1
|
Klages KL, Schwartz LE, Crabtree EJS, Brokamp C, Rasnick E, Dandoy CE, Davies SM, Pai ALH. Social determinants of health predict health outcomes following pediatric allogeneic hematopoietic stem cell transplant. Pediatr Blood Cancer 2024; 71:e30892. [PMID: 38302730 DOI: 10.1002/pbc.30892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 01/10/2024] [Accepted: 01/13/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Pediatric hematopoietic stem cell transplantation (HCT) is an intensive medical procedure that places substantial financial and logistical burdens on families and is associated with significant health risks, such as graft-versus-host disease (GVHD), and infections. The influence of the social determinants of health (SDoH) on outcomes following pediatric HCT is understudied. This study aimed to examine whether SDoH predicts outcomes following pediatric HCT. PROCEDURE Data were collected from 84 children who received HCT (Mage = 5.8 years, SD = 3.7) and their primary caregiver. Detailed demographic information was collected from caregivers at baseline, and child health information was extracted from the electronic medical records. Multivariate logistic regression was used to examine the association between SDoH and health outcomes within a 24-month period following pediatric HCT. RESULTS After controlling for malignancy as reason for transplant and donor type, lower family income predicted the incidence of chronic GVHD. Neighborhood deprivation, total family income, public health insurance, caregiver relationship status, caregiver educational attainment, and perceived family financial difficulties did not predict acute GVHD or the number of infections. CONCLUSIONS Total family income is a simple family indicator of SDoH that predicts chronic GVHD after pediatric allogeneic HCT. These findings provide further support for the importance of screening of child and family SDoH risks to ensure that fundamental needs can be met to mitigate potential health disparities for up to 2 years following pediatric HCT.
Collapse
Affiliation(s)
- Kimberly L Klages
- Patient and Family Wellness Center in the Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Laura E Schwartz
- Patient and Family Wellness Center in the Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Endia J Santee Crabtree
- Patient and Family Wellness Center in the Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Cole Brokamp
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Erika Rasnick
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Christopher E Dandoy
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Bone Marrow Transplantation & Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Stella M Davies
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Bone Marrow Transplantation & Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Ahna L H Pai
- Patient and Family Wellness Center in the Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| |
Collapse
|
2
|
Chardon ML, Klages KL, Joffe NE, Pai ALH. Pediatric Hematopoietic Stem Cell Transplant Medication Adherence Facilitators and Strategies: A Qualitative Study. J Pediatr Psychol 2023; 48:415-424. [PMID: 36173365 PMCID: PMC10199727 DOI: 10.1093/jpepsy/jsac078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 08/10/2022] [Accepted: 09/18/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Taking medications as prescribed after hematopoietic stem cell transplant (HCT) is key for ensuring children's survival; however, suboptimal medication adherence is common. Development of evidence-based interventions to improve medication adherence post-HCT is contingent upon understanding what adherence facilitators (i.e., unique traits, characteristics, or resources inherent to the individual, medical treatment, or healthcare team) and strategies (i.e., tools caregivers or medical providers intentionally use) promote medication adherence in this population. Therefore, this study examined caregiver-perceived medication facilitators post-HCT. METHODS Semi-structured qualitative interviews and demographic questionnaires were completed by 29 caregivers of children (≤12 years) who had received an HCT within the past 2 years. RESULTS Thematic analysis guided by grounded theory revealed 14 saturated themes that were grouped into 4 categories: family facilitators, medication facilitators, caregiver strategies, and multidisciplinary treatment team strategies. CONCLUSIONS Overall, findings suggest that caregivers of children who received an HCT are highly resourceful and independently develop many strategies to assist them with medication management after their child's HCT. These facilitators and strategies varied between caregivers and over time. Despite prevalent facilitators and strategies, caregiver burden associated with medication adherence remains high. Caregivers may benefit from the multidisciplinary treatment team providing individualized and multicomponent (educational and behavioral) medication adherence supports to ease this burden particularly shortly after hospital discharge.
Collapse
Affiliation(s)
- Marie L Chardon
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children’s Hospital Medical Center, USA
| | - Kimberly L Klages
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children’s Hospital Medical Center, USA
| | - Naomi E Joffe
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children’s Hospital Medical Center, USA
- Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, USA
| | - Ahna L H Pai
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children’s Hospital Medical Center, USA
- Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, USA
| |
Collapse
|
3
|
McGrady ME, Schwartz LE, Noser AE, Klages KL, Sweenie R, Breen G, Ramsey RR. Systematic Evaluation of the Behavior Change Techniques and Quality of Commercially Available Cancer Self-Management Apps. JCO Oncol Pract 2023; 19:e228-e237. [PMID: 36446046 PMCID: PMC9970297 DOI: 10.1200/op.22.00491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/08/2022] [Accepted: 10/07/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Apps have the potential to aid in cancer self-management, but there is limited guidance available for selecting among currently available options. The purpose of this study is to evaluate the behavior change techniques (BCTs) and quality of publicly available cancer self-management apps. METHODS Cancer self-management apps were identified from the Apple and Google Play stores in April 2022. Trained study team members coded the BCTs included in each app and rated its quality using the Mobile App Rating Scale (MARS). BCTs supported by previous literature were coded as cancer management BCTs. RESULTS The 39 apps meeting inclusion criteria included an average of 5.85 BCTs (standard deviation [SD], 3.49; range, 0-15) and 3.54 cancer management BCTs (SD, 1.90; range, 0-8). The most commonly included BCTs were educational or informational strategies: provide information about behavior-health link, provide instruction, and provide information on consequences. The overall app quality ranged from 1.69 to 4.20 (M, 3.29; SD, 0.67). CONCLUSION No cancer self-management apps were of excellent quality, and less than half included multiple cancer management BCTs beyond education. Clinical implications are discussed, and opportunities to improve the content and quality of apps to address the critical self-management needs of patients diagnosed with cancer are highlighted.
Collapse
Affiliation(s)
- Meghan E. McGrady
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Laura E. Schwartz
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Amy E. Noser
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Kimberly L. Klages
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Rachel Sweenie
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Gabriella Breen
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Rachelle R. Ramsey
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| |
Collapse
|
4
|
Chardon ML, Klages KL, Joffe NE, Pai ALH. Recommendations for Providing Medication Adherence Support After Pediatric Hematopoietic Stem Cell Transplant: Caregivers' Lived Experience. J Pediatr Hematol Oncol Nurs 2023; 40:5-16. [PMID: 36221958 PMCID: PMC9982233 DOI: 10.1177/27527530221121723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background. Medication adherence is challenging after pediatric hematopoietic stem cell transplant (HCT), particularly after hospital discharge. Post-HCT medication adherence is important to manage morbidity and mortality risk. Designing interventions that are effective and acceptable to caregivers is key to improving post-HCT medication adherence. This study aimed to characterize caregiver preferences about medication adherence support from their child's medical team. Methods. Twenty-nine caregivers of children who received an HCT completed semi-structured qualitative interviews about their experience with, and recommendations for improving, medication adherence support provided by the medical team. Twenty-two caregivers also completed a card sort task to clarify the content of received support and caregiver recommendations for future HCT families. Results. Thematic analysis revealed eight themes grouped into two categories: Communication Is Key and Practical Medication Adherence Support. Caregivers emphasized the importance of communication in helping them manage their child's outpatient medications and provided suggestions to further strengthen communication. The types of practical medication adherence support used varied across caregivers highlighting the importance of tailoring adherence support to each family's needs. Caregivers also identified all the domains as potentially helpful for other families. Discussion. Findings suggest that caregivers prefer that efforts to improve outpatient medication adherence post-HCT prioritize the medical team initiating frequent, clear, and open communication about medications, and provide educational materials on adherence (e.g., handouts). Results also indicate that practical medication adherence supports should be offered based on family preferences but that families may particularly appreciate tips about addressing medication challenges based on other caregivers' lived experience.
