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Hunter S, Hilario C, Patte KA, Leatherdale ST, Pabayo R. Association Between Area-Level Income Inequality and Health-Related School Absenteeism: Evidence From the COMPASS Study. THE JOURNAL OF SCHOOL HEALTH 2024; 94:148-157. [PMID: 37675587 DOI: 10.1111/josh.13390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 07/20/2023] [Accepted: 08/09/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Income inequality is theorized to impact health. However, evidence among adolescents is limited. This study examined the association between income inequality and health-related school absenteeism (HRSA) in adolescents. METHODS Participants were adolescents (n = 74,501) attending secondary schools (n = 136) that participated in the 2018-2019 wave of the COMPASS study. Chronic (missing ≥3 days of school in the previous 4 weeks) and problematic (missing ≥11 days of school in the previous 4 weeks) HRSA was self-reported. Income inequality was assessed via the Gini coefficient at the census division (CD) level. Multilevel modeling was used. RESULTS Greater income inequality was associated with a higher likelihood of chronic and problematic HRSA (chronic: OR = 1.17, 95% CI: 1.06, 1.30; problematic: OR = 1.29, 95% CI 1.11 to 1.50). Increased predicted probabilities for Problematic HRSA were observed at greater degrees of income inequality among students who identified as either white, black, Latinx, or mixed, while protective associations were observed among students who identified as Asian or other. No associations were modified by gender. CONCLUSION Income inequality demonstrated unfavorable associations with HRSA, which was modified by racial identity.
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Affiliation(s)
- Stephen Hunter
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Carla Hilario
- School of Nursing, Faculty of Health and Social Development, University of British Columbia Okanagan, 1147 Research Road ART, Kelowna, BC, V1V 1V7, Canada
| | - Karen A Patte
- Department of Health Sciences, Brock University, 1812 Sir Isaac Brock Way, St. Catharines, ON, L2S 3A1, Canada
| | - Scott T Leatherdale
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, TJB 2317, Waterloo, ON, N2L 3G1, Canada
| | - Roman Pabayo
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, AB, T6G 1C9, Canada
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Michel HK, Gorham TJ, Lee JA, Liu SB, Wright M, Maltz RM, Dotson JL. Impact of Telemedicine on Delivery of Pediatric Inflammatory Bowel Disease Care. J Pediatr Gastroenterol Nutr 2023; 77:519-526. [PMID: 37501225 DOI: 10.1097/mpg.0000000000003903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
OBJECTIVES Outpatient inflammatory bowel disease (IBD) care shifted from office visits (OVs) to a model with integrated telemedicine during the 2020 COVID-19 pandemic. We describe the impact of this shift on delivery of pediatric IBD care. METHODS We collected electronic medical record data from office and telemedicine visits for pediatric patients with IBD at a single center from April 2019 to December 2020. We compared visit volume, duration, and test ordering between 2019 and 2020, and between OV and telemedicine, and assessed for differences in telemedicine adoption by sociodemographic factors. RESULTS Visit volume was maintained between 2019 and 2020. Median overall appointment time was shorter for telemedicine versus OV [46 (interquartile range, IQR 35-72) vs 62 (IQR 51-80) minutes; P < 0.001] with no significant difference in time spent with provider [28 (IQR 21-41) vs OV 30 (IQR 24-39) minutes; P = 0.08]. Accounting for drive time, telemedicine visits were 2.6 times shorter than office visits in 2020 ( P < 0.001). In univariate analyses, there was no difference in telemedicine utilization by race or gender. Variables significantly associated with telemedicine were older age, English as primary language, being non-Hispanic, commercial insurance, living in an area of very high opportunity, and having a longer drive time to the office ( P < 0.05 for all comparisons). In multivariate analyses, visits among patients with commercial insurance were significantly more likely to be conducted via telemedicine ( P = 0.02). Among those with a telemedicine visit, multivariate analyses demonstrated multiracial patients were significantly more likely to have video visits (vs audio-only; P = 0.02), while patients with public insurance, no or missing insurance, and whose primary language was Arabic were significantly less likely to have video visits ( P < 0.05 for all comparisons). CONCLUSIONS Integrated telemedicine allowed for continued delivery of pediatric IBD care and significantly decreased appointment time. While telemedicine may improve access for those who live further from the office, concerns remain about the introduction of disparities.
