Health related quality of life among Saudi children and adolescents with celiac disease

Physical and psychological symptoms and survey importance in celiac disease

Celiac disease is an autoimmune condition that affects approximately 1% of the worldwide community. Originally thought to be confined mostly to the small intestine, resulting in villous atrophy and nutrient malabsorption, it has more recently been implicated in systemic manifestations as well, particularly when undiagnosed or left untreated. Herein, the physical and psychological symptoms of celiac disease are described and explored. An emphasis is placed on efforts to query prospective and confirmed celiac disease patients via the use of surveys. Suggestions are made regarding the development of efficacious surveys for the purpose of screening for celiac disease in undiagnosed persons, and monitoring efficacy of the gluten-free diet in persons diagnosed with celiac disease. There are broad categories of physical and psychological symptoms associated with celiac disease. There is also an essential interaction between such physical and the psychological symptoms. It is important to capture the association between symptoms, via queries directed toward suspected and confirmed persons with celiac disease. The use of anonymous online surveys can be helpful to determine the qualities and characteristics which may be associated with this condition. It is suggested that personal surveys should be given a greater role in screening and to lessen the time for diagnosis. Querying the subject directly via a survey can provide clues as to the types of symptoms being experienced by those with celiac disease currently, as well as to determine the salient aspects of the symptomatology, which will be useful for rapid screening and monitoring in future work.

The Impact on the Quality of Life Among Newly Diagnosed Children With Coeliac Disease in Malta: A Child Versus Parent Perspective

Background and objective Coeliac disease (CD) is an autoimmune condition that is managed by following a strict lifelong gluten-free diet. Its incidence is rising, and no cure is currently available. CD in children has a significant impact on both patients and their caregivers as they adapt to a new lifestyle. Tools to assess the quality of life (QoL) of children with chronic conditions can shed some light on the disease burden on these families. This study aimed to evaluate the impact on the QoL for newly diagnosed children with CD, considering and comparing both the child's and caregivers' perspectives. It covers various themes including physical and psychological health, the impact on education, and the financial burden on affected families. We sought to evaluate the multidimensional impact of CD on the QoL of newly diagnosed children and their caregivers in Malta and to identify key disparities between child and caregiver perceptions. Different aspects of QoL were assessed, such as financial matters, emotional stress, and physical activity, which were quantified using the standardized KIDSCREEN and CDDUX questionnaire. The perspectives of different patient groups (classified by gender, symptomatology, and age) were compared, providing insights into the differences, which may help refine the management.  Methods This was a retrospective study, collecting data from May 2022 to January 2023. All children under 16 years of age diagnosed with coeliac disease from January 2020 until January 2022 on the Maltese islands, were included in the study. Patients older than 16 years of age or those who had deceased were excluded from the study. The survey comprised the KIDSCREEN-52 and CDDUX questionnaires to assess the QoL. Results A total of 268 children fit the criteria for inclusion, with 134 (50%) children and 134 (50%) matched parent responses. CD was more common among females - 85 (63%) compared to 45 (34%) boys - and children living in the northern region of Malta: 44 (33%). There was no statistically significant difference in QoL when comparing the perspectives of parents vs. children, adolescents vs. young children, boys vs. girls, and asymptomatic vs. symptomatic patients. No significant financial burden was highlighted by the participants. Conclusions The QoL of children with CD in Malta is satisfactory. The perspectives of parents and children on the condition's impact on QoL mostly align, with differences mainly noted regarding the awareness of emotional and social struggles. Our findings suggest that an early CD diagnosis, irrespective of the symptomatology, age, or gender, does not negatively impact the QoL of Maltese children. The study also highlights that despite overall good health, providing adequate psychological, financial, and social support for these children and their families is important to achieve positive outcomes, together with raising further public awareness about this condition.

Assessing the Impact of Celiac Disease on the Quality of Life in Jordan

INTRODUCTION

Celiac disease profoundly impacts individuals' daily lives, prompting the need to assess health-related quality of life (HRQoL) in affected children. This study aimed to evaluate HRQoL among Jordanian children with celiac disease, considering sex, dietary adherence, presence or absence of growth issues, concurrent chronic diseases, and duration since diagnosis.

METHODS

A cross-sectional study invited children from the Celiac Disease Care Providers Society to complete an online Kidscreen-52 questionnaire in Arabic. Descriptive statistics and T-scores for 10 health domains were analyzed against international benchmarks. Cohorts were stratified by concurrent diseases, disease duration, dietary adherence, and growth issues, with comparisons made using t-tests and Cohen's ds.