Collapse
Affiliation(s)
- Marie L. Chardon
- Division of Behavioral Medicine & Clinical Psychology,
Cincinnati Children's Hospital Medical Center (CCHMC), Cincinnati, OH, USA
| | - Kimberly L. Klages
- Division of Behavioral Medicine & Clinical Psychology,
Cincinnati Children's Hospital Medical Center (CCHMC), Cincinnati, OH, USA
| | - Naomi E. Joffe
- Division of Behavioral Medicine & Clinical Psychology,
Cincinnati Children's Hospital Medical Center (CCHMC), Cincinnati, OH, USA
- Patient and Family Wellness Center, Cancer and Blood Diseases
Institute, CCHMC, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of
Medicine, Cincinnati, OH, USA
| | - Ahna L. H. Pai
- Division of Behavioral Medicine & Clinical Psychology,
Cincinnati Children's Hospital Medical Center (CCHMC), Cincinnati, OH, USA
- Patient and Family Wellness Center, Cancer and Blood Diseases
Institute, CCHMC, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of
Medicine, Cincinnati, OH, USA
| |
Collapse
|
5
|
Klages KL, Ittenbach RF, Long A, Willard VW, Phipps S. Examination of the Social Emotional Assets and Resilience Scales (SEARS) Youth Report: Factor Structure, Measurement Invariance, and Validity. Assessment 2022; 29:1522-1531. [PMID: 34105383 PMCID: PMC9857478 DOI: 10.1177/10731911211022844] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The Social and Emotional Assets and Resilience Scale (SEARS) is a promising instrument for prediction of resilience in youth; however, there is limited data to support its use. The purpose of the current study was to examine the factor structure, measurement invariance, internal consistency, and validity of the SEARS-Adolescent Report in youth 8 to 20 years of age. Two hundred and twenty-five childhood cancer survivors (Mage = 15.9, SD = 4.2; 51.4% male; 74.5% White) and 122 student controls without history of significant health problems (Mage = 14.2, SD = 3.5; 54.1% female; 79.5% White) 8 to 20 years of age completed the SEARS-A. The SEARS-A was found to have an adequate factor structure and model fit (χ2 = 1215.5, p < .001; root mean square error of approximation = .057; comparative fit index = .95; standardized root mean square residual = .06) and demonstrated invariance across domains of age, health status, gender, race, and socioeconomic status (Δ comparative fit index < -0.01). It also demonstrated excellent internal reliability, criterion validity, and current validity when compared with another well-established measure of psychological adjustment. As such, the SEARS-A has potential to be a useful, valid, and psychometrically sound tool for predicting social-emotional adjustment outcomes among at-risk youth 8 to 20 years of age.
Collapse
Affiliation(s)
- Kimberly L. Klages
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Psychology, The University of Memphis, Memphis, TN
| | - Richard F. Ittenbach
- Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Alanna Long
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Victoria W. Willard
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Sean Phipps
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| |
Collapse
|
6
|
Klages KL, Chardon ML, Drake SN, Myers KC, Morrison CF, Pai AL. Pain, depressive symptoms, and health-related quality of life among survivors of pediatric hematopoietic stem cell transplant. Pediatr Blood Cancer 2022; 69:e29846. [PMID: 35730649 PMCID: PMC9420784 DOI: 10.1002/pbc.29846] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/25/2022] [Accepted: 05/28/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Pediatric hematopoietic stem cell transplant (HCT) is an intensive medical procedure associated with significant late effects, of which pain is a prominent example. While pain is associated with increased depressive symptoms and health-related quality-of-life (HRQoL) impairments in other pediatric chronic illness populations, associations between these variables are not well understood in pediatric HCT. Clarifying these associations may inform clinical interventions to improve health outcomes following pediatric HCT. This study aimed to investigate the relations between pain intensity, depressive symptoms, and HRQoL in survivors of pediatric HCT. METHOD Fifty-one survivors of pediatric HCT (Mage = 14.3 years, standard deviation [SD] = 4.3; 58.8% male; 80.4% White) completed self-report measures of pain intensity, depressive symptoms, and HRQoL. Demographic and disease information was collected via demographic forms and medical record review. Path analysis was used to examine hypothesized associations between pain intensity, depressive symptoms, and HRQoL. RESULTS Analyses revealed direct effects of pain intensity on depressive symptoms (estimate [Est.] = .23, p < .001) and HRQoL (Est. = -.2, p = .04), and direct effects of depressive symptoms on HRQoL (Est. = -.68, p < .001). Depressive symptoms also mediated the relationship between pain intensity and HRQoL (Est. = -.16, p = .006). CONCLUSIONS Greater pain intensity was associated directly with increased depressive symptoms and indirectly with HRQoL through depressive symptoms. Results of this study suggest that multitargeted cognitive behavioral interventions that address pain and depressive symptoms may improve HRQoL ratings in survivors of pediatric HCT.
Collapse
Affiliation(s)
- Kimberly L. Klages
- Behavioral Medicine and Clinical Psychology & Patient and Family Wellness Center for Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229
| | - Marie L. Chardon
- Behavioral Medicine and Clinical Psychology & Patient and Family Wellness Center for Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229
| | - Sarah N. Drake
- Behavioral Medicine and Clinical Psychology & Patient and Family Wellness Center for Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229
| | - Kasiani C. Myers
- Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Ave, Cincinnati, OH 45267
| | | | - Ahna L.H. Pai
- Behavioral Medicine and Clinical Psychology & Patient and Family Wellness Center for Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229
- Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Ave, Cincinnati, OH 45267
| |
Collapse
|
7
|
Keenan ME, Berlin KS, Cook JL, Choquette AE, Ankney RL, Klages KL, Semenkovich KA, Rybak TM, Banks GG, Alemzadeh R, Eddington AR. Brief assessment of diabetes-specific psychological flexibility in racially and income diverse youth with type 1 diabetes. Pediatr Diabetes 2022; 23:370-379. [PMID: 35094464 DOI: 10.1111/pedi.13321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 01/11/2022] [Accepted: 01/22/2022] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Diabetes-specific psychological flexibility (the ability to engage in valued behaviors, be open to internal experiences, with present-moment awareness, while living with diabetes) is associated with HbA1c and health-related quality of life in youth with type 1 diabetes (T1D). Having brief diabetes-specific psychological flexibility assessments that perform equivalently across diverse individuals is important for research and clinical work addressing health disparities. The present study aimed to create 9-and 3-item short forms (DAASito-9 and -3) of the Diabetes Acceptance and Action Scale (DAAS-22), and evaluate their validity, reliability, and measurement invariance (MI). RESEARCH DESIGN AND METHODS Youth with T1D (n = 179, Mage = 14.64, 50% female, 56% Black/African American) completed self-report measures at an endocrinology clinic visit. HbA1c was extracted from medical records. One-half of the sample was used to develop the DAASitos with the highest reliability, McDonald's 𝜔 ≥ 0.75, and convergent validity (r ≥ 0.90 to DASS-22). Confirmatory factor analyses evaluated structural validity. MI was assessed across demographic (race, gender, grade, household income) and disease characteristic (illness duration, HbA1c) groups. Correlations with measures of psychological flexibility assessed additional convergent validity, and latent mean differences across groups were evaluated after confirming MI. RESULTS MI was supported. The DAASito-9 and -3 were correlated in expected directions with other psychological flexibility measures, HbA1c, and health-related quality of life. CONCLUSIONS The psychometric properties of the DAASito-9 and -3 support their use in research and clinical care of diverse youth with T1D. Significant differences in psychological flexibility across race, income, and glycemic health warrant further research and clinical intervention.
