. The present instrument may impact worldwide, offering conditions to investigate and promote mental health positive outcomes by reinforcing coping assessment during pandemics.

Children's complex health: Maternal experiences of care and decision making

An increasing number of children with complex life-limiting and life-threatening conditions are being cared for at home by their parents. Negative impacts on maternal health are now being recognised. This study sought to voice parental experiences to determine what matters most; explore day-to-day decision making and Advance Care Planning; and to inform local service development. Seven mothers from one community nursing service were interviewed using a semi-structured qualitative approach during the Coronavirus disease 2019 pandemic. Seven data-driven themes were identified following six phase thematic analysis: cherishing normality; navigating the system; being proactive; meaningful connections; beginner to expert - and back; they're not any child - they're my child; and Coronavirus disease 2019 pandemic. Practice implications include early discussion of what matters most and benefits of written plans to ensure fair access to treatment for children with complex health. Mothers highlighted that sharing their story enhanced their sense of coping and purpose. Increased support at times of vulnerability and permission to explore decisions were highly valued.

Individual and Family Determinants for Quality of Life in Parents of Children with Inborn Errors of Metabolism Requiring a Restricted Diet: A Multilevel Analysis Approach

OBJECTIVE

The objective of this study was to compare the quality of life (QoL) for parents of children with inborn errors of metabolism (IEMs) requiring a restricted diet with French population norms and investigate parental QoL determinants.

STUDY DESIGN

This cross-sectional study included mothers and/or fathers of children < 18 years of age affected by IEMs requiring a restricted diet (except phenylketonuria) from January 2015 to December 2017. Parents' QoL was assessed using the World Health Organization Quality of Life BREF questionnaire and compared with age- and sex-matched reference values from the French general population. Linear mixed models were used to examine the effects of demographic, socioeconomic, disease-related, and psychocognitive factors on parental QoL, according to a 2-level regression model considering individuals (parents) nested within families.

RESULTS

Of the 1156 parents invited to participate, 785 (68%) were included. Compared with the general population, parents of children with IEMs requiring a restricted diet reported a lower QoL in physical and social relationship domains but a higher QoL in the psychological domain. In the multivariate analysis, characteristics associated with poorer parental QoL included both parent-related factors (being a father, older age, more educated parent, nonworking parent, greater anxiety, seeking more social support, and using less positive thinking and problem-solving coping strategies) and family-related factors (disease complications, increased number of hospital medical providers, child's younger age, single-parent family, and lower family material wealth).

CONCLUSION

Parents of children with IEMs requiring a restricted diet reported poorer QoL in physical and social relationship domains than population norms. Psychocognitive factors, beyond disease-specific and family-related characteristics, were the most important determinants influencing parental QoL and may represent essential aspects for interventions.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov: NCT02552784.

Fathers' Experiences of Caring for a Child with a Chronic Illness: A Systematic Review

The prevalence of children living with chronic health conditions is increasing worldwide and can disrupt family roles, relationships, function, and parental involvement in family caregiving. The purpose of this systematic review was to explore fathers' experiences and involvement in caring for a child with a chronic condition. Systematic searches using seven databases were conducted. Study criteria included (1) peer-reviewed original research in English, Spanish, French, or Portuguese, (2) children less than 19 years of age with a chronic condition, (3) fathers (biological or guardian) as direct informants, and (4) outcomes addressing fathers' experience, perceptions, and/or involvement in the child's care. Data were synthesized from ten articles reflecting eight separate studies that utilized quantitative designs. Three areas of focus were identified: Family Functioning, Father's Psychological Health, and Need for Support. Data suggested increased involvement from the father in caring for their child with a chronic condition was associated with improved family functioning, increased anxiety and distress, decreased self-esteem, and increased need for support. This review revealed a paucity of data regarding fathers' experiences and involvement when caring for a child with a chronic condition, with that available primarily from developed countries. Rigorous empirical studies are needed to deepen understanding of how fathers are involved in the care of their child with a chronic condition.