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Affiliation(s)
- Hilary K Michel
- From the Division of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH
- the Department of Pediatrics, The Ohio State Wexner Medical Center, Columbus, OH
| | - Tyler J Gorham
- Information Technology Research & Innovation, Nationwide Children's Hospital, Columbus, OH
| | - Jennifer A Lee
- From the Division of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH
- the Department of Pediatrics, The Ohio State Wexner Medical Center, Columbus, OH
- the Department of Biomedical Informatics, the Ohio State University, Columbus, OH
| | - Swan Bee Liu
- Information Technology Research & Innovation, Nationwide Children's Hospital, Columbus, OH
| | - Molly Wright
- the Department of Biobehavioral Health, Pennsylvania State University, University Park, PA
| | - Ross M Maltz
- From the Division of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH
- the Department of Pediatrics, The Ohio State Wexner Medical Center, Columbus, OH
| | - Jennifer L Dotson
- From the Division of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH
- the Department of Pediatrics, The Ohio State Wexner Medical Center, Columbus, OH
- the Center for Child Health Equity and Outcomes Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH
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El-Matary W, Carroll MW, Deslandres C, Griffiths AM, Kuenzig ME, Mack DR, Wine E, Weinstein J, Geist R, Davis T, Chan J, Khan R, Matthews P, Kaplan GG, Windsor JW, Bernstein CN, Bitton A, Coward S, Jones JL, Lee K, Murthy SK, Targownik LE, Peña-Sánchez JN, Rohatinsky N, Ghandeharian S, Im JHB, Goddard Q, Gorospe J, Verdugo J, Morin SA, Morganstein T, Banning L, Benchimol EI. The 2023 Impact of Inflammatory Bowel Disease in Canada: Special Populations-Children and Adolescents with IBD. J Can Assoc Gastroenterol 2023; 6:S35-S44. [PMID: 37674497 PMCID: PMC10478811 DOI: 10.1093/jcag/gwad016] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
Abstract
Rates of inflammatory bowel disease (IBD) in Canadian children and adolescents are among the highest in the world, and the incidence is rising most rapidly in children under five years of age. These young children may have either a typical form of IBD with multi-factorial aetiology, or they may have a monogenic form. Despite the growing number of children in Canada living with this important chronic disease, there are few available medical therapies approved by Health Canada due to the omission of children from most clinical trials of newly developed biologics. As a result, off-label use of medications is common, and physicians have learned to use existing therapies more effectively. In addition, most Canadian children are treated in multidisciplinary, specialty clinics by physicians with extra training or experience in IBD, as well as specialist nurses, dietitians, mental health care providers and other allied health professionals. This specialized clinic approach has facilitated cutting edge research, led by Canadian clinicians and scientists, to understand the causes of IBD, the optimal use of therapies, and the best ways to treat children from a biopsychosocial perspective. Canadians are engaged in work to understand the monogenic causes of IBD; the interaction between genes, the environment, and the microbiome; and how to address the mental health concerns and medical needs of adolescents and young adults transitioning from paediatric to adult care.