Collapse
Affiliation(s)
- Mary E Keenan
- Department of Psychology, University of Memphis, Memphis, Tennessee, USA
| | - Kristoffer S Berlin
- Department of Psychology, University of Memphis, Memphis, Tennessee, USA.,Division of Pediatric Endocrinology & Diabetes, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Jessica L Cook
- Department of Psychology, University of Memphis, Memphis, Tennessee, USA
| | - Adora E Choquette
- Department of Psychology, University of Memphis, Memphis, Tennessee, USA
| | - Rachel L Ankney
- Psychology Department, Oklahoma State University, Stillwater, OK, USA
| | - Kimberly L Klages
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | | | - Tiffany M Rybak
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Gabrielle G Banks
- Department of Psychology, University of Memphis, Memphis, Tennessee, USA.,Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Ramin Alemzadeh
- Division of Pediatric Endocrinology & Diabetes, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Angelica R Eddington
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington DC, USA.,Endocrinology & Diabetes Clinic, Children's National Hospital, Washington DC, USA
| |
Collapse
|
8
|
Chardon ML, Klages KL, Joffe NE, Pai ALH. Caregivers' Experience of Medication Adherence Barriers during Pediatric Hematopoietic Stem Cell Transplant: A Qualitative Study. J Pediatr Psychol 2022; 47:685-695. [PMID: 35066587 PMCID: PMC9172836 DOI: 10.1093/jpepsy/jsab138] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 12/27/2021] [Accepted: 12/29/2021] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE Medications are critical for reducing morbidity and mortality risk in pediatric hematopoietic stem cell transplant (HCT). Nonetheless, medication adherence is suboptimal in this population. Identifying and managing barriers to medication management (i.e., medication barriers) is a key component of supporting medication adherence. However, understanding how medication barriers uniquely impact the pediatric HCT population and which barriers characterize each treatment stage remain unclear. Therefore, this study examined caregiver-perceived medication barriers over the course of pediatric HCT. METHODS Semi-structured qualitative interviews and demographic questionnaires were completed by 29 caregivers of children (≤12 years) who had received an HCT in the past 24 months and were either still admitted to, or had been discharged from, the hospital. RESULTS Grounded methodology revealed 21 qualitative themes grouped into 6 hierarchical categories. Findings reflected barriers to be present across HCT treatment but to differ based on treatment stage with only child medication refusal being a consistent barrier across all stages. Barriers were particularly prevalent after hospital discharge post-HCT when caregivers assumed full responsibility for medication management. In addition, families approaching hospital discharge often lacked insight about these post-discharge barriers such that they did not report anticipating the range of barriers described by caregivers who had already been discharged from the hospital and taken on full responsibility for medication management. CONCLUSIONS Findings support the benefit of medication barrier assessment across HCT treatment. These results suggest that families may benefit from intervention to address the specific barriers they experience around medication adherence especially during the post-HCT outpatient period.
Collapse
Affiliation(s)
- Marie L Chardon
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children’s Hospital Medical Center, USA
| | - Kimberly L Klages
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children’s Hospital Medical Center, USA
| | - Naomi E Joffe
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children’s Hospital Medical Center, USA,Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, USA,Department of Pediatrics, University of Cincinnati College of Medicine, USA
| | - Ahna L H Pai
- All correspondence concerning this article should be addressed to Ahna L.H. Pai, PhD, Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children’s Hospital Medical Center, 240 Albert Sabin Way, MLC 7039, Cincinnati, OH 45220, USA. E-mail:
| |
Collapse
|
9
|
Klages KL, Berlin KS, Cook JL, Merchant TE, Wise MS, Mandrell BN, Conklin HM, Crabtree VM. Health-related quality of life, obesity, fragmented sleep, fatigue, and psychosocial problems among youth with craniopharyngioma. Psychooncology 2021; 31:779-787. [PMID: 34859518 DOI: 10.1002/pon.5862] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/18/2021] [Accepted: 11/15/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Youth with craniopharyngioma experience weight gain, fragmented sleep, excessive daytime sleepiness (EDS), fatigue, and psychosocial problems that negatively impact their overall health-related quality of life (HRQoL). Greater hypothalamic tumor involvement (HI) may be associated with higher rates or severity of these impairments; however, the direct and indirect impact of HI on the physical and psychosocial consequences associated with pediatric craniopharyngioma remain unclear. The purpose of the current study was to examine relations between HI, body mass index (BMI), fragmented sleep, EDS, fatigue, psychosocial problems, and HRQoL among youth with craniopharyngioma. METHODS Eighty-four youth with craniopharyngioma (Mage = 10.27 ± 4.3 years, 53.6% female, 64.3% White) were assessed with actigraphy, nocturnal polysomnography, and multiple sleep latency tests prior to proton therapy, when indicated. Caregivers completed measures of fatigue, psychosocial functioning, and HRQoL. RESULTS Hypothalamic tumor involvement was associated with greater BMI (Est. = 2.97, p = 0.003) and daytime sleepiness (Est. = 2.53, p = 0.01). Greater fatigue predicted more psychosocial problems (Est. = 0.29, p < 0.001) and lower HRQoL (Est. = 0.23, p = 0.001). Psychosocial problems also predicted lower HRQoL (Est. = -0.34, p = 0.004). Fragmented sleep (Est. = 0.03, p = 0.04) and fatigue (Est. = 0.10, p = 0.02) indirectly predicted lower HRQoL through psychosocial problems. CONCLUSIONS Youth with craniopharyngioma with greater HI may benefit from weight reduction interventions and management of excessive sleepiness. Patients should be prospectively monitored for sleep problems, fatigue, and psychosocial problems, as these patients may benefit from interventions targeting fatigue and psychosocial health to improve HRQoL.
