Journal of asthma, allergy and clinical immunology (천식및알레르기)

The Korean Academy of Asthma, Allergy and Clinical Immunology (대한천식알레르기학회)
권호 표지

The Relationships among Severity Score, Behavioral Problem, Parental Stress, Maternal Depression, and Social Support in Children with Atopic Dermatitis

아토피피부염 환아의 중증도 및 행동 특성과 어머니의 양육 스트레스, 우울감, 사회적 지지와의 관계

Chung, Seung-Won;Chang, Eun-Young;Lee, Hee-Chul;Shin, Mi-Yong;Kim, Byung-Eui;Ahn, Kang-Mo;Lee, Sang-II
정승원;장은영;이희철;신미용;김병의;안강모;이상일

  • Published : 20050300
⟨ Previous Next ⟩

Abstract

Objective: This study was conducted in order to fmd out whether there are differences in behavioral characteristics between atopic and normal children and whether there are difference between the two groups in parental stress, maternal depression, and social support they perceived. Furthermore it was examined the relative influence of symptom severity score, parental stress, maternal depression, and social support contributing to behavioral characteristics of atopic children. Method: Forty patients with atopic dermatitis who showed higher than 15 of SASSAD (Six Area, Six Score in Atopic Dermatitis) score were enrolled. Their ages ranged from 4 to 16 years. Their mothers were subjected to parent-report questionnaire (Korean-Child Behavior Check List, Parenting Stress Index, the Center for Epidemiological Studies Depression Scale, and Social Support Index). The matched control group of 39 children (mean age 6.4 years) without any chronic disease was selected in terms of age and sex, and socioeconomic status of parents. Result: 1) According to the analysis of K-CBCL, children with AD showed higher behavioral problem score in comparison to the children in control group. An increase in behavioral symptoms, notably withdrawal (P$\prec$.01), depression/ anxiety (P$\prec$.001), aggression (P$\prec$TEX>$\prec$.01), social immaturity (P $\prec$.01), and attentional problem (P$\prec$.01) was found in children with AD. 2) Mothers of children with AD perceived themselves as suffering from higher parental stress (P$\prec$.001) and depression (P$\prec$.001) compared to mothers of the control group. On the other hand there was no statistically significant difference in social support between two groups. 3) In relative influences of behavioral score, parental stress ($\beta$=.379) was the most significant variable, accounting for 31% of variance. The higher parental stress was, the higher behavioral score atopic children showed. Conclusion: Our results suggest that the psychological dimensions of atopic dermatitis should be taken into account as part of routine intervention. Furthermore these results consistently underline the importance of psychological support for mothers of children with AD.