Coping strategies and associated factors among people with physical disabilities for psychological distress in Ethiopia

BACKGROUND

Coping strategies are frequently used among individuals with physical disabilities when they face adversities. Low- and middle-income countries are not investigated coping styles among psychological distress persons with disabilities despite the high prevalence of psychological distress. The aim of this study was to identify coping strategies among people with physical disabilities for their psychological distress in Ethiopia has a crucial role to improve the health status of persons with physical disabilities.

METHODS

An institution-based cross-sectional study was employed among individuals living with physical disabilities at the University of Gondar staff and students from May to June 2021. All staff and students with physical disabilities were screened for psychological distress (n = 269). The census sampling technique was used to select the study participants for psychological distress. The Brief Cope with Problems Experienced (COPE-28) was used to assess coping strategies. Bivariate and multivariate linear regression analyses were used to identify factors associated with coping strategies. An odd ratio (OR) with a 95% confidence interval (CI) at P < 0.05 was computed to assess the strength of the association.

RESULTS

The emotional-focused coping strategy was the most frequently used when dealing with psychological distress among participants with physical disabilities. The most commonly used emotional-focused coping strategy was spirituality. In the multivariate analyses; urban residence (β = 3.05, 95% CI: 0.98, 5.12), and stigma (β = 3.10, 95% CI: 0.61, 2.83) were factors positively associated with emotion-focused coping strategy, and World Health Organization Quality of Life (WHO QOL) (β = 0.18, 95% CI: 0.13, 0.22), and stigma (β = 1.11, 95% CI: 0.61, 2.83) were factors significantly associated with problem-focused coping. Urban residence (β= -0.96, 95% CI: -1.69, -0.22) was negatively associated with dysfunctional coping strategy, but WHO QOL (β = 0.35, 95% CI: 0.32, 0.38) was positively correlated with dysfunctional coping.

CONCLUSION

In this study revealed that spirituality is the most frequently used coping strategy among the study participants. Urban residents, stigma, and WHO QOL significantly correlated with coping strategies among such patients. The Ministry of Health, Ministry of Education, and other concerned organizations may find the present findings useful to strengthen the coping styles to minimize psychological distress among people with physical disabilities.

Burden of informal caregivers of people without natural speech: a mixed-methods intervention study

BACKGROUND

People with disabilities and without natural speech often rely on care provided by informal caregivers. The caregiving situation of these informal caregivers has been poorly researched. The objectives of the study are 1) to identify stressors, resources, and coping strategies among informal caregivers of people without natural speech and 2) to examine whether a complex intervention in augmentative and alternative communication (AAC) that is not primarily tailored to the needs of informal caregivers can reduce care-related burden.

METHODS

The main components of the AAC intervention were (1) initial counselling session, (2) 4 AAC training sessions, (3) 20 AAC therapy sessions and (4) accompanying case management. The control group received only the initial counselling session. Within a quasi-experimental intervention study, survey data on self-perceived burden (Burden Scale for Family Caregivers, BSFC-s) from n = 154 informal caregivers of people without natural speech were collected at three time points between June 2018 and April 2021 from a postal survey. Qualitative interviews with n = 16 informal caregivers were conducted.

RESULTS

Caregivers reported various stressors such as limited communication with the cared-for person and concerns about the living situation in adulthood. Diverse resources and effective coping strategies, which the caregivers refer to when dealing with stressors, could also be identified. Burden was significantly reduced in the intervention group compared to the control group. According to the results of the qualitative study, AAC use led to better communication skills and a reduction in behavioural problems and thus a decreased burden.

CONCLUSIONS

The AAC intervention seems to have a positive impact on self-perceived burden. Linkages between intervention components and burden reduction as well as stressors and coping strategies could be identified and provide an evidence-based foundation for developing future holistic interventions for families with individuals without natural speech.

TRIAL REGISTRATION

German Clinical Trials Register (DRKS); ID: DRKS00013628 (registered on 05/02/2018).

Biomarkers of stress in caregivers of children with special health care needs: A protocol for systematic review

BACKGROUND

Children with Special Health Care Needs (CSHCN) require greater attention from family caregivers as they present temporary or permanent physical, developmental, behavioral, or emotional issues. This demand for care generates overload and stress among family caregivers. So far, there is no study that gathers the available literature regarding the use of biomarkers to assess stress among caregivers of CSHCN. Hence, we aimed to synthetize and to assess the scientific evidence on biomarkers associated with stress in caregivers of CSHCN.