RESULTS

Among 400 registered members, 126 children (31.5%) participated. Males exhibited inferior HRQoL in multiple domains compared to the general population, with recent studies corroborating findings in females. Males with chronic diseases reported significantly worse moods and self-perception. Females with growth issues faced academic challenges and financial constraints, while those not strictly adherent to a gluten-free diet reported strained parental relationships and challenges in their home environment.

CONCLUSION

This study reveals a marked decline in HRQoL among Jordanian children with celiac disease, emphasizing the need for educational initiatives targeting patients and healthcare providers, alongside broader advocacy for gluten-free diet support. Further research is imperative to identify additional contributing factors and implement community-level interventions.

Psychological, Psychiatric, and Organic Brain Manifestations of Celiac Disease

INTRODUCTION

Celiac disease is an autoimmune condition that affects approximately 1% of the population worldwide. Although its main impact often concerns the small intestine, resulting in villous atrophy and nutrient malabsorption, it can also cause systemic manifestations, particularly when undiagnosed or left untreated.

METHOD

Attention is directed to the possible psychological, psychiatric, and organic brain manifestations of celiac disease. Specific topics related to the influence and risk of such manifestations with respect to celiac disease are defined and discussed. Overall, eighteen main topics are considered, sifted from over 500 references.

RESULTS

The most often studied topics were found to be the effect on quality of life, organic brain dysfunction and ataxia, epilepsy, Down syndrome, generalized psychological disorders, eating dysfunction, depression, and schizophrenia. For most every topic, although many studies report a connection to celiac disease, there are often one or more contrary studies and opinions. A bibliographic analysis of the cited articles was also done. There has been a sharp increase in interest in this research since 1990. Recently published articles tend to receive more referencing, up to as many as 15 citations per year, suggesting an increasing impact of the topics. The number of manuscript pages per article has also tended to increase, up to as many as 12 pages. The impact factor of the publishing journal has remained level over the years.

CONCLUSION

This compendium may be useful in developing a consensus regarding psychological, psychiatric, and organic brain manifestations that can occur in celiac disease and for determining the best direction for ongoing research focus.

Health-related quality of life among celiacs in Portugal: a comparison between general and specific questionnaires

Objective

This study aimed to compare the 36-Item Short Form Survey Instrument version 2 (SF-36-v2) (generic) and Celiac Disease Questionnaire (CDQ) (specific) questionnaires used to evaluate the quality of life (QoL) in celiac Portuguese adult individuals.

Methods

This cross-sectional study used non-probabilistic sampling based on Portuguese celiac patients who accessed the online survey in 2022. The online data collection used a self-reported instrument composed of three parts: (i) socioeconomic, health, and gluten-free diet (GFD) adherence questions; (ii) SF-36 v2 - Portuguese version (generic questionnaire) and (iii) Celiac Disease Questionnaire (CDQ) (specific questionnaire).

Results

A total of 234 individuals who accessed the survey completed the questionnaire. Seven of the eight SF-36 domains positively correlated to the specific questionnaire CDQ. The "General Health" domain (domain 4) showed a negative correlation with the CDQ. Differences in content between the two instruments might be able to explain this finding since the CDQ explores issues regarding the specificities of celiac disease (CD) and the lifelong GFD burden. About half of the sample from this study displayed poor diet adherence, it is possible that the SF-36 could not reflect the impact of CD treatment - the complete elimination of gluten from the diet - on patients' health. Therefore, this issue should be carefully evaluated in future research.

Conclusion

Specific validated questionnaires for CD individuals, such as the CDQ, contemplate social, economic, and clinical variables that permeate the patient's life context. Therefore, these instruments may be more suitable for evaluating QoL in this public. However, using a general questionnaire such as the SF-36 would be indicated for comparing QOL between celiac patients and the general population or even between CD and other disease individuals. In this case, we recommend assessing GFD compliance for control parallelly.

The effect of anxiety and depression levels of children with celiac disease on quality of life

PURPOSE

This study was conducted to examine the effect of anxiety and depression levels on quality of life in children with celiac disease.