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Affiliation(s)
- Wael El-Matary
- Department of Pediatrics and Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Matthew W Carroll
- Division of Pediatric Gastroenterology and Nutrition, University of Alberta, Edmonton, Alberta, Canada
| | - Colette Deslandres
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Anne M Griffiths
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - M Ellen Kuenzig
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - David R Mack
- CHEO IBD Centre and Department of Pediatrics, University of Ottawa, Ottawa, Canada
| | - Eytan Wine
- Departments of Pediatrics and Physiology, University of Alberta, Edmonton, Alberta, Canada
- Edmonton Pediatric IBD Clinic, Edmonton, Alberta, Canada
| | - Jake Weinstein
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rose Geist
- Department of Psychiatry, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Tal Davis
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Justin Chan
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, British Columbia Children Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Rabia Khan
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | | | - Gilaad G Kaplan
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Joseph W Windsor
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Charles N Bernstein
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- University of Manitoba IBD Clinical and Research Centre, Winnipeg, Manitoba, Canada
| | - Alain Bitton
- Division of Gastroenterology and Hepatology, McGill University Health Centre, IBD Centre, McGill University, Montréal, Quebec, Canada
| | - Stephanie Coward
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer L Jones
- Departments of Medicine, Clinical Health, and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kate Lee
- Crohn’s and Colitis Canada, Toronto, Ontario, Canada
| | - Sanjay K Murthy
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital IBD Centre, Ottawa, Ontario, Canada
| | - Laura E Targownik
- Division of Gastroenterology and Hepatology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Juan-Nicolás Peña-Sánchez
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Noelle Rohatinsky
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - James H B Im
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Quinn Goddard
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Julia Gorospe
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Jules Verdugo
- Crohn’s and Colitis Canada, Toronto, Ontario, Canada
| | - Samantha A Morin
- Department of Medical Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Taylor Morganstein
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Lisa Banning
- Crohn’s and Colitis Canada, Toronto, Ontario, Canada
| | - Eric I Benchimol
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Oliveira CRD, Alvarenga P, Paixão C. Repercussões das Doenças Inflamatórias Intestinais no Desenvolvimento Socioemocional de Pacientes Pediátricos. REVISTA PSICOLOGIA E SAÚDE 2023. [DOI: 10.20435/pssa.v14i3.1803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
Este estudo descreve as repercussões dos sintomas das doenças inflamatórias intestinais (DII) nas emoções, na vida escolar e nas interações sociais de pacientes pediátricos. Participaram 20 cuidadores de crianças e adolescentes com idades entre cinco e 17 anos e diagnosticados com alguma DII. Os cuidadores, que tinham entre 26 e 54 anos, forneceram informações clínicas e sociodemográficas e responderam a um questionário sobre as repercussões dos sintomas das DII na vida das crianças e dos adolescentes. A análise das frequências absolutas e relativas e o teste de aderência revelaram que os impactos dos sintomas foram significativamente maiores nas emoções quando comparados aos impactos na vida escolar e nas interações sociais (X² = 6,14; df= 2; p= 0,04). O tratamento das DII deve incluir a construção de planos terapêuticos sensíveis às necessidades psicossociais dos pacientes pediátricos.
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High Impact of Pediatric Inflammatory Bowel Disease on Caregivers' Work Productivity and Daily Activities: An International Prospective Study. J Pediatr 2022; 246:95-102.e4. [PMID: 35429506 DOI: 10.1016/j.jpeds.2022.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/31/2022] [Accepted: 04/08/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To evaluate the longitudinal evolution of work productivity loss and activity impairment in caregivers of children with inflammatory bowel disease (IBD). We also evaluated the associations between these impairments, IBD-related factors, and caregivers' health-related quality of life (HRQOL) and estimated the indirect costs related to work absenteeism. STUDY DESIGN Since January 2017, children with newly diagnosed IBD were enrolled prospectively in the Pediatric Inflammatory Bowel Disease Network for Safety, Efficacy, Treatment and Quality improvement of care study. The impact of pediatric-onset IBD on caregivers' socioeconomic functioning (work and daily activities) and HRQOL was assessed using the Work Productivity and Activity Impairment for caregivers questionnaire and the European Quality of Life Five Dimension Five Level questionnaire, at diagnosis and 3 and 12 months of age. Generalized estimating equation models were applied to evaluate outcomes longitudinally, adjusted for IBD type, disease activity, and child's age at diagnosis. RESULTS Up to July 2021, 491 children with IBD were eligible for analysis of caregivers' Work Productivity and Activity Impairment questionnaire. At diagnosis, the mean caregivers' employment rate was 78.4%; the adjusted mean work productivity loss was 44.6% (95% CI, 40.2%-49.0%), and the adjusted mean activity impairment was 34.3% (95% CI, 30.8%-37.7%). Work productivity loss and activity impairment significantly decreased over time and were associated with disease activity, but not with IBD type or child's age. Caregivers' HRQOL was associated with both impairments. Costs related to work absenteeism were at least €6272 ($7276) per patient during the first year after diagnosis. CONCLUSIONS Caregivers of children with IBD experience significant impairments in work and daily activities, especially at diagnosis. The impact decreases thereafter and is associated with disease activity and caregivers' HRQOL. Work absenteeism results in high indirect costs.
