DOI QR코드

DOI QR Code

Factors Affecting the Parental Stress of Children and Adolescents with Epilepsy

뇌전증 소아청소년 환아의 부모 스트레스에 영향을 주는 요인

  • Jung, Byu Lee (Department of Psychiatry, College of Medicine, Ewha Womans University) ;
  • Kim, Ga Eun (Department of Psychiatry, College of Medicine, Ewha Womans University) ;
  • Lee, Hyang Woon (Department of Neurology and Medical Science, College of Medicine, Ewha Womans University and Ewha Medical Research Institute) ;
  • Kim, Eui-Jung (Department of Psychiatry, College of Medicine, Ewha Womans University)
  • 정벼리 (이화여자대학교 의과대학 정신건강의학교실) ;
  • 김가은 (이화여자대학교 의과대학 정신건강의학교실) ;
  • 이향운 (이화여자대학교 의과대학 신경과학교실, 의과학과) ;
  • 김의정 (이화여자대학교 의과대학 정신건강의학교실)
  • Received : 2020.04.28
  • Accepted : 2020.06.04
  • Published : 2020.06.30

Abstract

Objectives : The aim of this study was to investigate the impact of clinical and psychological factors on the parental stress of children and adolescents with epilepsy. Methods : Children and adolescents with epilepsy (n=90, age range=6-17 years) completed questionnaires on epilepsy-related variables, children's depressive symptoms (Children's Depression Inventory, CDI), children's anxiety (Revised Children's Manifest Anxiety Scale, RCMAS) and performed the scale for children's intelligence (IQ). Parents who have children and adolescents with epilepsy completed questionnaires on parental stress (Questionnaire on Resources and stress, QRS), parental anxiety (State-Trait Anxiety Inventory, STAI), children's attention problems (Abbreviated Conners Parent Rating Scale Revised, CPRS), and children's behavioral problems (Korean Child Behavior Checklist, K-CBCL). Stepwise regression analysis was performed to determine the significant predictive variables that affect parental stress. Results : In the correlational analysis, duration of seizure treatment (r=0.253, p=0.016), children's IQ (r=-0.544, p<0.001), children's attention problems (r=0.602, p<0.001), children's depressive symptoms (r=0.335, p=0.002), children's anxiety (r=0.306, p=0.004), children's behavioral problems (r=0.618, p<0.001), and parental anxiety (r=0.478, p<0.001), showed a significant correlation with parental stress. Children's behavioral problem (β=0.241, p=0.010), children's IQ (β=-0.472, p<0.001), and parental anxiety (β=0.426, p<0.001) were significantly related to the parental stress (Adjusted R2=0.619). Conclusions : Clinicians should pay attention to children's intelligence and behavioral problems and parental anxiety, which affect parental stress with children and adolescents with epilepsy.

