Measuring the quality of life of youth with facial differences

A Survey of Psychological Assessment on Interdisciplinary Craniofacial Teams

Objective

To explore the role of mental health professionals on craniofacial teams and determine how craniofacial teams assess for psychological concerns in their patient populations.

Design

Online and paper surveys.

Participants

A total of 55 craniofacial team coordinators and 40 mental health professionals who are team members participated in this study.

Results

Results indicated that teams in 2007 generally viewed psychological services on their teams similarly to teams assessed in 1987. Most teams do not use formal measures in their assessment of psychological concerns, and they provide feedback via discussions with the families. Mental health professionals assess a wide variety of potential areas of concern and are generally satisfied with the referral sources available to their patients.

Conclusions

Craniofacial teams appear to practice in a manner consistent with professional standards, and these teams seem to value the inclusion of mental health professionals as part of the interdisciplinary team. Implications and limitations including response rate are discussed.

Living with a craniofacial condition: development of the Craniofacial Experiences Questionnaire (CFEQ) for adolescents and their parents

OBJECTIVE

To develop a new instrument (the Craniofacial Experiences Questionnaire, CFEQ) to measure both stressors and positive aspects of living with a craniofacial condition from adolescent and parent perspectives, and to examine its validity and reliability. A secondary aim was to explore experiences reported according to age, gender, and diagnosis.

DESIGN

Self-report and parent report questionnaires (CFEQ, Youth Self Report [YSR], Child Behavior Checklist [CBCL], Behavioral and Emotional Rating Scale [BERS]) were completed by adolescents with congenital craniofacial conditions and their parents.

PARTICIPANTS

Fifty adolescents with craniofacial conditions and 55 of their parents.

RESULTS

Internal reliability of the stressor and positive aspects scales was acceptable (.81 to .92) but was lower for some stressor subscales (.50-.86). Higher stressor scale scores were related to poorer adjustment (CBCL r = .55, YSR r = .37). There were no consistent differences in the stressful or positive experiences of young people with craniofacial conditions according to gender or age. There were no differences in stressors reported according to diagnosis.

CONCLUSIONS

The CFEQ shows promise as a clinical and research tool for investigating the stressors and positive experiences of young people with craniofacial conditions. Consistent with the literature on chronic pediatric conditions, there were few differences in experiences of young people according to diagnosis. Furthermore, the lack of gender or age differences supports the need for clinicians to comprehensively assess the experiences of young people regardless of demographic variables.

Quality of Life Varies with Gender and Age among Adults Treated for Unilateral Cleft Lip and Palate

Objective

To evaluate health-related quality of life among adults treated for unilateral cleft lip and palate and to investigate whether patients were affected differently depending on gender and age.

Design

Cross-sectional population study with long-term follow-up.

Patients/Settings

All unilateral cleft lip and palate patients born 1960–1987 and treated at Uppsala University Hospital were invited (n = 109). Response rate was 79% (n = 86). Mean follow-up time was 35 years. Norm data matched for age and gender were used for comparison (n = 1385).

Main Outcome Measures

Health-related quality of life measured with the SF-36 questionnaire. High values indicate good level of health-related quality of life.

Results

The total patient group had lower values in the Mental Health subscale compared with norm data ( p = .005). Values in all other subscales did not differ from norm data. Women had a higher positive difference than men in the subscale emotional role function compared with the matched norm population (p < .001). The younger age group (20 to 32 years old) consistently had a larger negative difference to matched norm data compared with the older age group (33 to 47 years old) in the subscales social function ( p = .009), physical role function ( p < .001), and emotional role function ( p < .001).

Conclusions

Unilateral cleft lip and palate affected health-related quality of life differently depending on gender and age of the patient. Younger patients were affected more negatively than older patients on several subscales. However, except for the mental health subscale, health-related quality of life was similar among unilateral cleft lip and palate patients and norm data.

Psychosocial Adjustment in Children and Adolescents with a Craniofacial Anomaly: Diagnosis-Specific Patterns

Objective

To obtain descriptive information about diagnosis-specific patterns of psychosocial adjustment for children and adolescents with craniofacial anomalies.

Design

Chart review of medical records was used to obtain psychosocial checklists. Scores were compared with published norms to evaluate elevated risk of problems, separately for six diagnostic groups.