METHODS

This systematic review and meta-analysis protocol was elaborated following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P). The search strategy will be undertaken through 7 electronic bibliographic databases: Embase, MEDLINE/PubMed, Cochrane Library, Web of Science, CINAHL, Scopus, and PsycINFO. In addition, secondary searches in other sources, such as Clinical trials.gov-NIH, The British Library, Pro Quest Dissertations Database, Google Scholar, and medRXiv will be also carried out. The reference section of the included studies will be hand searched for additional relevant studies. There will be no restriction regarding the publication dates or languages for this systematic review. Moreover, in an independently manner, 2 investigators will select studies, perform data extraction, as well as perform a critical appraisal of the risk of bias and overall quality of the selected studies, based on their designs. The heterogeneity among the studies will be assessed using the I2 statistic test. According to the results of this test, we will verify whether a meta-analysis is feasible. If feasibility is confirmed, a random-effect model analysis will be carried out. For data analysis, the calculation of the pooled effect estimates will consider a 95% CI and alpha will be set in 0.05 using the SPSS version 23.0.

RESULTS

This systematic review and meta-analysis will provide better insights regarding the biomarkers associated with stress in caregivers of CSHCN. Hence, consistent data and robust evidence will be provided to help practitioners and decision-makers in this area.

CONCLUSIONS

To the best of our knowledge this study, will be the first to synthetize and critically evaluate the scientific evidence on biomarkers associated with stress in caregivers of CSHCN.

Hope in the uncertainties and certainty for parents of children with rare neurological disorders: Part 2 (of 3): Certainty

This is the second of a three-part series that explores different aspects of uncertainty, certainty and hope in the context of providing clinical care for children with rare and life-limiting neurological disorders. When caring for families impacted by an overwhelming complex disorder in a child, complicated by threatening uncertainties and potentially more threatening certainties, clinicians utilise skills drawn from differing fields to make the load of information, and the emotional impact more manageable. The first article in this series addressed how clinicians might manage the 'accumulation of uncertainties' and to provide compassionate care not only to their patients, and their families, but also to themselves. This second paper delves into the less helpful aspects of 'certainty', including the associated losses and griefs endured by parents responding to threatening fears associated with their child's condition. In the extreme, disconnection and psychological isolation borne by parents can lead to a sense of hopelessness and desperation. Facing unwelcome certainties - clinicians and parents together - forms the basis of future trust and hope. Clinicians who share the field of trust with families and show commitment to helping parents, even when cure remains elusive, build a sense of hope. This is the sort of hopefulness that clinicians need to have and to offer as they share the journey with families. In this series, we seek to harness a shared approach to face unwelcome certainties and to kindle a sense of hope that is both credible and meaningful to the parents, family and clinician.

The experiences of caregivers of children with epilepsy: A meta-synthesis of qualitative research studies

Objective

Epilepsy is one of the most common chronic neurological disorders in children. The caregivers of these children bear heavy burden of care in the process of taking care of them. The objective of this metasynthesis was to explore the experiences and needs of caregivers of children with epilepsy.

Methods and data sources

Eight databases (PubMed, CINAHL, EMBASE, Web of Science, CNKI, Wanfang Data, VIP database, and CBM) were searched for qualitative studies from each database's inception to 31 June 2021. Studies were critically appraised using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research. Qualitative data were extracted, summarized, and meta-synthesized.

Results

13 studies were included, covering the data of 316 participants. 36 research results were extracted from these studies, which were combined into 11 categories, and finally formed 4 themes: (a) heavy burden of care; (b) emotional experience; (c) coping strategies; (d) care needs.

Conclusion

Caregivers beared a heavy burden of care and psychological burden. Despite the adoption of different coping strategies, their emotional distress was still very serious. Caregivers had unmet care needs. In order to improve caregivers' care capacity, the society and healthcare workers need to provide them with information support, psychological support, and take measures to create a friendly medical and living environment for them.