본 연구는 뇌전증 소아청소년 환아의 부모 스트레스에 대한 임상 및 심리적 요인의 영향을 조사하고자 하였다. 방 법 뇌전증이 있는 소아청소년(n=90, age range 6~17 years)을 대상으로 뇌전증 관련 임상 변수를 조사하였고, 환아에게 우울 및 불안 증상 설문지를 작성하도록 하였으며 지능검사를 시행하였다. 환아의 부모를 대상으로 부모의 스트레스, 부모 불안 및 환아의 주의력 문제, 행동 문제에 대한 설문을 작성하도록 하였다. 뇌전증 환아 부모의 스트레스와 변수들간의 연관성을 확인하기 위해 경향성 분석, 일원분산분석, 피어슨 상관분석으로 단변량 분석을 시행하였고, 부모의 스트레스에 영향을 미치는 독립 변수를 찾기 위해 단계적 회귀분석을 수행하였다. 결 과 상관 분석에서 발작의 치료 기간(r=0.253, p=0.016), 환아의 지능(r=-0.544, p<0.001), 주의력 문제(r=0.602, p<0.001), 우울 증상(r=0.335, p=0.002), 불안 증상(r=0.306, p=0.004), 행동 문제(r=0.618, p<0.001) 및 부모의 불안(r=0.478, p<0.001)은 부모의 스트레스와 유의한 상관 관계를 나타냈다. 부모의 스트레스에 영향을 미치는 독립변수는 환아의 행동 문제(β=0.241, p=0.010) 및 지능(β=-0.472, p<0.001) 그리고 부모의 불안(β=0.426, p<0.001)으로 나타났으며 부모의 스트레스에 대해 61.9%의 설명력을 보여주었다. 결 론 뇌전증을 가진 소아청소년 환아에서 부모의 스트레스는 환아의 행동문제와 인지기능 그리고 부모의 불안과 연관성이 높으며 따라서 임상의는 이에 주의를 기울이고 관리하는 것이 필요하겠다. 뇌전증 환아 부모의 스트레스를 경감시키기 위해서 뇌전증 환아의 지능과 행동문제를 조기에 평가하고 부모의 불안감에 대해서도 면밀하게 관찰하여 향후 뇌전증 치료에 반영하는 연구가 필요할 것으로 예상된다.