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The Combined Effects of Youth and Parent Illness Intrusiveness on Depressive Symptoms in Adolescents with Inflammatory Bowel Disease. J Clin Psychol Med Settings 2022; 30:238-247. [PMID: 35668287 DOI: 10.1007/s10880-022-09886-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2022] [Indexed: 10/18/2022]
Abstract
Inflammatory bowel disease (IBD) presents physical and emotional challenges for families and imposes significant lifestyle intrusions on both youth and parents. The present study examined the effects of IBD disease activity and youth illness intrusiveness on depressive symptoms in adolescents, and the moderating influence of parent illness intrusiveness on these associations. Adolescents and parents completed measures of illness intrusiveness; youth completed a measure of depressive symptoms. Physicians provided estimates of IBD disease activity. Mediation analysis revealed an IBD disease activity → youth intrusiveness → youth depressive symptoms indirect effect. Moderated mediation analyses revealed this indirect effect to be greater among youth whose parents endorsed more IBD-related intrusions. Youth encountering greater activity disruptions related to IBD are vulnerable to depressive symptoms. When parents also experience IBD-induced intrusions, youth are at even greater risk for depressive symptoms. Clinical implications are discussed within the context of youths' and parents' experiences of IBD.
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Plevinsky JM, Maddux MH, Fishman LN, Kahn SA, Greenley RN. Perceived effect of pediatric inflammatory bowel diseases on academics, college planning, and college adjustment. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:940-947. [PMID: 32643555 DOI: 10.1080/07448481.2020.1781869] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 03/30/2020] [Accepted: 06/07/2020] [Indexed: 06/11/2023]
Abstract
ObjectiveTo examine the relationship between perceived effect of inflammatory bowel diseases (IBD) on high school academics and college planning on college adjustment. Participants: Participants (N = 97) were college students with IBD. Methods: Participants completed an online survey including the Student Adaptation to College Questionnaire and study-developed questions assessing the perceived impact of their diagnosis on their high school academics and college planning. Results: Most participants reported average college adjustment across domains, except personal-emotional adjustment with 47% of participants falling within the very low to low ranges. Nearly half reported IBD impacted their choice of college (49%). The impact of IBD on college planning was most consistently associated with domains of college adjustment. Conclusions: IBD severely impacts college planning, decision-making, and adjustment in college-bound youth. Perceiving that having a chronic illness impacts college planning may result in greater difficulty with academic adjustment, attachment to the institution, and social adjustment during college.
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Affiliation(s)
- Jill M Plevinsky
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Michele H Maddux
- Department of Developmental and Behavioral Health, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Laurie N Fishman
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Stacy A Kahn
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Rachel N Greenley
- Department of Clinical Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
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Tempchin J, Storch B, Reigada LC. Systematic review: Psychosocial factors of resilience in young people with inflammatory bowel disease. J Psychosom Res 2021; 148:110558. [PMID: 34280678 DOI: 10.1016/j.jpsychores.2021.110558] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 06/10/2021] [Accepted: 06/25/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Inflammatory bowel disease (IBD) affects a growing number of young people. While factors associated with poor disease experience in pediatric IBD have garnered much attention in the literature, less attention has focused on the factors associated with the resilient outcomes seen in the majority of young people with IBD. This review seeks to contribute to the literature by synthesizing research on the psychosocial factors that promote resilience in pediatric IBD and by offering future directions for the field. METHODS Systematic searches of the MEDLINE, Embase, PsychInfo, and CINAHL databases were performed for quantitative English-language studies with keywords for IBD, resilience or factors of resilience, and pediatric populations, with no date restrictions. Reference lists of all included articles were searched. Quality assessments were performed using an NIH tool. RESULTS Of 3315 articles identified, 17 were included. Studies were heterogeneous, with 19 psychosocial factors identified and analyzed for associations with over two dozen indicators of resilience. A narrative synthesis of included studies was performed. Study details were organized into three domains-individual, social, and family. Preliminary data indicate that resilience in pediatric IBD may be associated with positive body image, increased mindfulness, and improved social functioning, among other potential factors. CONCLUSIONS Resilience in pediatric IBD is largely unstudied. Only one study pursued an understanding of resilience as an aim, and no studies incorporated validated measures of resilience. Future prospective, theory-driven research is needed to elucidate the network of factors and mechanisms that can foster resilience in children and adolescents with IBD.