Collapse
Affiliation(s)
- Kimberly L Klages
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.,Department of Psychology, The University of Memphis, Memphis, Tennessee, USA
| | - Kristoffer S Berlin
- Department of Psychology, The University of Memphis, Memphis, Tennessee, USA
| | - Jessica L Cook
- Department of Psychology, The University of Memphis, Memphis, Tennessee, USA
| | - Thomas E Merchant
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Merrill S Wise
- Mid-South Pulmonary and Sleep Specialists, Memphis, Tennessee, USA
| | - Belinda N Mandrell
- Department of Pediatric Medicine, Division of Nursing Research, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Heather M Conklin
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | | |
Collapse
|
10
|
Noser AE, Klages KL, Gamwell KL, Brammer CN, Hommel KA, Ramsey RR. A systematic evaluation of primary headache management apps leveraging behavior change techniques. Cephalalgia 2021; 42:510-523. [PMID: 34786974 DOI: 10.1177/03331024211053572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Mobile health apps have the potential to promote adherence to headache management through the use of evidence-based behavior change techniques (e.g., self-monitoring). While many headache management apps exist, the extent to which these apps include behavior change techniques remains unknown. Thus, the present study systematically evaluated the content and quality of commercially available headache management apps. METHODS Headache apps were identified using a systematic search in the Apple App and Google Play stores. A total of 55 apps were evaluated using the taxonomy of behavior change techniques and app quality using the Mobile App Rating Scale. RESULTS Headache management apps included 0-14 behavior change techniques (Mean [M] = 5.89) and 0-8 headache management behavior change techniques (M = 4.29). App quality ranged from 2.84-4.67 (M = 3.73) out of 5.00. Three apps, Migraine Trainer, Easeday: Headache & Migraine, and PainScale, included the highest number of overall and headache management behavior change techniques along with good quality scores. CONCLUSIONS While randomized controlled trials are necessary to determine the efficacy of individual headache apps, most existing apps include evidence-based headache management behavior change techniques. Headache apps often focus on either self-monitoring or stress management via relaxation training, suggesting that patients' needs should be used to inform app selection.
Collapse
Affiliation(s)
- Amy E Noser
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kimberly L Klages
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kaitlyn L Gamwell
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Caitlin N Brammer
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kevin A Hommel
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Rachelle R Ramsey
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| |
Collapse
|
11
|
Chardon ML, Klages KL, Joffe NE, Pai ALH. Family Adjustment to Pediatric Hematopoietic Stem Cell Transplant During COVID-19. J Pediatr Psychol 2021; 46:1172-1181. [PMID: 34537853 DOI: 10.1093/jpepsy/jsab092] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/30/2021] [Accepted: 07/29/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The COVID-19 pandemic has been difficult for families across the world due to fears about infection risk, increased social isolation, and significant changes in family roles and routines. Families with a child undergoing pediatric hematopoietic stem cell transplant (HCT) may be at even greater risk for poor adjustment during COVID-19 given their child's increased risk for infection. The purpose of the current study was to qualitatively examine the impact of COVID-19 on family adjustment during pediatric HCT to inform clinical care. METHODS Twenty-nine caregivers of children (≤12 years) who underwent an HCT within the past 2 years completed semi-structured qualitative interviews and demographic questionnaires in the first 4 months following initial COVID-19 quarantine. RESULTS Twenty-two themes emerged from the interviews using grounded theory methodology. Although nearly half of caregivers described COVID-19 as a stressor, 69% of caregivers reported adequate adjustment to COVID-19. Caregivers generally attributed their positive adjustment to HCT preparing the family for COVID-19 and more difficult adjustment to increased physical or social isolation and COVID-19 amplifying germ fears. The child's HCT treatment status also had important implications on family adjustment to COVID-19. CONCLUSIONS Results suggest that families undergoing pediatric HCT are uniquely prepared to cope with the impacts of a global pandemic; however, families experiencing certain risk factors (e.g., more recent transplant, impaired access to social support, reduced access to coping tools) may experience poorer adjustment during pandemics such as COVID-19 and may benefit from increased psychosocial support from their healthcare team.
Collapse
Affiliation(s)
- Marie L Chardon
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kimberly L Klages
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Naomi E Joffe
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ahna L H Pai
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| |
Collapse
|
12
|
Semenkovich KA, Berlin KS, Ankney RL, Keenan ME, L Cook J, Klages KL, Banks GG, Rybak TM, Alemzadeh R, Eddington AR. Development and initial validation of the diabetes family conflict scale (revised)-short form in a racially and income diverse sample. Pediatr Diabetes 2021; 22:529-539. [PMID: 33476074 DOI: 10.1111/pedi.13182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 12/03/2020] [Accepted: 01/18/2021] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE The purpose of the study was to develop a short form of the revised diabetes family conflict scale (DFCS) in a racially and income diverse sample while retaining strong psychometric properties. METHODS One seventy nine youth with type 1 diabetes (ages 12-18 years) and caregivers completed the DFCS-Revised as well as assessments of adherence, psychosocial functioning, and diabetes-related stress. Hemoglobin A1c was also obtained. The sample was split at random into a development sample and validation sample. RESULTS Confirmatory factor analyses in the validation sample supported the use of a six-item short form (DFCS-SF) either as a total score (6-items) or a direct (3-item) and indirect (3-item) score. Variations of the DFCS-SF (three items of the 6-item short form) also had acceptable model fit. The short-form questionnaires had acceptable internal consistency and convergent validity (6-item: Cronbach's a = 0.865, full scale DFCS r = 0.954; 3-item: Cronbach's a = 0.757, full scale DFCS r = 0.912). The DFCS-SF showed measurement invariance across both youth and caregiver respondents. Greater report of the DFCS-SF by both youth and caregivers was significantly associated with higher HbA1c, more diabetes-related stress, and more psychosocial concerns. CONCLUSIONS The DFCS-SF developed in the present study shows psychometric integrity in a diverse population of youth and can be utilized by providers to rapidly assess and potentially implement interventions to reduce diabetes family conflict, a psychosocial concern which is associated with elevated HbA1c, non-optimal adherence, diabetes-related stress, and psychological distress.
Collapse
Affiliation(s)
| | - Kristoffer S Berlin
- Department of Psychology, The University of Memphis, Memphis, Tennessee, USA.,Department of Endocrinology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Rachel L Ankney
- Department of Psychology, The University of Memphis, Memphis, Tennessee, USA
| | - Mary E Keenan
- Department of Psychology, The University of Memphis, Memphis, Tennessee, USA
| | - Jessica L Cook
- Department of Psychology, The University of Memphis, Memphis, Tennessee, USA
| | - Kimberly L Klages
- Department of Psychology, The University of Memphis, Memphis, Tennessee, USA.,Department of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Gabrielle G Banks
- Department of Psychology, The University of Memphis, Memphis, Tennessee, USA.,Department of Pediatrics, University of Mississippi Medical Center, Mississippi, USA
| | - Tiffany M Rybak
- Department of Psychology, The University of Memphis, Memphis, Tennessee, USA.,Department of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Ramin Alemzadeh
- Department of Endocrinology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Angelica R Eddington
- Department of Psychology, The University of Memphis, Memphis, Tennessee, USA.,Department of Endocrinology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| |
Collapse
|
13
|
Klages KL, Berlin KS, Cook JL, Keenan ME, Semenkovich K, Banks GG, Rybak TM, Ankney RL, Decker KM, Whitworth JR, Corkins MR. Examining Risk Factors of Health-Related Quality of Life Impairments Among Adolescents with Inflammatory Bowel Disease. Behav Med 2021; 47:140-150. [PMID: 34048329 DOI: 10.1080/08964289.2019.1676193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Inflammatory Bowel Disease (IBD) is a chronic, costly, and burdensome disease that is typically diagnosed during adolescence. Despite the use of effective treatments, rates of relapse and intestinal inflammation remain high and put patients at risk for long term physical and psychosocial health complications. Given the costs associated with IBD, it is critical to examine potential risk factors of poor health-related quality of life (HRQoL) among patients for the enhancement and further development of interventions. As such, the aim of the current study was to examine how sociodemographic and disease characteristics, psychosocial problems, and adherence behaviors impact HRQoL among a sample of youth with IBD. 107 adolescents with IBD and their caregiver completed self- and parent-report measures as part of a psychosocial screening service. Medical records were reviewed to obtain information regarding diagnosis, insurance, medication use, illness severity, and disease activity. Results revealed lower HRQoL scores among adolescents with more psychosocial problems (Est. = -3.08; p < .001), greater disease severity (Est. = -.40; p = .001), and those who identified as Black (Est. = -.38; p < .05). Greater disease severity (Est. = .13 p = .004), use of nonpublic insurance (Est. = .32 p = .004), and fewer psychosocial problems (Est. = -.13 p = .04) were associated with greater adherence behaviors. These findings suggest that implementing individually tailored, evidence-based psychological interventions focused on coping with psychosocial problems and symptoms may be important in enhancing adherence behaviors and HRQoL among adolescents with IBD.
