Emotional and behavioral problems in adolescents and young adults with food allergy
TL;DR: The prevalence of emotional and behavioral problems in an epidemiological sample of adolescents and young adults with food allergy and whether food allergy is associated with adolescent and maternal reports of such problems are estimated.
Abstract: Background Adolescents with food allergy have poorer psychosocial outcomes compared with their nonallergic counterparts; however, few studies have prospectively examined the mental health of adolescents and young adults in this vulnerable population. Our objectives were to estimate the prevalence of emotional and behavioral problems in an epidemiological sample of adolescents and young adults with food allergy; determine whether food allergy is associated with adolescent and maternal reports of such problems; and examine the patterns of change in emotional and behavioral problems from adolescence to young adulthood among individuals with and without food allergy. Methods Data came from 1303 participants at 14 and 21 years of age in the Mater University Study of Pregnancy. Emotional and behavioral problems were measured using self- and maternal-reported symptoms of depression, anxiety, attention/deficit hyperactivity disorder (ADHD), oppositional defiant disorder, and conduct disorder. Results Maternal, but not self-reports suggested that emotional and behavioral problems were higher among adolescents with food allergy. Food allergy was associated with increased odds of elevated levels of maternal-reported symptoms of depression [OR = 4.50 (1.83, 11.07)], anxiety [OR = 2.68 (1.12, 6.44)], and ADHD [OR = 3.14 (1.07, 9.19)] in adolescence. Food allergy was also associated with depressive symptoms that persisted from adolescence to young adulthood [OR = 2.05 (1.04, 4.03)]. Conclusions Emotional and behavioral problems, particularly symptoms of depression, anxiety, and ADHD, are common among adolescents with food allergy in the general population and, in the case of elevated levels of depressive symptoms, persist into young adulthood. Healthcare professionals should seek adolescent and parental perspectives when assessing emotional and behavioral problems and monitor mental health during the transition to adulthood. Language: en
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TL;DR: Clinicians must be aware of underappreciated burdens faced by children and families with food allergies and of efforts to avoid overdiagnosis in synergy with balanced counseling about the risks of food allergies.
Abstract: Purpose of reviewFood allergies have become more common, and management involves dietary avoidance that can impair quality of life. Patients and families must manage the daily risk of anaphylaxis at each meal. The purpose of this review is to describe the impact of food allergies on quality of life
80 citations
TL;DR: Preliminary evidence suggests that mental disorder in children with a physical condition is very common and has a negative impact on quality of life over time and suggests that multimorbidity is an important concern for families.
Abstract: Objectives Methodologically, to assess the feasibility of participant recruitment and retention, as well as missing data in studying mental disorder among children newly diagnosed with chronic physical conditions (ie, multimorbidity). Substantively, to examine the prevalence of multimorbidity, identify sociodemographic correlates and model the influence of multimorbidity on changes in child quality of life and parental psychosocial outcomes over a 6-month follow-up. Design Prospective pilot study. Setting Two children’s tertiary-care hospitals. Participants Children aged 6–16 years diagnosed in the past 6 months with one of the following: asthma, diabetes, epilepsy, food allergy or juvenile arthritis, and their parents. Outcome measures Response, participation and retention rates. Child mental disorder using the Mini International Neuropsychiatric Interview at baseline and 6 months. Child quality of life, parental symptoms of stress, anxiety and depression, and family functioning. All outcomes were parent reported. Results Response, participation and retention rates were 90%, 83% and 88%, respectively. Of the 50 children enrolled in the study, the prevalence of multimorbidity was 58% at baseline and 42% at 6 months. No sociodemographic characteristics were associated with multimorbidity. Multimorbidity at baseline was associated with declines over 6 months in the following quality of life domains: physical well-being, β=−4.82 (–8.47, –1.17); psychological well-being, β=−4.10 (–7.62, –0.58) and school environment, β=−4.17 (–8.18, –0.16). There was no association with parental psychosocial outcomes over time. Conclusions Preliminary evidence suggests that mental disorder in children with a physical condition is very common and has a negative impact on quality of life over time. Based on the strong response rate and minimal attrition, our approach to study child multimorbidity appears feasible and suggests that multimorbidity is an important concern for families. Methodological and substantive findings from this pilot study have been used to implement a larger, more definitive study of child multimorbidity, which should lead to important clinical implications.
70 citations
Cites background from "Emotional and behavioral problems i..."
...MAF currently holds the Canada Research Chair in Youth Mental Health, MHB holds the Canada Research Chair in the Social Determinants of Child Health, KG holds the Dan Offord Chair in Child Studies, JWG holds the Scotiabank Chair in Child Health Research, AG is supported by a Canadian Institutes for Health Research New Investigator Award, HLM holds the Chedoke Health Chair in Child Psychiatry and RJVL holds the Canada Research Chair in the Perinatal Programming of Mental Disorders and Albert Einstein/Irving Zucker Chair in Neuroscience. competing interests None declared. ethics approval The study protocol received ethical approval from the Hamilton Integrated Research Ethics Board (14-130) and Research Ethics Board (105505)....