Impact

Understanding the experiences of caregivers of children with epilepsy will inform future research and practice. Healthcare workers could develop interventions to reduce caregiver burden and improve the level of caregivers' mental health. On the other hand, effective programs should be designed to improve caregivers' knowledge of the disease and enhance their ability to care. Society needs to take steps to improve the medical environment and the social stigma that is not friendly to epilepsy.

Caregiver experiences with transitions from pediatric to adult healthcare for children with complex care needs

BACKGROUND

Caring for a youth with complex care needs (CCN) who is transitioning from paediatric to adult healthcare can produce many challenges. For example, caregivers must often manage their youth's care at home, coordinate care and advocate for their youth. Experiences of fragmented and uncoordinated care often result in caregivers feeling ill-prepared and uncertain about the transition process. The current study explores caregiver experiences with the transition from paediatric to adult healthcare for youth with CCN in a semi-rural Canadian province.

METHODS

This study used a cross-sectional qualitative descriptive design, involving semi-structured interviews with caregivers of youth with CCN who were preparing for, in the process of, or completed a transition from paediatric to adult healthcare within the province of New Brunswick, Canada. Thematic analysis focused on describing caregiver experiences with the transition from paediatric to adult healthcare.

RESULTS

Seventeen caregivers completed interviews for this study. Four key themes emerged relating to caregiver experiences with the transition from paediatric to adult healthcare for these youth: (1) lack of caregiver support, (2) lack of continuity of care, (3) need for collaborative care and (4) difficulty navigating transition.

CONCLUSION

There is a clear need to address the challenges experienced by youth with CCN and their caregivers throughout the transition from paediatric to adult healthcare. An effective transition strategy should involve early and coordinated planning between the paediatric and adult care team; continued communication across the care team throughout the transition process; and coordination among health, education and social services.

Parenting Children with Cystic Fibrosis: Developmental Acquisition of Expertise

OBJECTIVE

This study was designed to increase our understanding of parents' experiences managing the needs of their children with cystic fibrosis (CF) and to identify potential gaps in services.

METHOD

We used grounded dimensional analysis of anonymous survey data obtained from a quality improvement initiative conducted by the Cystic Fibrosis Foundation (CFF). The Patient and Family Experience of Care (PFEC) survey was administered continuously at 125 CF care centers throughout the United States in 2017. The subsample of data for this study was completed by 80 parents/caregivers of children with CF (younger than 18 years).

RESULTS

Two unifying themes emerged from parents' survey responses: (1) parents' expertise expands continually as they learn and adapt to changes in their children's maturity or health and (2) parental expertise is sometimes visible or invisible to clinicians. Parents' expertise evolved with their children's development. Visible to care teams was at-home care, e.g., respiratory treatments and medications. Less visible were intangible management activities, e.g., social processes, emotions, and concerns that were omnipresent for parents but seldom disclosed to or seen/recognized by clinicians. Themes, such as the quality of encounters with care teams, progressive nature of CF, and hope derived from advances in research, were associated with specific contextual factors.

CONCLUSION

The findings expand our understanding of lived parental experiences of CF across childhood and offer direction for future quality improvement and research. Online parent surveys offer a valuable tool to identify unmet needs across subgroups of families affected by chronic childhood health conditions.

Cognitive deficiency, parental relationship, and coping strategies are related with anxiety and depression among parents of children with epilepsy

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.

Coping styles associated with depression, health anxiety and health-related quality of life in pulmonary hypertension: cross-sectional analysis

OBJECTIVES

Pulmonary hypertension (PH) is a life-shortening disease associated with early mortality and high morbidity. With advancements in medical treatment, people are living longer with the disease, and research is now needed to explore variables that help to enhance patient-reported outcomes. This study investigated the coping strategies of individuals with PH and examined the relationship between coping, depression, health anxiety and health-related quality of life (HRQoL).

DESIGN

A cross-sectional survey design was used.

PARTICIPANTS

Participants (n=121) were recruited from membership of Pulmonary Hypertension Association (PHA) UK.