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Affiliation(s)
- Jacob Tempchin
- Quantitative Methods in the Social Sciences, The Graduate Center, City University of New York, New York, NY, USA.
| | - Barbara Storch
- Health Psychology and Clinical Science Program in Psychology, The Graduate Center, City University of New York, New York, NY, USA.
| | - Laura C Reigada
- Health Psychology and Clinical Science Program in Psychology, The Graduate Center, City University of New York, New York, NY, USA; Psychology Department, Brooklyn College, City University of New York, Brooklyn, NY, USA.
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Affiliation(s)
- Nathan S Rubalcava
- Section of Pediatric Surgery, Department of Surgery, University of Michigan, Mott Children's Hospital, 1540 East Hospital Drive SPC 4217, Ann Arbor, MI 48109 - 4217, USA
| | - Samir K Gadepalli
- Section of Pediatric Surgery, Department of Surgery, University of Michigan, Mott Children's Hospital, 1540 East Hospital Drive SPC 4217, Ann Arbor, MI 48109 - 4217, USA; Susan B. Meister Child Health Evaluation and Research Center, Michigan Medicine, Ann Arbor, MI 48109, USA.
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Roberts CM, Addante SM, Baudino MN, Edwards CS, Gamwell KL, Jacobs NJ, Tung J, Grunow JE, Mullins LL, Chaney JM. Stigma Moderates the Relation Between Peer Victimization, Thwarted Belongingness, and Depressive Symptoms in Youth with Inflammatory Bowel Disease. J Pediatr Nurs 2021; 59:137-142. [PMID: 33878539 DOI: 10.1016/j.pedn.2021.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/10/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The stigmatizing nature of IBD symptoms may place youth at risk for being targets of peer victimization, potentially resulting in a decreased sense of social belongingness and poorer emotional adjustment. The present study tested a series of mediation and moderated mediation models examining the associations among peer victimization, thwarted social belongingness, and depressive symptoms, as well as the moderating role of IBD stigma in these associations. We hypothesized peer victimization would have an indirect effect on youth depressive symptoms through thwarted belongingness, and this effect would be amplified for youth endorsing greater IBD stigma. DESIGN AND METHODS Seventy-five youth (10-18 yrs.) diagnosed with IBD were recruited from a pediatric gastroenterology clinic. Participants completed self-report measures of IBD stigma, peer victimization, thwarted belongingness, and depressive symptoms. RESULTS As anticipated, mediation analyses revealed a significant peer victimization → thwarted belongingness → depressive symptoms indirect path. Moderated mediation analyses indicated that this indirect effect was moderated by IBD stigma and was significantly greater among youth reporting higher IBD stigma. CONCLUSIONS Youth who experience higher levels of IBD-related stigma are at increased risk for depressive symptoms as a function of the socially isolating effects of peer victimization. PRACTICE IMPLICATIONS Our findings highlight the need for routine screening and identification of the socioemotional challenges faced by youth with IBD. Clinical interventions that incorporate coping strategies aimed at minimizing youths' stigmatizing self-perceptions and improving overall social skills and social engagement may lessen the negative impact of peer victimization on youths' social and emotional adjustment.