Collapse
Affiliation(s)
| | - Kristoffer S Berlin
- Department of Psychology, The University of Memphis.,Department of Pediatrics, University of Tennessee Health Sciences Center
| | | | | | | | | | | | | | | | - John R Whitworth
- Department of Pediatrics, University of Tennessee Health Sciences Center
| | - Mark R Corkins
- Department of Pediatrics, University of Tennessee Health Sciences Center
| |
Collapse
|
14
|
Berlin KS, Klages KL, Banks GG, Rybak TM, Ankney RL, Semenkovich K, Keenan ME, Ellis DA, Diaz-Thomas AM, Alemzadeh R, Eddington AR. Toward the Development of a Culturally Humble Intervention to Improve Glycemic Control and Quality of Life among Adolescents with Type-1 Diabetes and Their Families. Behav Med 2021; 47:99-110. [PMID: 31580213 DOI: 10.1080/08964289.2019.1660299] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Type-1 Diabetes (T1D) is a prevalent and costly disorder associated with substantial morbidity that differentially impacts low-income and/or minority adolescents and their families. The primary study objective was to develop a guiding model to inform culturally humble interventions for Mid-southern youth with T1D presenting with multiple correlates of suboptimal glycemic control and their families. In order to develop a clinic specific guiding model, conceptualizations of health, the need/type of intervention thought to be most helpful, the optimal structure, and strategies to improve the cultural/regional fit was ascertained from (A) youth with T1D (n = 13) and caregivers (n = 11) via qualitative interviews and, (B) pediatric endocrinologists and nurse practitioners (n = 6), and (C) nurses, diabetes educators, dietitians, and social workers (n = 9) via focus groups. Qualitative themes were synthesized to guide the treatment development model whereby Quality of Life and Glycemic Control would be directly enhanced by interventions to promote Coping, Support, Education, and Improved Psychosocial Functioning and indirectly through improved Adherence and T1D Autonomy delivered in a culturally humble way that affirms youths' T1D identify. These finding suggest that existing evidence-based treatments may provide a great fit for low-income, and/or minority youth with T1D and their families living in the mid-south, provided these interventions are delivered in culturally humble manner.
Collapse
Affiliation(s)
- Kristoffer S Berlin
- Department of Psychology, The University of Memphis.,Department of Pediatrics, University of Tennessee Health Science Center
| | | | | | - Tiffany M Rybak
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | | | | | | | - Deborah A Ellis
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine
| | | | - Ramin Alemzadeh
- Department of Pediatrics, University of Tennessee Health Science Center
| | - Angelica R Eddington
- Department of Psychology, The University of Memphis.,Department of Pediatrics, University of Tennessee Health Science Center
| |
Collapse
|
15
|
Keenan ME, Berlin KS, Cook JL, Ankney RL, Klages KL, Semenkovich KA, Rybak TM, Banks GG, Choquette AE, Alemzadeh R, Eddington AR. Predictors of HbA1c Trajectories in Predominantly Black Adolescents With Type 1 Diabetes. J Pediatr Psychol 2021; 46:241-250. [PMID: 33398334 DOI: 10.1093/jpepsy/jsaa124] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 12/04/2020] [Accepted: 12/04/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Following the Journal of Pediatric Psychology's special edition on health disparities, calling for Phase 2 research exploring mechanisms of racial groups in health disparities, this study aims to explore social information processing predictors of longitudinal hemoglobin A1c (HbA1c) trajectories in a racially diverse group of adolescents. The social information processing model of glycemic control in type 1 diabetes (T1D) posits that adolescents who make negative attributions about reactions of friends are likely to find adherence difficult in social situations, have increased stress, and have suboptimal glycemic control. METHODS One hundred eighty-four youth with T1D completed self-report measures and HbA1c at three time points within 1 year was extracted from medical records. Growth mixture modeling empirically derived classes of HbA1c trajectories and explored predictive relationships of social information processing variables, demographics, and diabetes characteristics. RESULTS Three classes emerged: High Decelerating, Mid-High Accelerating, and Near-Optimal Accelerating. Black/African American participants were highly likely to be in the High and Mid-High groups. Higher anticipated adherence difficulties in social situations predicted increased odds of being in the Mid-High versus Near-Optimal HbA1c group. Increased diabetes stress predicted increased odds of being in the High versus Near-Optimal and Mid-High groups. CONCLUSIONS Continuing research on mechanisms behind this health disparity is necessary with more representation from varied racial and ethnic groups. Equal access to diabetes technology and psychosocial treatments are recommended and implications for clinical intervention development are discussed.
Collapse
Affiliation(s)
| | - Kristoffer S Berlin
- Department of Psychology, The University of Memphis.,Division of Pediatric Endocrinology & Diabetes, University of Tennessee Health Science Center
| | | | | | | | | | - Tiffany M Rybak
- Department of Psychology, Cincinnati Children's Hospital Medical Center
| | | | | | - Ramin Alemzadeh
- Division of Pediatric Endocrinology & Diabetes, University of Tennessee Health Science Center
| | - Angelica R Eddington
- Department of Psychology, The University of Memphis.,Division of Pediatric Endocrinology & Diabetes, University of Tennessee Health Science Center
| |
Collapse
|
16
|
Berlin KS, Keenan ME, Cook JL, Ankney RL, Klages KL, Semenkovich K, Rybak TM, Banks GG, Alemzadeh R, Eddington AR. Measuring psychological flexibility in youth with type 1 diabetes. Pediatr Diabetes 2020; 21:1566-1574. [PMID: 32915520 DOI: 10.1111/pedi.13110] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/11/2020] [Accepted: 09/02/2020] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To determine reliability and validity of the acceptance and action diabetes questionnaire (AADQ) and the diabetes acceptance and action scale for children and adolescents (DAAS), measures of diabetes-specific psychological flexibility. METHODS One hundred and eight-one youth with type 1 diabetes completed the AADQ, DAAS, and measures of mindfulness, cognitive fusion, and health-related quality of life. HbA1c was extracted from medical records. Confirmatory factor analysis (CFA) was used to cull items and evaluate the factor structures of the AADQ and DAAS. Bivariate correlations were conducted between all measures to explore content validity. RESULTS CFAs supported a one-factor structure of the AADQ (for youth and parent report) and a second-order DAAS solution with a total score indicated by avoidance, values impairment, and avoidance subscales. All scales and subscales displayed strong internal consistency (α = .86-.95). The AADQ and DAAS evidence good content validity based on associations with other measures. CONCLUSIONS The AADQ and DAAS are reliable, valid measures of diabetes-specific psychological flexibility.