OUTCOME MEASURES

Participants completed a series of questionnaires assessing depression (Patient Health Questionnaire-9), health anxiety (Short Health Anxiety Inventory), HRQoL (emPHasis-10) and coping (Brief COPE). A principal component analysis was used to identify participants' coping profile. A series of correlational, linear and moderated multiple regression analyses were performed to examine the relationship between coping and health-related outcomes.

RESULTS

Overall, 43% participants met criteria for potential clinical depression. Depression and health anxiety were strongly associated with HRQoL, explaining 37% and 30% of variance respectively (p<0.001). A principal component analysis identified a four-component model of coping. Dimensions were named based on construct items: 'cognitive and affirmation coping' (seven items), 'passive coping' (four items), 'external coping' (seven items) and 'substance use coping' (two items). Cognitive and affirmation and external coping moderated the relationship between depression and HRQoL, with high use of these coping strategies reducing the impact of depression on HRQoL. External coping also moderated the effect of health anxiety on HRQoL.

CONCLUSIONS

The results uniquely highlight the importance of coping styles and psychological distress in predicting HRQoL in PH. Our findings indicate the importance to assess for psychological distress in this population and suggest the need to offer psychological interventions that take into account coping resources and strategies.

Mental health outcomes and experiences of family caregivers of children with disabilities during the COVID-19 pandemic in Bolivia

This study examined whether certain demographic characteristics, caregiver strain, and coping behaviors were associated with the mental health outcomes of family caregivers of children with disabilities in Bolivia during the COVID-19 pandemic. A mixed-methods convergent study design was used with virtual interviews to quantitatively assess caregivers' demographic characteristics, caregiver strain, coping behaviors, and mental health outcomes, as well as qualitatively assess how the pandemic affected their family. Approximately 32%-71% of caregivers experienced poor mental health outcomes (stress, anxiety, and depression), especially among those experiencing poor health, high caregiver strain, and those using maladaptive coping strategies. Qualitative responses revealed that they experienced several unique stressors during the pandemic that affected them and their children. These findings highlight the need for culturally tailored prevention and treatment interventions to help offset the adverse effects of the COVID-19 pandemic on the mental health outcomes of this at-risk population.

Single session therapy in pediatric healthcare: the value of adopting a strengths-based approach for families living with neurological disorders

BACKGROUND

Pediatric patients with neurological disorders often require lifelong management of symptoms and behaviours that can result in enduring emotional burden, stress and impacted health-related quality of life. Single session therapy (SST) draws upon patients' existing skills and knowledge and has emerged as a therapeutic approach to address pediatric patient and family needs in a timely manner. This study aimed to assess the clinical effectiveness of SST for pediatric patients with neurological disorders and their families, considering self-efficacy, distress, anxiety, therapeutic alliance and client satisfaction, as well as perceptions of whether SST met their pressing needs.

METHODS

A convergent parallel mixed-methods design included quantitative data collection via five standardized questionnaires across three time points and qualitative data collection through semi-structured interviews. Quantitative and qualitative data were analyzed independently and then integrated.

RESULTS

The study comprised of 135 participants, including patients, parents and siblings across diverse neurological conditions. Scores of self-efficacy and anxiety in children, and distress and anxiety in adults, improved significantly after the SST. Notably, changes in anxiety in adults remained significant five to seven weeks after the SST. Seventeen participants participated in 12 semi-structured interviews. Participants described that SST (1) was a missing piece in ongoing clinical care, (2) illuminated existing strengths and resilience, and (3) effected a lasting impact beyond the single session.

CONCLUSIONS

SST may be a promising initial, strengths-based treatment to support the short-term and potentially long-term needs of pediatric patients with neurological disorders and their families by emphasizing existing strengths, supporting therapeutic alliance and cultivating hope.

A cluster analysis to explore the burden of primary caregivers of children with cancer in Oman

PURPOSE

Few studies have sought to evaluate the risk burden of primary caregivers, particularly in Oman. This study aimed to explore whether different risk patterns of caregiver burden exist among the primary caregivers of Omani children with leukemia.