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Affiliation(s)
- Caroline M Roberts
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University, USA.
| | - Samantha M Addante
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University, USA
| | - Marissa N Baudino
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University, USA
| | - Clayton S Edwards
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University, USA
| | | | - Noel J Jacobs
- University of Oklahoma Children's Physicians, General and Community Pediatrics, USA
| | - Jeanne Tung
- University of Oklahoma Children's Physicians, Pediatric Gastroenterology, USA
| | - John E Grunow
- University of Oklahoma Children's Physicians, Pediatric Gastroenterology, USA
| | - Larry L Mullins
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University, USA
| | - John M Chaney
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University, USA
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Roberts CM, Gamwell KL, Baudino MN, Grunow JE, Jacobs NJ, Tung J, Gillaspy SR, Hommel KA, Mullins LL, Chaney JM. The Contributions of Illness Stigma, Health Communication Difficulties, and Thwarted Belongingness to Depressive Symptoms in Youth with Inflammatory Bowel Disease. J Pediatr Psychol 2020; 45:81-90. [PMID: 31633787 DOI: 10.1093/jpepsy/jsz084] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 09/21/2019] [Accepted: 09/22/2019] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE Youth with inflammatory bowel disease (IBD) often experience difficulties communicating about their disease. It is suspected that the stigmatizing nature of IBD symptoms contributes to youths' health communication difficulties, leaving youth feeling disconnected from their social environment and potentially resulting in decreased social belongingness and poorer emotional functioning. In this study, we tested an illness stigma → health communication difficulties → thwarted belongingness → depressive symptoms serial mediation model. It was anticipated that youth illness stigma would confer a serial indirect effect on youth depressive symptoms through the sequential effects of stigma on health communication difficulties and thwarted social belongingness. METHODS Seventy-five youth with IBD between the ages of 10 and 18 completed measures of perceived illness stigma, health communication difficulties, thwarted belongingness, and depressive symptoms. RESULTS Results indicated a significant illness stigma → thwarted belongingness → depressive symptoms simple mediation path. Importantly, findings also revealed a significant serial mediation path for illness stigma → health communication difficulties → thwarted belongingness → depressive symptoms. CONCLUSIONS Youth who perceive greater IBD stigma appear to experience increased difficulty communicating about their IBD with others, which in turn is associated with feelings of thwarted social belongingness and ultimately elevated depressive symptoms. These findings suggest that difficulty communicating about IBD is one potential route by which illness stigma has a negative impact on youth adjustment outcomes. Results could also inform clinical interventions to address IBD stigma and health communication difficulties associated with the social and emotional challenges in youth with IBD.
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Affiliation(s)
- Caroline M Roberts
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University
| | - Kaitlyn L Gamwell
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University
| | - Marissa N Baudino
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University
| | | | | | - Jeanne Tung
- University of Oklahoma Health Sciences Center
| | | | | | - Larry L Mullins
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University
| | - John M Chaney
- Center for Pediatric Psychology, Psychology Department, Oklahoma State University
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Michel HK, Kim SC, Siripong N, Noll RB. Gaps Exist in the Comprehensive Care of Children with Inflammatory Bowel Diseases. J Pediatr 2020; 224:94-101. [PMID: 32482390 PMCID: PMC7483573 DOI: 10.1016/j.jpeds.2020.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 02/18/2020] [Accepted: 04/01/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To describe patterns of primary and specialty care delivery in pediatric patients with inflammatory bowel diseases (IBD), delineate which members of the healthcare team provided services, and identify gaps in care. STUDY DESIGN Cross-sectional survey of parents of children (2-17 years) with IBD and adolescents with IBD (13-17 years) at a free-standing, quaternary children's hospital regarding healthcare receipt. RESULTS There were 161 parents and 84 adolescents who responded to the survey (75% and 60% response, respectively). The mean patient age was 14 ± 3 years, 51% were male, 80% had Crohn's disease, 16% ulcerative colitis, and 4% IBD-unspecified. Most parents were white (94%), living in a suburban setting (57%). Sixty-nine percent of households had ≥1 parent with a bachelor's degree or higher. Most had private insurance (43%) or private primary with public secondary insurance (34%). Most patients received annual check-ups (70%), vaccinations (78%), and care for minor illnesses (74%) from their primary care provider. Check-ups for gastrointestinal symptoms, IBD monitoring, and changes in type/dosing of IBD treatment were provided by their gastroenterology provider (77%, 93%, and 86% of patients, respectively). Discussions about family/peer relationships, school/extracurricular activities, and mood were not addressed in 30%-40% of participants. Adolescents frequently reported that no one had talked to them about substance use (40%), sexual health (50%), or body image (60%); 75% of adolescents and 76% of their parents reported that no one had discussed transitioning to an adult provider. CONCLUSIONS There were gaps in the psychosocial care of pediatric patients with IBD. Coordinated, comprehensive care delivery models are needed.
