Stress Management Important for Mothers of Pediatric Patients With Atopic Dermatitis

Parents of children who have atopic dermatitis (AD), their mothers in particular, have been shown in a new study to experience high levels of stress and a decreased quality of life (QOL) due to caring for the children. These findings indicate the lack of and great need for more substantive support for caregivers of pediatric patients who have AD, as well as potential for government-supported stress-relief programs.

“The chronic course of the disease, including recurrent acute exacerbations, treatment burden, dermatological complications, and coexisting medical comorbidities, as well as psychiatric conditions, degrade the QOL of patients and their families,” the study authors wrote in Acta Dermato-Venereologica. “Although several journals have reported the psychological stress in parents of children with AD, there has been no large-scale, well-designed statistical study.”

Their cross-sectional analysis utilized data from 2009 to 2012 from the Korean National Health and Nutrition Examination Survey, and it covered 6903 pediatric (younger than 19 years) patients matched 1:6 to the AD group (n = 970) or healthy controls (n = 5733). Psychological stress was evaluated across 4 areas: self-perception of stress, depressed mood, suicidal ideation, and receiving a depression diagnosis from a clinician.

Mean (SD) measures of patients’ statistics were comparable between the groups, with 51.49% (1.88%) and 53.36% (0.78%), respectively, being male patients; mean (SD) ages of 9.75 (0.21) and 10.48 (0.11) years; most patients being younger than 10 years (49.18% [2.13%] and 40.65% [0.97%]) or aged 10 to 15 years (30.56% [1.85%] and 30.69 [0.72%]); 8.77% (1.48%) and 9.63% (0.76%) considered low income; and body mass indexes of 18.74 (0.17) and 19.2 (0.07) kg/m². Among the parents, those who had children with AD were younger than those whose children did not have AD (41.26 vs 42.72 years), fewer drank on a monthly basis (43.37% vs 49.11%), fewer of the mothers were considered obese (19.04% vs 25.03%), and more of the fathers had a high level of education (93.64% vs 88.64%).

In the authors’ first model, which adjusted only for parental age, stress and suicidal ideation were significantly increased among the mothers of children with AD compared with those whose children did not have AD, at 47% (adjusted odds ratio [aOR], 1.47; 95% CI, 1.23-1.75; P < .01) and 39% (aOR, 1.39; 95% CI, 1.087-1.77; P < .01) higher, respectively. For the second model that adjusted for age, gender, education level, occupation, and marital status, stress and suicidal ideation had similar elevated rates for the mothers, at 46% (aOR, 1.46; 95% CI, 1.22-1.74; P < .001) and 40% (aOR, 1.40; 95% CI, 1.10-1.79; P < .01).

“Fathers of children with AD did not show a significant difference in all items from those of children without AD,” the authors added.

Results regarding QOL as evaluated using the EuroQol-5 dimension (EQ-5D) index and the EuroQol Visual Analogue Scale (EQ-VAS) show significantly lower results for the mothers of children living with AD vs children who did not have AD:

• EQ-5D: 0.96 vs 0.97 (P < .01)
• EQ-VAS: 74.54 vs 76.35 (P = .01)

Speaking to how their findings add to the current literature, the present study authors note that they echo previous literature that shows an increase of parenting stress only among mothers. Potential reasons for the increased stress include time spent doing housework, which the authors note is 4 times longer for women vs men in Korea; feeling more guilt about their child’s symptoms; and the time needed to care for the children with AD. In addition, among younger children with AD, lack of sleep and emotional stress are reported, the authors noted.

“It is meaningful that analysis of the results of mothers and fathers separately showed the need to focus more on mothers, who are the main caregivers in Korean society, regarding stress management of parents,” the authors concluded. “The findings have important implications for clinical practice with respect to the need for evaluation, management, and support for parents, especially mothers, of children with AD.”

Reference

Lee HJ, Lee G-N, Lee JH, et al. Psychological stress in parents of children with atopic dermatitis: a cross-sectional study from the Korea National Health and Nutrition Examination Survey. Acta Derm Venereol. 2023;103:adv00844. doi:10.2340/actadv.v103.2242