Collapse
Affiliation(s)
- Kristoffer S Berlin
- Department of Psychology, The University of Memphis, Memphis, Tennessee, USA.,Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Mary E Keenan
- Department of Psychology, The University of Memphis, Memphis, Tennessee, USA
| | - Jessica L Cook
- Department of Psychology, The University of Memphis, Memphis, Tennessee, USA
| | - Rachel L Ankney
- Department of Psychology, The University of Memphis, Memphis, Tennessee, USA
| | - Kimberly L Klages
- Department of Psychology, The University of Memphis, Memphis, Tennessee, USA
| | | | - Tiffany M Rybak
- Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Gabrielle G Banks
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Ramin Alemzadeh
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Angelica R Eddington
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| |
Collapse
|
17
|
Plevinsky JM, Young MA, Carmody JK, Durkin LK, Gamwell KL, Klages KL, Ghosh S, Hommel KA. The Impact of COVID-19 on Pediatric Adherence and Self-Management. J Pediatr Psychol 2020; 45:977-982. [PMID: 32929482 PMCID: PMC7522296 DOI: 10.1093/jpepsy/jsaa079] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 08/07/2020] [Accepted: 08/07/2020] [Indexed: 11/13/2022] Open
Abstract
The COVID-19 pandemic has presented unique circumstances that have the potential to both positively and negatively affect pediatric adherence and self-management in youth with chronic medical conditions. The following paper discusses how these circumstances (e.g., stay-at-home orders, school closures, changes in pediatric healthcare delivery) impact disease management at the individual, family, community, and healthcare system levels. We also discuss how barriers to pediatric adherence and self-management exacerbated by the pandemic may disproportionately affect underserved and vulnerable populations, potentially resulting in greater health disparities. Given the potential for widespread challenges to pediatric disease management during the pandemic, ongoing monitoring and promotion of adherence and self-management is critical. Technology offers several opportunities for this via telemedicine, electronic monitoring, and mobile apps. Moreover, pediatric psychologists are uniquely equipped to develop and implement adherence-promotion efforts to support youth and their families in achieving and sustaining optimal disease management as the current public health situation continues to evolve. Research efforts addressing the short- and long-term impact of the pandemic on pediatric adherence and self-management are needed to identify both risk and resilience factors affecting disease management and subsequent health outcomes during this unprecedented time.
Collapse
Affiliation(s)
- Jill M Plevinsky
- Center for Adherence and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | | | - Julia K Carmody
- Division of Gastroenterology and Nutrition, Boston Children's Hospital
| | - Lindsay K Durkin
- Department of Clinical Psychology, College of Health Professions, Rosalind Franklin University of Medicine and Science
| | - Kaitlyn L Gamwell
- Center for Adherence and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | - Kimberly L Klages
- Center for Adherence and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | - Shweta Ghosh
- Cancer and Blood Disorders Center, Department of Psychiatry and Behavioral Medicine, Seattle Children's Hospital
| | - Kevin A Hommel
- Center for Adherence and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
| |
Collapse
|
18
|
Niel K, LaRosa KN, Klages KL, Merchant TE, Wise MS, Witcraft SM, Hancock D, Caples M, Mandrell BN, Crabtree VM. Actigraphy versus Polysomnography to Measure Sleep in Youth Treated for Craniopharyngioma. Behav Sleep Med 2020; 18:589-597. [PMID: 31303059 DOI: 10.1080/15402002.2019.1635133] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE/BACKGROUND Youth with craniopharyngioma are at increased risk for excessive daytime sleepiness and narcolepsy. Polysomnography (PSG) is the gold standard for diagnosing sleep disorders, but is time-intensive, costly, and does not offer an in vivo measure of typical sleep routine. We determined the sensitivity, specificity, and accuracy of actigraphy compared with PSG in measuring nocturnal sleep in pediatric craniopharyngioma. PARTICIPANTS Fifty youth with craniopharyngioma (age 3-20 years) were assessed by overnight PSG and concurrent actigraphy after surgical resection and before proton therapy. METHODS PSG and actigraphy data were synchronized utilizing an epoch-by-epoch comparison method. Sensitivity, specificity, and accuracy were calculated using measures of true wake, true sleep, false wake, and false sleep. Bland-Altman plots were conducted to further assess level of agreement. RESULTS Actigraphy was 93% sensitive (true sleep [TS]) and 87% accurate (ability to detect TS and true wake) in measuring sleep versus wakefulness and was a reliable measure of sleep efficiency (SE) and sleep latency (SL). Specificity (true wake) was poor (55%) and total sleep time (TST) was underestimated by an average of 15.1 min. Wake after sleep onset (WASO) was overestimated by an average of 14.7 min. CONCLUSIONS Actigraphy was highly sensitive and accurate and was a reliable measure of SE and SL. Although there were differences in TST and WASO measurements by actigraphy and PSG, our findings provide the basis for future studies on the use of actigraphy to monitor treatment response to wakefulness-promoting medications in youth with craniopharyngioma who demonstrate excessive daytime sleepiness.
Collapse
Affiliation(s)
- Kristin Niel
- Department of Psychology, St. Jude Children's Research Hospital , Memphis, TN
| | - Kayla N LaRosa
- Department of Psychology, St. Jude Children's Research Hospital , Memphis, TN
| | | | - Thomas E Merchant
- Department of Radiation Oncology, St. Jude Children's Research Hospital , Memphis, TN
| | - Merrill S Wise
- Department of Sleep Disorders, Methodist Healthcare Sleep Disorders Center , Memphis, TN
| | - Sara M Witcraft
- Department of Psychology, The University of Mississippi , MS
| | - Donna Hancock
- Department of Pediatric Medicine, Division of Nursing Research, St. Jude Children's Research Hospital , Memphis, TN
| | - Mary Caples
- Department of Pediatric Medicine, Division of Nursing Research, St. Jude Children's Research Hospital , Memphis, TN
| | - Belinda N Mandrell
- Department of Pediatric Medicine, Division of Nursing Research, St. Jude Children's Research Hospital , Memphis, TN
| | | |
Collapse
|
19
|
Banks GG, Berlin KS, Keenan ME, Cook J, Klages KL, Rybak TM, Ankney R, Semenkovich K, Cohen R, Thurston I, Diaz-Thomas A, Alemzadeh R, Eddington A. How Peer Conflict Profiles and Socio-Demographic Factors Influence Type 1 Diabetes Adaptation. J Pediatr Psychol 2020; 45:663-672. [PMID: 32483599 DOI: 10.1093/jpepsy/jsaa036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 04/21/2020] [Accepted: 04/23/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE This study aimed to (a) validate the factor structure for a measure of peer conflict in youth with type 1 diabetes (T1D); (b) determine empirical patterns of peer conflict in terms of context (friend vs. nonfriend) and content (diabetes-specific vs. general) within a broader context of socio-demographic factors; and (c) examine how these patterns and socio-demographic factors relate to adolescents' T1D adherence, quality of life, and glycemic control (HbA1c). METHODS Youth with T1D (N = 178), ages 12-18, reported demographic variables, illness duration, adherence, quality of life, and peer conflict. HbA1c was extracted from medical records. Confirmatory factor analysis validated a factor structure for the Diabetes Peer Conflict Scale (DPCS) and latent profile analysis (LPA) determined profiles of peer conflict. RESULTS A four-factor structure emerged for the DPCS: general friend conflict, general nonfriend conflict, T1D friend conflict, and T1D nonfriend conflict. Using these factors as indicators in LPA, four profiles were confirmed: (a) Low Overall Conflict (LOC) and (b) Moderate Overall Conflict (MOC), (c) a Nonfriend Conflict (NFC), and (d) a Friend Conflict (FC) profile. Differences were not identified between diabetes specific versus general conflict. Socio-demographic variables did not predict class membership. The LOC profile reported the highest quality of life and best glycemic control, whereas the FC profile reported the lowest adherence behaviors. Conclusions: Peer conflict uniquely contributes to diabetes adaptation above and beyond socio-demographic and illness factors.