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Affiliation(s)
- Hilary K. Michel
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center (UPMC) Children’s Hospital of Pittsburgh, Pittsburgh, PA, United States,Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children’s Hospital and The Ohio State University College of Medicine, Columbus, OH, United States
| | - Sandra C. Kim
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center (UPMC) Children’s Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Nalyn Siripong
- Clinical Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, United States
| | - Robert B. Noll
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, United States
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Barnes C, Ashton JJ, Borca F, Cullen M, Walker DM, Beattie RM. Children and young people with inflammatory bowel disease attend less school than their healthy peers. Arch Dis Child 2020; 105:671-676. [PMID: 31937567 DOI: 10.1136/archdischild-2019-317765] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 12/09/2019] [Accepted: 12/12/2019] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Chronic diseases, such as inflammatory bowel disease (IBD), can impact negatively on education and social development. Examining the impact of IBD on school/college attendance for children and young people (CYP) is vital to provide targeted support to patients, families and schools. METHODS We performed a cross-sectional survey to determine the school/college attendance rates, the reasons for absence related to IBD and facilitators or barriers to school/college attendance. In a subset of patients followed up locally, we performed a detailed review of hospital attendance data to assess healthcare burden. RESULTS Two hundred and thirty-one questionnaires were given to CYP with IBD aged 5-17 years. Response rate was 74% (final sample 169). The median school/college attendance rate was 92.5%, significantly lower than all children in England (95.2%). 39.6% of children with IBD were persistently absent, defined nationally as missing 10% or more of school. Only five children (3%) had a 100% attendance record. Increasing age and use of monoclonal therapy were predictors of poor school attendance. Concerns about feeling unwell at school/college, access to toilets, keeping up with work and teachers' understanding of IBD are the main issues for CYP with IBD. There was a significant negative correlation between number of days in hospital and school attendance. CONCLUSION IBD has a significant impact on school/college attendance, with hospital attendance, disease burden and school difficulties being major factors. Employing strategies to minimise healthcare burden and developing a partnership between health and education to support children with IBD will serve to facilitate school/college attendance.
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Affiliation(s)
- Claire Barnes
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
| | - James John Ashton
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK .,Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK
| | - Florina Borca
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Mick Cullen
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
| | | | - Robert Mark Beattie
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
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Baudino MN, Gamwell KL, Roberts CM, Grunow JE, Jacobs NJ, Gillaspy SR, Edwards CS, Mullins LL, Chaney JM. Disease Severity and Depressive Symptoms in Adolescents With Inflammatory Bowel Disease: The Mediating Role of Parent and Youth Illness Uncertainty. J Pediatr Psychol 2020; 44:490-498. [PMID: 30551150 DOI: 10.1093/jpepsy/jsy091] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 10/27/2018] [Accepted: 10/29/2018] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE The objective of this study is to examine parent and youth appraisals of illness uncertainty as potential serial mediators in the relation between disease severity and youth depressive symptoms in adolescents with inflammatory bowel disease (IBD). METHODS Participants were 85 adolescents 13-18 years of age (Mage = 15.75, SD =1.51) with a confirmed diagnosis of IBD (Crohn's disease, 59%; ulcerative colitis, 41%) and a primary caregiver. At a scheduled outpatient visit, caregivers completed a measure of illness uncertainty, while adolescents completed measures of illness uncertainty and depressive symptoms. Pediatric gastroenterologists provided global estimates of disease severity. RESULTS Path analysis revealed several significant direct and indirect associations among the modeled variables. Importantly, results provided support for the hypothesized disease severity→parent illness uncertainty→youth illness uncertainty→youth depressive symptoms serial mediation path (95% confidence interval = 0.04 to 1.10). CONCLUSIONS Results indicate that increased disease activity may serve to magnify the unpredictable nature of IBD for parents, reflected in heightened perceptions of illness uncertainty. Our findings also suggest that increased parent illness uncertainty has a significant influence on youth illness uncertainty appraisals, which in turn translates into elevated depressive symptoms in adolescents with IBD. The clinical implications of our findings and suggestions for future studies are discussed.