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...Integrated Research Ethics Board (14-130) and Research Ethics Board (105505)....
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TL;DR: The psychosocial impacts of food allergies are described and survey treatments that can be used to address this burgeoning problem are described.
Abstract: Over the past few years, the rates of food allergies have dramatically increased. As a result, the lives of patients and their caregivers have been dramatically altered. While most attention surrounding food allergies has focused on treatment, less consideration has been given to the mental health ramifications of living with this condition, among them depression, anxiety, post-traumatic stress, being bullied, and an overall poorer quality of life. At the same time, patients' family lives are often disrupted. Parents of food-allergic children, especially mothers, report anxiety, depression, and a decreased quality of life. Indeed, mental health issues associated with food allergies are likely underrecognized. In this review, we describe not only the psychosocial impacts of food allergies but also survey treatments that can be used to address this burgeoning problem. Interventions include educating members of the greater community about food allergies, camps for food allergic children, and support groups for parents. For physicians, treatment options consist of oral challenges, proximity challenges, oral immunotherapy, and cognitive behavioral therapy. Although the existing research is built on an already strong foundation, ultimately more studies are needed to deepen our understanding of the relationship between food allergies and mental health.
65 citations
TL;DR: Clinicians must be aware of the association between FA and anxiety, understand their role in recognizing maladaptive anxiety and encouraging to seek psychological support when needed, as well as limitations and further research directions.
Abstract: Food allergy (FA) is recognized as a growing public health burden affecting 5%-10% of children worldwide. Several unique features specific to FA elicit high levels of emotional distress and anxiety in patients and caregivers, the first among all the possibility of a life-threatening reaction. Anxiety disorders are highly prevalent in patients with chronic disease, but remain undertreated despite significant negative consequences on patient health. This review aimed to offer a comprehensive overview of literature data on FA and anxiety of the last two decades. A review of the medical and psychological literature from the year 2000 (MEDLINE, PubMed and PsycINFO) was done using the keywords "anxiety" and "food allergy." Clinical implications for disease management, various manifestations in different target groups, proper interventions and possible explanations on the nature of the association between FA and anxiety have been discussed, as well as limitations and further research directions. The relationship between FA and anxiety is attributed to FA-specific fears and anxiety, rather than a general propensity towards anxiety. Some anxiety-short-lived and related to key events-is to be expected and may even be helpful if it sustains allergen avoidance and preparedness to emergency. However, some data reported that increased anxiety did not improve adherence. Rather, high levels of anxiety have been demonstrated counterproductive and related to maladaptive coping. Further research is needed to elucidate the association between FA and anxiety, especially to understand biopsychosocial directions of the underlying mechanisms and to build proper, effective, standardized protocols of intervention. Clinicians must be aware of the association between FA and anxiety, understand their role in recognizing maladaptive anxiety and encouraging to seek psychological support when needed.
52 citations
TL;DR: Quality of life (QOL) is impaired in patients with food allergy and improves following oral immunotherapy (OIT), but the treatment itself is prolonged and demanding.
Abstract: Background
Quality of life (QOL) is impaired in patients with food allergy and improves following oral immunotherapy (OIT). However, the treatment itself is prolonged and demanding. We examined changes in patient QOL during OIT for food allergy.
Methods
The FAQLQ-PF was administered to children aged 4-12 years undergoing OIT for milk, peanut, or egg allergy, at the beginning and after 4 months of treatment. Patients were categorized as improved, unchanged, or diminished FAQLQ-PF (>0.5 point decrease, a change of ≤0.5 points, or >0.5 increase, respectively) and compared. Food-allergic patients not undergoing OIT served as controls.
Results
The Food Anxiety, Social and Dietary Limitation, and total FAQLQ-PF scores improved significantly during the study period (P=.001, P=.018, and P=.01, respectively) in treated but not in control patients, while the Emotional Impact did not. The change in the FAQLQ-PF was independent of the maximal tolerated dose at baseline or following four months of treatment, the pace of dose increase, or the number or severity of reactions experienced. The total FAQLQ-PF score was inversely associated with the score at baseline on multivariate analysis (regression coefficient=−0.56, P<.001). That was driven primarily by improvement in QOL scores in patients with high score (worse QOL) at baseline. Some patients with low FAQLQ-PF score (better QOL) at baseline deteriorated.