Setting

Plastic surgery department in urban university medical center.

Participants

As part of routine ongoing care, 408 caregivers completed checklists assessing psychosocial adjustment of children aged 2 to 18 years with diagnosis of cleft lip and palate, cleft lip only, cleft palate only, craniosynostosis, hemifacial microsomia, and hemangioma.

Main Outcome Measure

Child Behavior Checklist ( Achenbach, 1991 , 1992 ).

Results

The craniosynostosis group showed elevated rates (beyond norms) of social, academic, and attention problems. The cleft lip and palate group showed elevations in social problems and deficits in social, academic, and activities competencies. The other diagnostic groups had few areas of elevated problems and had reduced risk in some areas.

Conclusion

Specific patterns of strengths and weaknesses in psychosocial adjustment may vary by craniofacial anomaly diagnosis. Replication of these findings, with extension to other craniofacial anomaly diagnoses, is warranted.

Concealment, depression and poor quality of life in patients with congenital facial anomalies

OBJECTIVES

Studies have shown that patients with congenital facial anomalies are vulnerable to depression. In addition, concealment of facial anomalies in an effort to mask handicaps is common, and these patients also often have difficulties with interpersonal relationships and in social situations. Despite this, no previous study has investigated the association between concealment of facial anomalies and depression, and a patient's quality of life.

METHODS

A group of 65 patients, who had been scheduled for plastic surgery, completed this study. A total of 50 patients who had congenital facial anomalies, some of whom concealed their facial anomalies (N=22), and some whom didn't (N=28), as well as 15 patient controls were interviewed and subsequently administered the Beck Depression Inventory-II (BDI-II), the Structured Clinical Interview for DSM-IV (SCID), the Millon Behavioral Medicine Diagnostic (MBMD) and the WHO Quality of Life (WHOQOL).

RESULTS

Among patients with congenital facial anomalies, those who concealed their anomalies exhibited a significantly higher level of depression and anxiety; higher rates of self-accusation, dissatisfaction, hypochondria, weight loss and antisocial personality traits; and a lower quality of life than those who did not conceal their anomalies. To the contrary, no significant differences were found with respect to depression, anxiety and quality of life between the congenital facial anomaly group and controls. Further, the concealment of facial anomalies was a significant predictor for lifetime major depressive disorder (odds ratio (OR)=7.1, 95% confidence interval (CI) 1.4-37.3), after adjusting for age, gender and microtia.

CONCLUSION

Facial concealment is a significant predictor of depression and poor quality of life in patients with congenital facial anomalies.

The impact of orofacial clefts on quality of life and healthcare use and costs

Orofacial clefts are common birth defects that may impose a large burden on the health, quality of life, and socioeconomic well-being of affected individuals and families. They also result in significant healthcare use and costs. Understanding the impact of orofacial clefts on these outcomes is important for identifying unmet needs and developing public policies to reduce the burden of orofacial clefts at the individual, family and societal levels. This paper reviews and summarizes the main findings of recent studies that have evaluated the impact of orofacial clefts on these outcomes, with a focus on quality of life, socioeconomic outcomes, long-term health, and healthcare use and costs. Several studies identify an increased burden of orofacial clefts on these outcomes, but some of the findings are inconsistent. A summary of the primary limitations of the studies in this area is presented, along with recommendations and directions for future research.

Critical issues in craniofacial care: quality of life, costs of care, and implications of prenatal diagnosis

Since the 2000 Surgeon General's Report on Oral Health (SGROH), substantial areas of inquiry relative to individuals, especially children and youth, with orofacial clefts and other craniofacial conditions have emerged. These areas include access to and cost of care, stigmatization and quality of life, and social and ethical issues around prenatal diagnosis. This update on the 2000 SGROH examines what we have learned about the cost and ability to access cleft and craniofacial care, prenatal diagnosis, and how quality of life is impacted by these conditions and the burden of care. The development of new research tools to assess quality of life since 2000 will permit further study of the impact of oral and craniofacial conditions on children and families and the effect of treatment on quality of life. Despite a better understanding of the higher use of services and increased costs of care for families of children with craniofacial conditions, major gaps in research must be addressed to assist with program planning and policy development for these groups of children and their families. Further work is also needed to assess the cost-effectiveness of craniofacial team care and to better understand family experience with accessing needed care. Finally, prenatal detection and diagnosis of clefts and craniofacial conditions have advanced dramatically, and the roles of craniofacial professionals and teams have been affected. New understandings of prenatal diagnosis and genomic sciences are redefining genetic counseling, therapy, and future preventive initiatives.