DESIGN AND METHODS

A cross-sectional study was conducted between May and November 2020. A total of 101 primary caregivers of children with leukemia were recruited from a public hospital in Oman. The Caregiver Burden Inventory (CBI) was used to assess caregiver burden.

RESULTS

A two-step cluster analysis indicated that the cohort was not homogeneous (silhouette value: 1.41). Caregivers in Cluster 1 (n = 42; 41.6%) were relatively older, less educated, and had a higher caregiving burden (mean CBI score: 37.7 ± 19.9). In contrast, caregivers in Cluster 2 (n = 59; 58.4%) were younger, more highly educated, and had a moderate caregiving burden (mean CBI score: 26.3 ± 13.6). As such, Clusters 1 and 2 were characterized as the "high-risk" and "moderate-risk" burden groups, respectively.

PRACTICE IMPLICATIONS

This study highlights the need for a policy draft to target and reduce the caregiver burden in Oman, Nursing professionals should seek to develop and implement customized care depending on the caregiver risk burden, including additional financial, psychological, and physical support. They should seek to stratify caregivers by risk burden as some groups may require additional support. However, in light of recent precautionary measures due to the current pandemic situation, such services will have to be provided online or via telephone instead of in person for the foreseeable future.

Engelli Çocuğa Sahip Ebeveynlerin Yaşam Kaliteleri ve Etkiyen Faktörler

Giriş: Amacımız Tokat ilinde engelli çocuğa sahip ailelerin yaşam kalitelerinin değerlendirilmesi ve yaşam kalitesini etkileyen faktörlerin belirlenmesidir. İlişkili olabilecek faktörler tanımlanması ile literatüre katkı sağlamak hedeflenmiştir. Yöntemler: Tokat ilinde yaşayan 6-14 yaş aralığındaki 134 engelli çocuğun ebeveynleri ile aynı yaş grubundaki 136 sağlıklı çocuğun ebeveynleri, bu kesitsel ve tanımlayıcı tipteki çalışmamızın evrenini oluşturdu. Sosyo-demografik veri formu ve WHOQOL-BREF olmak üzere iki kısımdan oluşan anket formu araştırmacılar tarafından katılımcılara yüz-yüze uygulanmıştır. Bulgular:Engel türlerine göre değerlendirildiğinde, çocuklarda en fazla zihinsel engellilik (%54,4) olduğu görüldü. Katılımcıların yaşam kalitesi karşılaştırıldığında, engelli çocuğu olanlar kontrol grubuna göre istatistiksel olarak anlamlı şekilde düşük bulunmuştur (p < 0.001). Engelli çocuğu olan anne ve babaların yaşam kaliteleri karşılaştırıldığında, ruhsal (p=0,029), sosyal (p=0.003) ve çevresel (p=0.038) alanlarda annelerin yaşam kalitesi ölçeği ortalama puanı babalarınkinden istatistiksel olarak anlamlı şekilde düşük bulunmuştur. Sonuç: Çalışmamızda engelli çocuğa sahip ebeveynlerin, sağlıklı çocuğa sahip anne ve babalara göre bedensel, ruhsal, sosyal ve çevresel alanlarda yaşam kalitelerinin anlamlı derecede düşük olduğu saptanmıştır. Engelli birey ve ailelerinin yaşam kalitelerini etkileyen faktörlerin tanımlanması, gelişen teknoloji ile değişebilen yaşam standartları ve beklentileri ışığında desteklerin belirlenmesi için kapsamlı çalışmalara ihtiyaç duyulmaktadır.

Range of invasive meningococcal disease sequelae and health economic application - a systematic and clinical review

Background

Invasive meningococcal disease (IMD) is uncommon, life-threatening, with many diverse sequelae. The aims were to: 1) comprehensively characterise the sequelae; 2) have a systematic application for sequelae impact in economic evaluation (EE).

Methods

Sequelae categorised as physical/neurological or psychological/behavioural were identified from a systematic review of IMD observational studies (OS) and EEs in high-income countries (published 2001–2020). A comprehensive map and EE-relevant list, respectively, included physical/neurological sequelae reported in ≥2OS and ≥ 2OS + 2EE (≥1OS and ≥ 1OS + 1EE for psychological/behavioural). Sequelae proportions were selected from the highest quality studies reporting most sequelae. Three medical experts independently evaluated the clinical impact of findings.