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Kubesch A, Boulahrout P, Filmann N, Blumenstein I, Hausmann J. Real-world data about emotional stress, disability and need for social care in a German IBD patient cohort. PLoS One 2020; 15:e0227309. [PMID: 31899780 PMCID: PMC6941800 DOI: 10.1371/journal.pone.0227309] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 11/23/2019] [Indexed: 12/25/2022] Open
Abstract
To date, there is insufficient insight into inflammatory bowel disease (IBD)-associated stress, recognized disability, and contact with the social care system. We aimed to assess these parameters in IBD patients and a non-IBD control group, who were invited to participate in an online survey developed specifically for this study (www.soscisurvey.de) with the help of IBD patients. 505 IBD patients and 166 volunteers (i.e., control group) participated in the survey. IBD patients reported significantly increased levels of stress within the last six months and five years (p<0.0001) and were more likely to have a recognized disability (p<0.0001). A low academic status was the strongest indicator of a disability (p = 0.006). Only 153 IBD patients (30.3%) reported contact with the social care system, and a disability was the strongest indicator for this (p<0.0001). Our study provides data on stress and disability in a large unselected German IBD cohort. We showed that patients with IBD suffer more often from emotional stress and more often have a recognized disability. As only about 1/3 of the patients had come into contact with the social care system and the corresponding support, this patient group is undersupplied in this area.
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Affiliation(s)
- Alica Kubesch
- Department of Internal Medicine 1, Goethe-University Hospital, Frankfurt, Germany
| | - Patric Boulahrout
- Department 4 Social Work and Health, Frankfurt University of Applied Sciences, Frankfurt, Germany
| | - Natalie Filmann
- Institute of Biostatistics and Math Modeling, Goethe-University Hospital, Frankfurt, Germany
| | - Irina Blumenstein
- Department of Internal Medicine 1, Goethe-University Hospital, Frankfurt, Germany
| | - Johannes Hausmann
- Department of Internal Medicine 1, Goethe-University Hospital, Frankfurt, Germany
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The pediatric inflammatory bowel disease INTERMED: A new clinical tool to assess psychosocial needs. J Psychosom Res 2019; 119:26-33. [PMID: 30947814 DOI: 10.1016/j.jpsychores.2019.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/01/2019] [Accepted: 02/03/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The adult INTERMED is used to determine case complexity and psychosocial needs. We developed and validated a pediatric version of the INTERMED for children and adolescents with inflammatory bowel disease (IBD) and assessed its utility in predicting healthcare utilization. METHODS We performed a cross-sectional study of children (aged 8-17 y) with IBD (n = 148) and their parents, seen in a hospital-based clinic. Subjects completed semi-structured interviews that were scored on the 34 pIBD-INTERMED items. To assess inter-rater reliability, 40 interviews were videotaped and scored by a second assessor. Convergent and predictive validity were assessed by examining the relation of the pIBD-INTERMED to standardized measures of psychological, social, and family functioning, disease activity, and healthcare utilization. RESULTS Correlational analyses supported the validity of all five pIBD-INTERMED domains with very good inter-rater reliability (median r = 0.87) and internal consistency (α = 0.91) for the total complexity index. Ratings of 2-3 on the pIBD-INTERMED "mental health/cognitive threat" item were associated with greater odds of behavior and social problems (CBCL-Internalizing scale OR = 7.27, 95% CI 2.17-24.36); CBCL-Externalizing scale OR = 24.79, 95% CI 5.00-122.84), depression (Children's Depression Inventory OR = 8.52, 95% CI 1.70-43.02) and anxiety (Multidimensional Anxiety for Children OR = 11.57, 95% CI 3.00-45.37). The pIBD-INTERMED complexity index added significantly to the prediction of healthcare utilization, beyond the contribution of disease severity. CONCLUSIONS The pIBD-INTERMED is a reliable and valid tool for identifying psychosocial risks and needs of children with IBD. It can be used to guide planning of individualized care and enhance interdisciplinary pediatric IBD care.
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