DESIGN AND METHOD

This descriptive and correlational study was conducted with 98 children diagnosed with celiac disease who applied to the pediatric outpatient clinic of a university hospital in Eastern Anatolia between September 2021 and August 2022. Data were collected using the State-Trait Anxiety Scale, Depression Scale, and Quality of Life Scale through face-to-face interviews conducted by the researchers. Percentage distribution, mean, independent samples t-test, Pearson correlation analysis and regression analysis were used to analyze the data.

RESULTS

It was found that 62% of the participant children were female and their mean age was 11.69 ± 4.15 years. The mean scores of state anxiety, trait anxiety, depression and quality of life of children with celiac disease were 42.46 ± 5.42 (high), 43.83 ± 7.08 (high), 23.37 ± 4.79 (high) and 43.67 ± 19.67 (low), respectively. Regression analysis revealed that anxiety had a statistically significant relationship with quality of life.

CONCLUSIONS

It was found that children with celiac disease experienced high levels of depression and anxiety along with physical functionality and psychosocial health problems and this negatively affected their quality of life. It is recommended that children with celiac disease should be followed up and supported psychosocially.

PRACTICE IMPLICATIONS

That healthcare professionals can contribute to reducing the depression and axienty and improving the quality of life by strengthening the social support systems of childrens with celiac disease.

Anthropometry and physical appearance can be associated with quality of life in Brazilian women with Turner syndrome

Objective

This study aimed to analyze if anthropometric factors and physical appearance are associated to QoL in Turner syndrome (TS).

Materials and methods

Observational, analytical, and cross-sectional study. The SF-36 was applied along with an additional questionnaire regarding specific characteristics of TS.

Results

There were no differences in quality of life (QoL) in TS women regarding median height and appropriate height according to parental target height, however, participants satisfied and who did not desire to change their height had better scores in the mental health and role emotional domains than those not satisfied and desired to change it. When comparing participants who were or were not bothered by physical appearance, the results showed that those not bothered by physical appearance had a better score in the vitality and social function domains. Considering patients who did or did not desire to change physical appearance, those who did not want to change their physical appearance had higher scores in the mental component and in the social function and mental health domains of the SF-36.

Conclusion

This study indicated that anthropometric factors and physical appearance may possibly be associated to QoL in TS, and also emphasizes the need to develop and validate an official questionnaire regarding specific TS characteristics in order to assess in more detail how specific characteristics of TS interfere with their QoL.

Examining the Psychosocial Well-Being of Children and Adolescents With Coeliac Disease: A Systematic Review

This review aimed to synthesize the available literature regarding the psychosocial well-being of children and adolescents with coeliac disease (CD). Research on psychosocial well-being outcomes in children and adolescents with CD under the age of 18 were identified through a systematic search in the PsychInfo, Medline, Embase, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases in July 2021. Outcomes, including health-related quality of life (HRQOL), psychological adjustment, mental health, and social functioning were examined. Changes in outcomes over time and the geographic representation of the included studies were also analyzed. A total of 43 studies were included. Mixed results were found in the domain of HRQOL and mental health. Both challenges with psychological adjustment and adaptive coping strategies were identified. Social functioning was found to be an area of difficulty for children and adolescents with CD. However, there was high heterogeneity in methodology and participant characteristics between studies. This review concluded there were mixed findings regarding the HRQOL and mental health of young people with CD. However, CD and the gluten-free diet initiates a need for psychological adjustment and impacts on social functioning. The review highlights the need for the integration of physical and psychosocial care, and further research to determine the most appropriate screening measures, and the most efficacious psychological interventions for this group. Future research should continue examining changes in psychosocial outcomes over time given the increase in the availability of gluten-free foods and changes in food labeling policies.

Oral health-related quality of life in children with celiac disease

PURPOSE

There is limited knowledge about oral health-related quality of life (OHRQoL) in children with celiac disease (CD). This study aimed to assess OHRQoL in children with CD compared to healthy controls.

METHODS

This case-control study included children with CD and healthy controls. Three scales were used to assess OHRQoL in different age groups: 6-7 years, 8-10 years, and 11-14 years. The OHRQoL scores were compared between cases and controls to examine the possible associations between OHRQoL and demographics, socioeconomic status, and oral health.