Keywords

References

  1. Kim DW, Lee SY, Chung SE, Cheong HK, Jung KY. Korean Epilepsy Society. Clinical characteristics of patients with treated epilepsy in Korea: a nationwide epidemiologic study. Epilepsia 2014;55:67-75. https://doi.org/10.1111/epi.12469
  2. Sbarra DA, Rimm-Kaufman SE, Pianta RC. The behavioral and emotional correlates of epilepsy in adolescence: a 7-year follow-up study. Epilepsy Behav 2002;3:358-367. https://doi.org/10.1016/S1525-5050(02)00035-5
  3. Reilly C, Atkinson P, Das KB, Chin RFMC, Aylett SE, Burch V, Gillberg C, Scott RC, Neville BGR. Neurobehavioral comorbidities in children with active epilepsy: a population-based study. Pediatrics 2014;133:e1586-1593. https://doi.org/10.1542/peds.2013-3787
  4. Hoare P, Kelley S. Psychosocial adjustment of children with chronic epilepsy and their families. Dev Med Child Neurol 1991;33:201-255. https://doi.org/10.1111/j.1469-8749.1991.tb05109.x
  5. Chiou HH, Hsieh LP. Parenting stress in parents of children with epilepsy and asthma. Journal of Child Neurology 2008;23:301-306. https://doi.org/10.1177/0883073807308712
  6. Cushner-Weinstein S, Dassoulas K, Salpekar JA, Henderson SE, Pearl PL, Gaillard WD, Weinstein SL. Parenting stress and childhood epilepsy: the impact of depression, learning, and seizure-related factors. Epilepsy Behav 2008;13:109-114. https://doi.org/10.1016/j.yebeh.2008.03.010
  7. Iseri PK, Ozten E, Aker AT. Posttraumatic stress disorder and major depressive disorder is common in parents of children with epilepsy. Epilepsy Behav 2006;8:250-255. https://doi.org/10.1016/j.yebeh.2005.10.003
  8. Camfield C, Breau L, Camfield P. Impact of pediatric epilepsy on the family: a new scale for clinical and research use. Epilepsia 2001;42:104-112. https://doi.org/10.1046/j.1528-1157.2001.081420.x
  9. Farrace D, Tommasi M, Casadio C, Verrotti A. Parenting stress evaluation and behavioral syndromes in a group of pediatric patients with epilepsy. Epilepsy Behav 2013;29:222-227. https://doi.org/10.1016/j.yebeh.2013.07.020
  10. Holroyd J. The questionnaire on resources and stress: an instrument to measure family response to a handicapped family member. J Community Psychol 1974;2:92-94. https://doi.org/10.1002/1520-6629(197401)2:1<92::AID-JCOP2290020133>3.0.CO;2-A
  11. Friedrich WN, Greenberg MT, Crnic K. A short-form of the questionnaire on resources and stress. Am J Ment Defic 1983;88:41-48.
  12. Achenbach TM, Edelbrock CS. Manual for the Child Behavior Checklist and Revised Child Behavior Profile. Burlington, VT: University of Vermont;1983.
  13. Lee HL, Oh KJ, Hong KE, Ha EH. Clinical validity study of Korean CBCL through item analysis. J Korean Acad Child Adolesc Psychiatry 1991;2:138-149.
  14. Conners CK. Symptom patterns in hyperkinetic, neurotic, and normal children. Child Development 1970;41:667-682. https://doi.org/10.1111/j.1467-8624.1970.tb01022.x
  15. Goyette CH, Conners CK, Ulrich RF. Normative data on revised Conners Parent and Teacher Rating Scales. J Abnorm Child Psychol 1978;6:221-236. https://doi.org/10.1007/BF00919127
  16. Oh KJ, Lee HL. Assessment of ADHD with abbreviated conners rating scale. Kor J Clin Psychol 1989;8:135-142.
  17. Spielberger CD. Manual for the State-Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press;1972.
  18. Spielberger CD. Anxiety: Current Trends in Theory and Research. New York, NY: Academic Press;1972.
  19. Spielberger CD, Gorsuch RL, Lushene RE. STAI: Manual For the State-Trait Anxiety Invetory. Palo Alto, CA: Consulting Psychologists Press;1970.
  20. Kim JT, Shin DK. A study based on the standardization of the STAI for Korea. New Med J 1978;21:69-75.
  21. Kovacs M. The children's depression, inventory (CDI). Psychopharmacol Bull 1985;21:995-998.
  22. Cho SC, Lee YS. Development of the Korean form of the Kovacs' Childeren's Depression Inventory. J Korean Neuropsychiatr Assoc 1990;29:943-956.
  23. Reynolds CR, Richmond BO. What I think and feel: a revised measure of children's manifest anxiety. J Abnormal Child Psychol 1978;6:271-280. https://doi.org/10.1007/BF00919131
  24. Choi JS, Cho SC. Assessment of anxiety in children: reliability and validity of revised children's manifest anxiety scale. J Korean Neuropsychiatr Assoc 1990;29:691-702.
  25. Kwak KJ, Park HW, Kim CT. A pilot study for the standardization of Korean WISC-3. The Korean Journal of Developmental Psychology 2001;14:43-59.