Keywords

References

  1. Barnetson RSC, Rogers M. Childhood atopic eczema. BMJ 2002; 324:1376-9 https://doi.org/10.1136/bmj.324.7350.1376
  2. Oh JW, Kim GE, Pyun BY, Lee HL, Jeong JT, Hong SJ, et al. Nationwide study for epidemiological change of atopic dermatitis in school aged children between 1995 and 2000 and kindergarten aged children in 2003 in Korea. Pediatr Allergy Respir Dis Korea 2003;13:227-37
  3. Lee HS, Kim JS, Pyun BY. Changes of the prevalence and the allergens of atopic dermatitis in children: from 1992 to 2002. Pediatr Allergy Respir Dis Korea 2002; 12:263-70
  4. Cotterill JA. Psychiatry and the skin. Br J Hos Med 1989;42: 401-4
  5. Chung JS, Kim GH, Hong KE. A study on comorbid psychopathology and parenting attitude in children and adolescents wirh atopic dermatitis. J Korean Child and Adolescent Psychiatry 1999;10:34-42
  6. Jordan JM, Whitlock FA. Atopic dermatitis, anxiety and conditioned scrarch response. J Psycosom Res 1974;18:297-9 https://doi.org/10.1016/0022-3999(74)90047-6
  7. Jordan JM, Whitlock FA. Emotions and the skin: the conditioning of scratch responses in case of atopic dermariris. Br J Dermatol 1972;86:574-85 https://doi.org/10.1111/j.1365-2133.1972.tb05072.x
  8. Marshall P. Attention deficit disorder and allergy: a neurochemical model of the relation between the illnesses. Psychol Bull 1989; 106:434-46 https://doi.org/10.1037/0033-2909.106.3.434
  9. Ring J, Palos E. Psychosomatic aspects of parent-child relationships in aropic eczema in childhood. I. Psychodiagnostic Hautarzr 1986;37:560-7
  10. Roth N, Beyreiss J, Schlenzka K, Beyer H. Coincidence of attention deficir disorder and atopic disorders in children: empirical findings and hyporhetical background. J Abnorm Child Psychol 1991;19:1-13 https://doi.org/10.1007/BF00910561
  11. Absolon CM, Cottrell D, Eldridge SM, Glover MT. Psychological disturbance in atopic eczema: the extent of rhe problem in schoolaged children. Br J Dermatol 1997;137:241-5 https://doi.org/10.1046/j.1365-2133.1997.18121896.x
  12. Howlett S. Emotional dysfunction, child-family relarionships and childhood atopic dermatitis. Br J Dermatol 1999;140:381-4 https://doi.org/10.1046/j.1365-2133.1999.02696.x
  13. Lewis-Johns MS, Finlay AY. The children's dermatology life qualiry index (CDLQI): initial validation and practical use. Br J Dermatol 1995;132:942-9 https://doi.org/10.1111/j.1365-2133.1995.tb16953.x
  14. Brown DG. Stress as a precipitant factor of eczema. J Psychosom Res 1972;16:321-7 https://doi.org/10.1016/0022-3999(72)90084-0
  15. Koblenzer CS. Stress and the skin: significance of emotional factors in dermatology. Stress Med 1988;4:21-6 https://doi.org/10.1002/smi.2460040105
  16. Gil KM, Keefe FJ, Sampson HA, McCaskill CC, Rodin J, Crisson JE. The relation of stress and family environment to atopic dermatiris symproms in children. J Psychosom Res 1987;31:673-84 https://doi.org/10.1016/0022-3999(87)90016-X
  17. Koblenzer CS, Koblenzer PJ. Chronic intractable atopic eczema. Arch Dermatol 1988;124:1673-7 https://doi.org/10.1001/archderm.124.11.1673
  18. Fritz GK. Psychologic aspect of atopic dermatitis. Clin Pediatr Phila 1979;18:360-4 https://doi.org/10.1177/000992287901800609
  19. Marks R, Kilkenny M, Plunkett A, Merlin K. The prevalence of common skin conditions in Australian school students: 2. atopic dermatitis. Br J Dermatol 1999;140:468-73 https://doi.org/10.1046/j.1365-2133.1999.02711.x
  20. White A, Horne DJ, Varigos GA. Psychological profile of atopic eczema patient. Australas J Dermatol 1990;31:13-6 https://doi.org/10.1111/j.1440-0960.1990.tb00643.x
  21. Pauli-Port U, Darui A, Beckmann D. Infants with atopic dermatitis; maternal hopelessness, child-rearing attitudes and perceived infant temperament. Psychother Psychosom 1999;68:39-45 https://doi.org/10.1159/000012309
  22. Rush R, Storakan MA, Obermayer ME. Neurodermatitis and emotional tension. Arch Dermtol 1957;76:766-71 https://doi.org/10.1001/archderm.1957.01550240084016
  23. Bang HD, Ahn PS, Kim KH, Park KC, Kwon JS. A study of rhe personality of adults parients with atopic dermatiris. Korean J Dermatol 1996;34:359-65
  24. Daud LR, Garralda ME, David TJ. Psychological adjustment in preschool children wirh atopic eczema. Arch Dis Child 1993;69: 670-6 https://doi.org/10.1136/adc.69.6.670
  25. Hanifin JM, Rajaka G. Diagnostic feature of atopic dermaritis. Acta Derm Venerol 1980;92:44-7
  26. Berth-Jones J. Six Area, Six Sign Atopic Dermatitis (SASSAD) severity score. Br J Dermatol 1996;135(suppl 48):25-30 https://doi.org/10.1111/j.1365-2133.1996.tb00706.x
  27. Hong DS: An exploratory study about Korean social class-economic development and social class. Korean social science study association, 1981
  28. Abidin RR: Parenting Stress Index Short Form. Pediatric Psychology Press, Charlottesville, VA, 1983
  29. Chon KK, Choi SC, Yang BC Integrated adaptation of CES-D in Korea. Korean J Health Psychol 2001;6:59-76
  30. Park JW: A study for the development of instrumentarion of social support. Doctoral dissertation of Yonsei University, Seoul, 1989
  31. Achenbach TM, Edelbrock CS: Manual for the Child Behavior Checklisr and Revised Child Behavioral Profile. Burlington, VT, University of Vermont, Department of Psychiatry, 1983
  32. Oh KJ, Hong KE, Lee HR: K-CBCL Child Youth Behavioral Checklisr. Joongang Juksung Press, Seoul, 1969
  33. Hashiro M, Okumura M. Anxiety, depression and psychosomaric symptoms in patients wirh atopic dermatitis: comparison with normal controls and among groups of different degrees of severity. J Dermatol Sci 1997;14:63-7 https://doi.org/10.1016/S0923-1811(96)00553-1
  34. Park HR, Park SN, Jung KH, Kim HJ. Hope, burden, and family functioning in mothers of children with cancer. J Korean Acad Child Health Nurs 2001;7: 1:51-61