Results

Sixty-Six OS and 34 EE reported IMD sequelae. The comprehensive map included 44 sequelae (30 physical/neurological, 14 psychological/behavioural), of which 18 (14 physical/neurological and 4 psychological/behavioural) were EE-relevant. Experts validated the study and identified gaps due to limited evidence, underreporting of psychological/behavioural sequelae in survivors/their families, and occurrence of multiple sequelae in the acute phase and long-term.

Conclusions

The considerable burden of IMD sequelae on survivors and their families is potentially underestimated in EE, due to underreporting and poorly-defined subtle sequelae. When assessing IMD burden and potential interventions e.g., vaccination, sequelae range and duration, underreporting, and indirect burden on dependents should be considered.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13342-2.

Invasive meningococcal disease survivors frequently suffer from variable sequelae.

A broad sequelae map plus those relevant to economic evaluation (EE) were defined.

Forty-four sequelae were selected: 30 physical/neurological and 14 psychological/behavioural.

Eighteen EE-relevant sequelae included 14 physical/neurological and 4 psychological/behavioural

Underreporting, family impact and multiple sequelae cases were critical gaps.

A video summary linked to this article can be found on Figshare: 10.6084/m9.figshare.19753840.

Comparative Analysis of the Quality of Life in Families with Children or Adolescents Having Congenital versus Acquired Neuropathology

AIM

This research aims to determine whether the time of injury (congenital or acquired) affects the quality of life (QOL) in families having a child or adolescent with neurological impairment.

DESIGN

Comparative, cross-sectional study.

MATERIAL AND METHODS

To find out if there are differences in the quality of life domains between these two groups, 66 subjects (31 mothers of patients with congenital disorders and 35 mothers of patients with acquired disorders) completed the PedsQL-Family Impact Module (PedsQL-FIM), the World Health Organization Quality of Life Instrument-Short Form (WHOQOL-BRIEF), and the Cognitive Emotion Regulation Questionnaire (CERQ).

RESULTS

Analyzing the PedsQL-FIM dimensions, we found significant differences between groups in terms of emotional functioning, communication, and worry, which favor the congenital group. There are no statistically significant differences between social functioning, cognitive functioning, and daily activities groups. No significant differences between groups when evaluating the WHOQOL-BRIEF's domains (physical health, psychological health, social relationships, environment) have been found. According to CERQ results, adaptive strategies had higher mean scores in the congenital than in the acquired group. The mean score for maladaptive strategies in the congenital group is higher than that in the acquired one, except for catastrophizing, which is higher for acquired.

CONCLUSION

Our findings show that the mothers of patients with acquired neuropathology have a lower quality of life in the emotional functioning, communication, and worry domains.

Personality metatraits predict resilience among family caregivers responsible for a dependent youth's chronic respiratory management

Background

Family caregivers of children and youth with severe neurodisabilities that require chronic respiratory management often report a compromised quality of life. In this cross-sectional study, we used DeYoung’s (Psychol Inq 21(1): 26–33, 2010. 10.1080/10478401003648674) conceptualization of two personality metatraits, Alpha and Beta, to test their theorized role in facilitating resilience among these family caregivers. We expected higher Alpha and Beta would exhibit direct, beneficial effects on caregiver mental and physical health quality of life (QoL), and they would operate through self-reported resilience and coping to exert positive, indirect effects on caregiver QoL.

Methods

Family caregivers of children and youth at an outpatient chronic respiratory management clinic were informed of the study. Of the 68 who consented, 61 provided complete data on measures of personality traits, coping styles, and physical and mental health-related QoL. Factor analytic techniques verified the two personality metatraits, consistent with the DeYoung model. The metatraits were then used as predictor variables in a path model to predict physical and mental health-related QoL. Self-reported resilience and a coping variable were examined as possible mediators of the personality-QoL relationship.