Research and action: toward good quality of life and equity in health

A brief summary of key presentations at the 15th Annual International Society for Quality of Life conference is presented. Special highlights of this conference were its location (South America) and its aim to present current and potential contributions of the health-related quality of life (QoL) field to equity in healthcare at a clinical and population level, providing crucial inputs for decision-making in a person-centered health conception. Present and future utilization of health-related QoL measures, norms and bank items were introduced by David Cella, who also called for researchers' cooperation, stating that efforts towards a commonly shared language and metric are better than a relentless pursuit of perfection. Other central topics in the search of equity were stigma and poverty. The importance of negative attributes by others in stigma severity perception and low self-reported QoL was demonstrated by Donald Patrick, who suggested interventions for reducing stigma. Poverty impact on children's QoL and the importance of social determinants were demonstrated through a unique, longitudinal Brazilian study. Complementarily, the importance of a biological basis of oncologic symptoms, particularly cytokines, and the impact of their control on health-related QoL were addressed by Charles Cleeland. The meeting stressed the combined importance of social, psychological and biological factors in determining patient-reported outcomes.

Qualitative Approaches in Craniofacial Research

This article proposes the customary use of qualitative methods as complementary research tools to enhance the evidence base in the craniofacial field. The recognition given to qualitative approaches in other healthcare areas and their value in enhancing understanding of lay and professional beliefs and behaviors is contrasted with the paucity of qualitative studies to date in the craniofacial field. Research tools from the qualitative repertoire are briefly introduced and their underpinning principles are explained. The contribution made to research with children and families in wider healthcare areas and in the craniofacial field to date is outlined. Future potential applications of these methods to craniofacial research are discussed. It is suggested that qualitative methods be integrated into craniofacial research as part of the standard toolbox of inquiry, and that interdisciplinary collaborations with colleagues from the social sciences appropriately skilled in the methods should be developed.

Psychosocial functioning and sleep patterns in children and adolescents with cleft lip and palate (CLP) compared with healthy controls

OBJECTIVE

The aim of this study was twofold: to assess psychological functioning, interactional competencies, and sleep patterns in children and adolescents with cleft lip and palate (CLP), and to compare these results with those from age- and gender-matched controls. It was hypothesized that participants with CLP would exhibit greater difficulties in psychological functioning, more interactional difficulties, and poorer sleep patterns than those without CLP.

PARTICIPANTS

Thirty-two children and adolescents with CLP and 34 controls were recruited. Ages ranged from 6 to 16 years.

MAIN OUTCOME MEASURES

For psychosocial assessment, the Strength and Difficulties Questionnaire (SDQ) and a questionnaire on interactional competencies (PIELCQ) were completed; for sleep assessment, a sleep log was completed for seven consecutive nights.

RESULTS

Participants with and without CLP did not differ with respect to emotional problems, conduct problems, or hyperactivity. With respect to interactional competencies, participants with CLP were six times more likely to report difficulties. Unfavorable sleep patterns were associated with psychosocial strain but not with the presence of CLP.

CONCLUSIONS

RESULTS indicate that children and adolescents with CLP may report that they have sleep irregularities as often as those without CLP. In adolescence, the presence of CLP may be associated with increased difficulties. Consequently, skill training to improve context-related social competencies may be appropriate.

Clinical research in pediatric plastic surgery and systematic review of quality-of-life questionnaires

In the first part of this article, examples of different research designs used to study pediatric patients who undergo plastic surgery are described. The remainder of the article discusses the measurement of outcomes in pediatric plastic surgery research, with a particular focus on the assessment of quality of life (QOL). Issues specific to measuring QOL in children are discussed (eg, developmental considerations, use of self- versus proxy report). The results of a systematic literature review to identify and appraise pediatric plastic surgery condition-specific measures of QOL are presented.