Collapse
Affiliation(s)
| | | | | | - Jessica Cook
- Department of Psychology, The University of Memphis
| | - Kimberly L Klages
- Department of Psychology, Cincinnati Children's Hospital Medical Center
| | - Tiffany M Rybak
- Department of Psychology, Cincinnati Children's Hospital Medical Center
| | | | | | - Robert Cohen
- Department of Psychology, The University of Memphis
| | - Idia Thurston
- Department of Psychology & Brain Science, Texas A&M University
| | - Alicia Diaz-Thomas
- Department of Pediatrics-Endocrinology, The University of Tennessee Health Science Center
| | - Ramin Alemzadeh
- Department of Pediatrics-Endocrinology, The University of Tennessee Health Science Center
| | - Angelica Eddington
- Department of Pediatrics-Endocrinology, The University of Tennessee Health Science Center
| |
Collapse
|
20
|
Tillery R, Willard VW, Howard Sharp KM, Klages KL, Long AM, Phipps S. Impact of the parent‐child relationship on psychological and social resilience in pediatric cancer patients. Psychooncology 2019; 29:339-346. [DOI: 10.1002/pon.5258] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/09/2019] [Accepted: 10/10/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Rachel Tillery
- Department of Psychology St. Jude Children's Research Hospital Memphis Tennessee
| | - Victoria W. Willard
- Department of Psychology St. Jude Children's Research Hospital Memphis Tennessee
| | | | - Kimberly L. Klages
- Department of Psychology St. Jude Children's Research Hospital Memphis Tennessee
- Department of Psychology The University of Memphis Memphis Tennessee
| | - Alanna M. Long
- Department of Psychology St. Jude Children's Research Hospital Memphis Tennessee
| | - Sean Phipps
- Department of Psychology St. Jude Children's Research Hospital Memphis Tennessee
| |
Collapse
|
21
|
LaRosa KN, Niel K, Klages KL, Merchant TE, Wise MS, Witcraft S, Hancock D, Caples M, Mandrell B, Crabtree VM. 0808 Comparison of Actigraphy to Polysomnography in the Measurement of Nocturnal Sleep in Children with Craniopharyngioma. Sleep 2019. [DOI: 10.1093/sleep/zsz067.806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kayla N LaRosa
- Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Kristin Niel
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | | | | | | | - Donna Hancock
- St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Mary Caples
- St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | | |
Collapse
|
22
|
Semenkovich K, Berlin KS, Ankney RL, Klages KL, Keenan ME, Rybak TM, Banks GG, Alemzadeh R, Eddington A. Predictors of diabetic ketoacidosis hospitalizations and hemoglobin A1c among youth with Type 1 diabetes. Health Psychol 2019; 38:577-585. [PMID: 30973748 DOI: 10.1037/hea0000719] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Diabetic ketoacidosis (DKA) and elevated hemoglobin A1c (HbA1c) in youth with Type 1 diabetes (T1D) can result in significant morbidity and mortality. Elucidating the risk factors for poor glycemic control and DKA hospitalizations is crucial for the refinement and development of prevention and treatment efforts. METHOD Based on a conceptual framework, this study used path analysis to evaluate individual and family characteristics, psychosocial responses, and individual and family responses that prospectively predict the number of DKA hospitalizations and HbA1c approximately 1 year after assessment, accounting for sociodemographics. A total of 174 youth 12-18 years old with T1D (M = 14.68, SD = 1.77) and their caregivers completed measures assessing demographics, internalizing symptoms, diabetes stress, diabetes-related family conflict, and adherence. Medical records were reviewed to obtain the number of episodes of DKA and the HbA1c at 1-year follow-up. RESULTS Thirty-one participants had at least 1 episode of DKA based on chart review. Greater duration of diabetes, higher baseline HbA1c, lower income, identifying as non-Hispanic White, and higher youth report of internalizing symptoms were significant predictors of DKA at follow-up (p < .05). Identifying as Black-African American, a younger age, and higher baseline HbA1c significantly predicted higher HbA1c at follow-up (p < .05). CONCLUSIONS Future studies should assess the utility and accuracy of using screeners for internalizing symptoms in pediatric endocrinology clinics to identify youth at risk for DKA hospitalizations. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Collapse
|
23
|
Kamody RC, Berlin KS, Rybak TM, Klages KL, Banks GG, Ali JS, Alemzadeh R, Ferry RJ, Diaz Thomas AM. Psychological Flexibility Among Youth with Type 1 Diabetes: Relating Patterns of Acceptance, Adherence, and Stress to Adaptation. Behav Med 2018; 44:271-279. [PMID: 28524766 DOI: 10.1080/08964289.2017.1297290] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Psychological flexibility, a complex concept encompassing both acceptance and action related factors, has been identified as a target for intervention for diabetes management. Research suggests acceptance, self-management, and stress, all factors that influence psychological flexibility, have an impact on adaptation to type 1 diabetes (T1D) by youth independently. However, yet to be explored is individually varying patterns of these variables and how they may relate to diabetes adaptation outcomes. The present study aimed to establish individual variations of patterns of these factors to derive profiles of psychological flexibility, and examine their relations to the adaptation outcomes of glycemic control and health-related quality of life. Youth (N = 162, aged 12-17 years) with T1D completed the Acceptance and Action Diabetes Questionnaire, Diabetes Stress Questionnaire, Self-Care Inventory, and Pediatric Quality of Life-Diabetes Module. Hemoglobin A1c values were abstracted from medical records. Latent profile analysis yielded three profiles: High Acceptance & Adherence/Low Stress, Low Acceptance/Moderate Adherence & Stress, and Low Acceptance & Adherence/High Stress. The High Acceptance & Adherence/Low Stress group displayed significantly higher health-related quality of life and lower HbA1c compared to other groups. Fluid psychological variables, such as acceptance and diabetes stress, and adherence behaviors may be salient targets to increase psychological flexibility for individual psychosocial interventions aimed at improving adaptation to type 1 diabetes in youth.