Results

Correlational analyses isolated a coping variable that met criteria as a possible mediator. The path model exhibited good fit to the data. The Alpha metatrait—characterized by emotional stability, self-regulation, perseverance, and intrinsic motivation—was directly predictive of caregiver mental health. The Beta metatrait, reflecting a disposition for adaptive flexibility, responsiveness, and interpersonal initiative, demonstrated significant indirect effects to physical and mental health through its positive association with coping efforts to maintain social support and a sense of self.

Conclusions

Consistent with DeYoung’s conceptualization, higher Alpha and Beta predicted caregiver resilience, albeit through different pathways. The emotional stability, perseverance and emotional regulation associated with Alpha likely accounted for its positive association with caregiver mental health. Beta, in contrast, may operate through their adaptive flexibility, personal resourcefulness and social engagement to augment coping efforts that involve others and support family activities, which, in turn, promote their own physical and mental health. Limitations of the cross-sectional design, and potential theoretical and clinical implications of the personality metatraits and their relation to resilience are discussed.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40359-022-00791-y.

Living with a genetic, undiagnosed or rare disease: A longitudinal journalling study through the COVID-19 pandemic

Introduction

COVID‐19 changed the way we lived with uncertainty from the outset as the pandemic impacted every aspect of our lives from well‐being, socializing to accessing healthcare. For people in vulnerable populations, such as those with genetic, undiagnosed and rare disorders, the experience was heightened.

Aim

The aim of this study was to identify how the rapidly changing COVID‐19 environment impacted the lives of the Genetic, Undiagnosed and Rare Disease community.

Methods

From June 2020 to May 2021, we collected monthly open‐ended journals from people living in Australia with genetic, undiagnosed and rare disorders. Data analysis was deductive, using the Resilience Scale for Adults, and inductive using thematic analysis.

Results

We recruited 29 people (average of n = 9.7 submissions each month). Responses changed over the year, with initial journals focusing on the importance of developing new structures for day‐to‐day lives, while later journals started to focus on mental well‐being. Throughout the project, participants reported challenges in accessing health and social care that was compounded by fear and concern over being exposed to the virus. Later journals highlight inconsistent messaging for vaccinations for this vulnerable community.

Discussion/Conclusion

In parallel with the waves of the COVID‐19 pandemic, there need to be waves of targeted support for vulnerable communities. The first support wave needs to focus on facilitating the identification of new frameworks to structure day‐to‐day lives. A later second wave needs to focus on mental well‐being and coping with isolation, while consistent communication relating to health and social care throughout was essential.

Patient/Public Contribution

This study was co‐designed, co‐led and analysed with a patient support network.

Parents Caring for Children Diagnosed with a Blood Cancer from Infancy to Emerging Adulthood: A Life span Perspective

Purpose: Pediatric blood cancer diagnosis is a stressful experience for families as it can involve urgent treatment that can be life-threatening and require extended hospital stays. Little is known about the experiences of parent caregivers of children with a blood cancer during the diagnosis period and how families' needs may differ in light of the patient's developmental phase in the life span. Methods: We conducted semistructured in-depth interviews with 20 parent caregivers (aged 30-65) of children diagnosed with a blood cancer, recruited through The Leukemia & Lymphoma Society's (LLS) constituency. Interview transcripts were thematically analyzed using the constant comparative method. To elucidate similarities and differences in caregiving experiences, findings were compared across parents with children diagnosed in three developmental periods: infancy-early childhood, age 0-6 (n = 9); pre-early adolescence, aged 9-14 (n = 5); and late adolescence-emerging adulthood, aged 16-27 (n = 6). Results: Across all developmental periods, parents described three similar caregiving experiences during the diagnosis period: being persistent to obtain a diagnosis, attending to the child's quality of life challenges, and attending to their other children's well-being. Among caregivers of younger children, persistence was motivated by parental intuition and challenges included coping with traumatic physical and psychological impacts of treatment procedures. For caregivers of late adolescents-early adults, persistence was motivated by the child's self-assessment and fertility-related concerns emerged. Conclusion: Results illustrate core issues for parent blood cancer caregivers and highlight ways to tailor supportive resources that facilitate good communication practices and shared decision-making to children's distinct developmental needs.