Conclusions
QOL of patients with food allergy improves in some but deteriorates in others during OIT. Patients with impaired QOL at baseline improve significantly despite the treatment burden. Some patients with better QOL at baseline might deteriorate during OIT.
46 citations
Cites background from "Emotional and behavioral problems i..."
...(anxiety, depression, isolation, and problems with peers) were previously shown to be more common among adolescents with food allergy.(33,34) In our study, the EI did not significantly change during OIT, probably expressing the balance between the emotional burden of the treatment on one hand, and the increasing confidence and diversity of foods consumed, on the other....
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References
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01 Jan 2016
TL;DR: The multiple imputation for nonresponse in surveys is universally compatible with any devices to read and is available in the book collection an online access to it is set as public so you can download it instantly.
Abstract: multiple imputation for nonresponse in surveys is available in our book collection an online access to it is set as public so you can download it instantly. Our book servers hosts in multiple locations, allowing you to get the most less latency time to download any of our books like this one. Merely said, the multiple imputation for nonresponse in surveys is universally compatible with any devices to read.
5,470 citations
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TL;DR: The appropriate use and reporting of the multiple imputation approach to dealing with missing data is described by Jonathan Sterne and colleagues.
Abstract: Most studies have some missing data. Jonathan Sterne and colleagues describe the appropriate use and reporting of the multiple imputation approach to dealing with them
5,293 citations
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TL;DR: A theoretical framework is presented to guide research and theory examining informant discrepancies in the clinic setting and theoretically driven attention to conceptualizing informant discrepancies across informant pairs is focused on.
Abstract: Discrepancies often exist among different informants' (e.g., parents, children, teachers) ratings of child psychopathology. Informant discrepancies have an impact on the assessment, classification, and treatment of childhood psychopathology. Empirical work has identified informant characteristics that may influence informant discrepancies. Limitations of previous work include inconsistent measurement of informant discrepancies and, perhaps most importantly, the absence of a theoretical framework to guide research. In this article, the authors present a theoretical framework (the Attribution Bias Context Model) to guide research and theory examining informant discrepancies in the clinic setting. Needed directions for future research and theory include theoretically driven attention to conceptualizing informant discrepancies across informant pairs (e.g., parent-teacher, mother-father, parent-child, teacher-child) as well as developing experimental approaches to decrease informant discrepancies in the clinic setting.
2,092 citations
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...It is unclear whether mothers overestimate or adolescents underestimate symptoms of emotional and behavioral problems—an unfortunate limitation in understanding informant discrepancies (39)....
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TL;DR: There are data from numerous studies to suggest an increase in prevalence, but methodologic concerns warrant caution, and insights on risk factors, prevalence, and natural course that may inform clinical trials to improve diagnosis, prevention, and treatment are provided.
Abstract: Adverse reactions to foods can occur for a variety of reasons, but a food allergy is caused by a specific immune response. Challenges to determine the prevalence of food allergy include misclassification, biased participation, lack of simple diagnostic tests, rapid evolution of disease, large numbers of potential triggers, and varied clinical phenotypes. Nonetheless, it is clear that this is a common disorder, with studies suggesting a cumulative prevalence of 3% to 6%, representing a significant impact on quality of life and costs. The inclusion of mild reactions to fruits and vegetables could result in calculation of prevalence exceeding 10% in some regions. There are data from numerous studies to suggest an increase in prevalence, but methodologic concerns warrant caution. Prevalence varies by age, geographic location, and possibly race/ethnicity. Many childhood food allergies resolve. Population-based epidemiologic studies have generated numerous novel theories regarding risks, including modifiable factors such as components of the maternal and infant diet, obesity, and the timing of food introduction. Recent and ongoing studies provide insights on risk factors, prevalence, and natural course that may inform clinical trials to improve diagnosis, prevention, and treatment.
646 citations
TL;DR: Quantified, normed DSM-oriented and empirically based scales scored from the same instruments can facilitate assessment of individuals, statistical analyses for research purposes, and integration of top-down and bottom-up approaches to deriving constructs for psychopathology.
Abstract: Separately for ages 11/2 to 5 and 6 to 18, used items for rating behavioral and emotional problems to construct (a). "top-down" DSM-oriented scales from experts' ratings of the items' consistency with Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV], American Psychiatric Association, 1994) categories, and (b). "bottom-up" empirically based syndromes from factor analyses of parent, caregiver, teacher, and self ratings (N = 14853). Both kinds of scales are scored from the same assessment instruments and are displayed on profiles normed on the same national samples. Psychometric properties were similar for both kinds of scales. Associations between counterpart scales were medium to strong. Quantified, normed DSM-oriented and empirically based scales scored from the same instruments can facilitate assessment of individuals, statistical analyses for research purposes, and integration of top-down and bottom-up approaches to deriving constructs for psychopathology.
553 citations
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