Collapse
Affiliation(s)
| | - Kristoffer S Berlin
- b Department of Psychology , The University of Memphis.,c Department of Pediatrics , University of Tennessee Health Science Center
| | | | | | | | | | - Ramin Alemzadeh
- c Department of Pediatrics , University of Tennessee Health Science Center.,d Le Bonheur Children's Hospital
| | | | - Alicia M Diaz Thomas
- c Department of Pediatrics , University of Tennessee Health Science Center.,d Le Bonheur Children's Hospital
| |
Collapse
|
24
|
Rybak TM, Ali JS, Berlin KS, Klages KL, Banks GG, Kamody RC, Ferry RJ, Alemzadeh R, Diaz-Thomas AM. Patterns of Family Functioning and Diabetes-Specific Conflict in Relation to Glycemic Control and Health-Related Quality of Life Among Youth With Type 1 Diabetes. J Pediatr Psychol 2018; 42:40-51. [PMID: 28173113 DOI: 10.1093/jpepsy/jsw071] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 07/25/2016] [Accepted: 07/27/2016] [Indexed: 01/12/2023] Open
Abstract
Objectives General and diabetes-specific family functioning may be associated with youth’s adaptation to type 1 diabetes (T1D); however, empirically derived patterns of family functioning and diabetes-specific conflict among youth have not been explored in relation to T1D adaptation. Methods Youth (N = 161, aged 12–18) with T1D and caregivers completed measures of family functioning and diabetes-specific conflict that served as indicators in latent profile analyses. Differences in glycemic control (measured by hemoglobin A1cs [HbA1c] and health-related quality of life [HRQoL]) were compared across profiles. Results Four profiles that varied by levels of family functioning, diabetes-specific conflict, and congruence between youth and caregiver perspectives emerged and related to T1D adaptation differently. Greater agreement between caregiver and youth and lower diabetes-specific conflict was associated with lower HbA1c and greater HRQoL. Conclusions Person-centered approaches are useful to quantify how many individuals fit into a particular pattern and determine how specific family dynamics may function together differently in relation to T1D adaptation for various subgroups of the population.
Collapse
Affiliation(s)
- Tiffany M Rybak
- Department of Psychology, The University of Memphis, Memphis, TN, USA
| | - Jeanelle S Ali
- Department of Psychology, The University of Memphis, Memphis, TN, USA
| | - Kristoffer S Berlin
- Department of Psychology, The University of Memphis, Memphis, TN, USA.,Department of Pediatrics, University of Tennessee Health Science Center-Memphis, Memphis, TN, USA
| | - Kimberly L Klages
- Department of Psychology, The University of Memphis, Memphis, TN, USA
| | - Gabrielle G Banks
- Department of Psychology, The University of Memphis, Memphis, TN, USA
| | - Rebecca C Kamody
- Department of Psychology, The University of Memphis, Memphis, TN, USA
| | - Robert J Ferry
- Department of Pediatrics, University of Tennessee Health Science Center-Memphis, Memphis, TN, USA
| | - Ramin Alemzadeh
- Department of Pediatrics, University of Tennessee Health Science Center-Memphis, Memphis, TN, USA
| | - Alicia M Diaz-Thomas
- Department of Pediatrics, University of Tennessee Health Science Center-Memphis, Memphis, TN, USA
| | | |
Collapse
|
25
|
Klages KL, Berlin KS, Silverman AH, Mugie S, Di Lorenzo C, Nurko S, Ponnambalam A, Sanghavi R, Sood MR. Empirically Derived Patterns of Pain, Stooling, and Incontinence and Their Relations to Health-Related Quality of Life Among Youth With Chronic Constipation. J Pediatr Psychol 2017; 42:325-334. [PMID: 27474732 DOI: 10.1093/jpepsy/jsw068] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 06/30/2016] [Indexed: 12/22/2022] Open
Abstract
Objective Chronic constipation is associated with pain, stress, and fecal incontinence, which negatively impact health-related quality of life (HRQoL); however, it is unclear if patterns of pain, stool frequency, and incontinence are differentially associated with HRQoL in youth with chronic constipation. Methods 410 caregivers completed a demographics and symptoms form, the Parental Opinions of Pediatric Constipation, Pediatric Symptom Checklist, and the Functional Disability Inventory. Results Stooling patterns were derived using Latent Variable Mixture Modeling. A three-class model emerged: withholding/avoiding ( WA ), pain , and fecal incontinence ( FI ). The pain class reported the greatest amount of disease burden/distress, greatest impairments in illness-related activity limitations, more psychosocial problems, and, along with the FI class, elevated levels of family conflict. The FI class reported the greatest amount of parental worry of social impact. Conclusions Youth with chronic constipation who experience pain or fecal incontinence may be at a greater risk for specific HRQoL problems such as illness-related activity limitations, psychosocial issues, disease burden and worry, and family conflict.
Collapse
Affiliation(s)
- Kimberly L Klages
- Department of Psychology, The University of Memphis, Memphis, TN, USA
| | - Kristoffer S Berlin
- Department of Psychology, The University of Memphis, Memphis, TN, USA
- University of Tennessee Health Sciences Center, Memphis, TN, USA
| | - Alan H Silverman
- Department of Gastroenterology, Children's Hospital of Wisconsin, Milwaukee, USA
- Department of Gastroenterology, Medical College of Wisconsin, Milwaukee, USA
| | - Suzanne Mugie
- Department of Gastroenterology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Carlo Di Lorenzo
- Department of Gastroenterology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Samuel Nurko
- Department of Gastroenterology, Boston Children's Hospital, Boston, MA, USA
| | - Ananthasekar Ponnambalam
- Department of Gastroenterology, Children's and Women's Hospital at University of South Alabama, USA
| | - Rina Sanghavi
- Department of Gastroenterology, University of Texas Southwest Medical Center, Dallas, TX, USA
| | - Manu R Sood
- Department of Gastroenterology, Medical College of Wisconsin, Milwaukee, USA
| |
Collapse
|
26
|
Lennon JM, Klages KL, Amaro CM, Murray CB, Holmbeck GN. Longitudinal study of neuropsychological functioning and internalizing symptoms in youth with spina bifida: social competence as a mediator. J Pediatr Psychol 2015; 40:336-48. [PMID: 25244941 PMCID: PMC4366446 DOI: 10.1093/jpepsy/jsu075] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 08/13/2014] [Accepted: 08/13/2014] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE To examine the longitudinal relationship between neuropsychological functioning and internalizing symptoms, as mediated by social competence in youth with spina bifida (SB). METHODS A total of 111 youth (aged 8-15 years, M = 11.37) with SB, their parents, and teachers completed questionnaires regarding attention, social competence, and internalizing symptoms. Youth also completed a battery of neuropsychological tests. RESULTS An indirect-only mediation model revealed that social competence mediated the relation between neuropsychological functioning and subsequent levels of teacher-reported internalizing symptoms, but not parent or youth report of internalizing symptoms. Specifically, better neuropsychological functioning was associated with better social competence, which, in turn, predicted fewer internalizing symptoms 2 years later. CONCLUSIONS Youth with SB with lower levels of neuropsychological functioning may be at risk for poorer social competence and, as a result, greater internalizing symptoms. Interventions that promote social competence, while being sensitive to cognitive capacities, could potentially alleviate or prevent internalizing symptoms in these youth.
Collapse
Affiliation(s)
- Jaclyn M Lennon
- Psychology Department, Loyola University Chicago and Clinical Child Psychology Program, University of Kansas
| | - Kimberly L Klages
- Psychology Department, Loyola University Chicago and Clinical Child Psychology Program, University of Kansas
| | - Christina M Amaro
- Psychology Department, Loyola University Chicago and Clinical Child Psychology Program, University of Kansas
| | - Caitlin B Murray
- Psychology Department, Loyola University Chicago and Clinical Child Psychology Program, University of Kansas
| | - Grayson N Holmbeck
- Psychology Department, Loyola University Chicago and Clinical Child Psychology Program, University of Kansas
| |
Collapse
|