RESULTS

Overall, 104 children with CD and 104 healthy children (controls) were included. The mean age was 10.67 ± 2.39 years in CD patients and 10.69 ± 2.36 in controls (P = 0.971). Male and female children constituted 50% of each group. Children with CD had significantly higher OHRQoL scores than controls (P = 0.003). Low education levels of parents of children with CD and a higher number of siblings in controls were associated with high OHRQoL scores (P = 0.002, P < 0.020, and P = 0.010, respectively). Recurrent aphthous stomatitis (RAS) increased the OHRQoL scores by 7.5 on average (P = 0.016).

CONCLUSION

Children with CD had poor OHRQoL compared with healthy controls. Poor OHRQoL in children with CD was associated with RAS and with lower parental income and education. RAS was an independent predictor of poor OHRQoL in children with CD.

Celiac disease in the COVID-19 pandemic

Background

The COVID-19 pandemic has had an impact on global health.

Design

The impact of the COVID-19 pandemic on patients with coeliac disease was assessed in the present review.

Results

The incidence of coeliac disease and the problems associated with coeliac disease increased during the COVID-19 pandemic. Adherence to the diet is crucial for the patient's health and quality of life since the only approved therapy for coeliac disease is a gluten withdrawal.

Conclusions

A gluten-free diet should be promoted by the therapeutic team and implemented among these categories of patients.

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Health education to follow the GFD does not exist in many countries. Unfortunately, the COVID-19 pandemic has increased psychological problems among patients with CD.

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The association of T1D with CD has been and remains a problem in CD management.

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Associating IBD with CD is again a challenge. Psychological problems also appeared in the associations of CD with T1D and IBD. The COVID-19 virus did not pose an increased risk to CD patients, but the COVID-19 pandemic brought many psychological problems to CD patients.

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CD patients should adhere to GFD, in general, hence pay attention to gluten withdrawal during the COVID-19 pandemics, to avoid other complications and improve their QOL.

The influence of a gluten-free diet on health-related quality of life in individuals with celiac disease

Background

Adherence to a gluten-free diet (GFD) and food insecurity (FI) may influence health-related quality of life (HRQOL) in individuals with celiac disease (CD). This study aimed to investigate the association between adherence to a GFD, FI, and HRQOL in individuals with CD.

Methods

This cross-sectional study included 97 adults (mean age: 34 ± 9 years) diagnosed with CD. The participants were on a GFD for more than 6 months. Sociodemographic characteristics and medical history were assessed. Adherence to a GFD, FI, and HRQOL were assessed using validated questionnaires.

Results

Most participants (73%) adhered to a GFD, and 62% were experiencing FI. Individuals with CD faced difficulty in accessing GF foods due to the high cost (90%) and limited availability (79%). The mean overall HRQOL score was 60. Scores on the physical and mental health domains were 69 and 47, respectively. Adherence to a GFD was significantly associated with FI (P = 0.02), while there was no association between adherence to a GFD and HRQOL measures (P > 0.05). Participants facing FI had lower scores in emotional well-being and mental health domains, and overall HRQOL (P < 0.05).

Conclusions

The findings of the present study demonstrate that FI influences adherence to a GFD, and that FI is associated with HRQOL in terms of both emotional well-being and mental health.

Social media usage pattern and its influencing factors among celiac patients and their families

BACKGROUND/AIM

The aim of this study was to investigate social media usage patterns among celiac patients and explore the potential factors that may influence the frequency of its usage.

PATIENTS AND METHODS

A cross-sectional survey was conducted, in which an online questionnaire was sent to celiac patients registered in the Saudi celiac patients' support group through email and its related social media accounts. Eligible participants included all patients with biopsy-confirmed celiac disease or their parents.

RESULTS

In total, 221 participants completed the survey. The majority (96%, n = 212/221) reported using social media networks for their disease management. We included only those participants in the analysis. The median age was 36 years (range; 18-60 years). The majority of respondents (59.4%) were female. Most participants (65.6%) were patients with celiac disease and 34.4% were parents of celiac patients. The median duration of the disease was three years (range; 1 month-26 years). The three most frequently visited social media platforms were WhatsApp by 175 (82.5%) participants, Instagram by 132 (62.3%), and Twitter by 124 (58.5%) participants. The median time spent on social media was 60 min per day (range; 10-720 min). Multivariate logistic regression showed that celiac disease patients used social media two times more than the parents of celiac patients (OR 2.37, 95% CI: 1.19 - 4.72; P = 0.014).

CONCLUSIONS

Celiac patients are highly involved in social media activities for purposes related to their disease. We encourage healthcare providers to be available online to provide trustable and high-quality educational materials.