  26. Kwak KJ, Park HW, Kim CT. A study for standardization of Korean WISC-3. The Korean Journal of Developmental Psychology 2002;15:19-33.
  27. Akay AP, Kurul SH, Ozek H, Cengizhan S, Emiroglu N, Ellidokuz H. Maternal reactions to a child with epilepsy : depression, anxiety, parental attitudes and family functions. Epilepsy Research 2011;95:213-220. https://doi.org/10.1016/j.eplepsyres.2011.03.020
  28. Dunn DW, Kronenberger WG. Childhood epilepsy, attention problems, and ADHD: review and practical considerations. Semin Pediatr Neurol 2005;12:222-228. https://doi.org/10.1016/j.spen.2005.12.004
  29. Shore CP, Austin JK, Dunn DW. Maternal adaptation to a child's epilepsy. Epilepsy Behav 2004;5:557-568. https://doi.org/10.1016/j.yebeh.2004.04.015
  30. Reilly CJ. Attention deficit hyperactivity disorder (ADHD) in childhood epilepsy. Res Dev Disabil 2011;32:883-893. https://doi.org/10.1016/j.ridd.2011.01.019
  31. Berl MM, Terwilliger V, Scheller A, Sepeta L, Walkowiak J, Gaillard WD. Speed and complexity characterize attention problems in children with localization-related epilepsy. Epilepsia 2015;56:833-840. https://doi.org/10.1111/epi.12985
  32. Klassen AF, Miller A, Fine S. Health-related quality of life in children and adolescents who have a diagnosis of attention-deficit/hyperactivity disorder. Pediatrics 2004;114:e541-e547. https://doi.org/10.1542/peds.2004-0844
  33. Dunn DW, Kronenberger WG. Childhood epilepsy, attention problems, and ADHD: review and practical considerations. Semin Pediatr Neurol 2005;12:222-228. https://doi.org/10.1016/j.spen.2005.12.004
  34. Bailet LL, Turk WR. The impact of childhood epilepsy on neurocognitive and behavioral performance: a prospective longitudinal study. Epilepsia 2000;41:426-431. https://doi.org/10.1111/j.1528-1157.2000.tb00184.x
  35. Austin JK, Dunn DW, Huster GA. Childhood epilepsy and asthma: changes in behavior problems related to gender and change in condition severity. Epilepsia 2000;41:615-623. https://doi.org/10.1111/j.1528-1157.2000.tb00217.x
  36. Dunn DW. Neuropsychiatric aspects of epilepsy in children. Epilepsy Behav 2003;4:101-106. https://doi.org/10.1016/S1525-5050(03)00022-2
  37. Floyd FJ, Gallagher EM. Parental stress, care demands, and use of support services for school-age children With disabilities and behavior problems. Family Reactions 1997;46:359-371. https://doi.org/10.2307/585096
  38. Ettinger AB, Weisbrot DM, Nolan EE, Gadow KD, Vitale SA, Andriola MR, Lenn NJ, Novak GP, Hermann BP. Symptoms of depression and anxiety in pediatric epilepsy patients. Epilepsia 1998;39:595-599. https://doi.org/10.1111/j.1528-1157.1998.tb01427.x
  39. Dunn DW, Austin JK, Huster GA. Symptoms of depression in adolescents with epilepsy. J Am Acad Child Adolesc Psychiatry 1999;38:1132-1138. https://doi.org/10.1097/00004583-199909000-00017
  40. Alwash RH, Hussein MJ, Matloub FF. Symptoms of anxiety and depression among adolescents with seizures in Irbid, northern Jordan. Seizure 2000;9:412-416. https://doi.org/10.1053/seiz.2000.0427
  41. Oguz A, Kurul S, Dirik E, Eylul D. Relationship of epilepsy-related factors to anxiety and depression scores in epileptic children. J Child Neurol 2002;17:37-40. https://doi.org/10.1177/088307380201700109
  42. Shatla R, Sayyah HE, Azzam H, Elsayed RM. Correlates of parental stress and psychopathology in pediatric epilepsy. Ann Indian Acad Neurol 2011;14:252-256. https://doi.org/10.4103/0972-2327.91938
  43. Jones C, Reilly C. Parental anxiety in childhood epilepsy: a systematic review. Epilepsia 2016:57:529-537. https://doi.org/10.1111/epi.13326
  44. Chapieski L, Brewer V, Evankovich K, Culhane-Shelburne K, Zelman K, Alexander A. Adaptive functioning in children with seizures: impact of maternal anxiety about epilepsy. Epilepsy Behav 2005;7:246-252. https://doi.org/10.1016/j.yebeh.2005.05.002
  45. Seidenberg M, Berent S. Childhood epilepsy and the role of psychology. Am Psychol 1992;47:1130-1133. https://doi.org/10.1037/0003-066X.47.9.1130
  46. Bernstein GA, Borchardt CM, Perwien AR. Anxiety disorders in children and adolescents: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry 1996;35:1110-1119. https://doi.org/10.1097/00004583-199609000-00008
  47. Rodenberg R, Wagner JL, Austin JK, Kerr M, Dunn DW. Psychosocial issues for children with epilepsy. Epilepsy Behav 2011;22:47-54. https://doi.org/10.1016/j.yebeh.2011.04.063