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Pediatric Global Health in Children with Very Early-Onset Inflammatory Bowel Disease
Christina E Holbein1, Jill Plevinsky1,2, Trusha Patel3,4
1Department of Child & Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia.
Insights
Children with very early-onset inflammatory bowel disease (VEO-IBD) experience lower quality of life, with gastrointestinal symptoms explaining the difference. Many VEO-IBD children show resilience, but psychosocial screening is vital for support.
Area of Science:
- Pediatric gastroenterology
- Child psychology
- Health-related quality of life research
Background:
- Very early-onset inflammatory bowel disease (VEO-IBD) is distinct but often excluded from psychosocial studies.
- Understanding health-related quality of life (HRQOL) in VEO-IBD is crucial for comprehensive care.
Purpose of the Study:
- Assess HRQOL in children with VEO-IBD using a novel pediatric global health measure.
- Compare HRQOL between children with VEO-IBD and healthy peers.
- Determine if gastrointestinal symptoms mediate differences in HRQOL.
Main Methods:
- Caregivers of 51 children with VEO-IBD and 54 healthy children completed the PROMIS Pediatric Global Health Scale (PGH-7).
- Gastrointestinal symptom questionnaires were administered.
- Statistical analyses included ANCOVA and bootstrapping mediation analyses.
Main Results:
- Caregivers reported generally positive HRQOL for children with VEO-IBD, but lower scores on specific items with increased disease severity.
- Children with VEO-IBD scored significantly lower on overall health, physical health, mental health, and quality of life compared to healthy children.
- Gastrointestinal symptoms significantly mediated the relationship between health status and HRQOL.
Conclusions:
- While many children with VEO-IBD demonstrate resilience, some are at risk for HRQOL deficits.
- Psychosocial screening is essential for identifying needs and facilitating referrals to behavioral health services.
- Further research on psychosocial adjustment in VEO-IBD is warranted.
Objective:
Children with very early-onset inflammatory bowel disease (VEO-IBD) represent a distinct group of patients with IBD with unique phenotypic and genetic characteristics; however, they are frequently omitted from psychosocial research. This study used a novel, brief measure of pediatric global health to assess (1) overall health-related quality of life (HRQOL) in children with VEO-IBD, (2) HRQOL compared to healthy children, and (3) whether gastrointestinal symptoms account for the differences in HRQOL between these groups.
Methods:
Caregivers of 51 children with VEO-IBD (Mage = 4.26 years, 75% male) and 54 healthy children (Mage = 3.50 years, 54% male) completed the PROMIS Pediatric Global Health Scale (PGH-7) parent-proxy form to assess HRQOL and a questionnaire assessing gastrointestinal symptoms. Descriptive statistics, analysis of variance with covariates (ANCOVA), and meditation analyses with bootstrapping were conducted.
Results:
Caregivers of children with VEO-IBD rated their HRQOL as relatively positive, although children with greater disease yielded lower ratings on some PGH-7 items (e.g., fun with friends, physical health, sadness). Compared to healthy youth, children with VEO-IBD scored lower on the PGH-7, with significantly lower item-level scores on overall health, physical health, mental health, and quality of life. Gastrointestinal symptoms mediated the association between health status (i.e., VEO-IBD vs. healthy) and HRQOL, αβ = -2.84, 95% CI = -5.70, -0.34.
Conclusions:
While some children with VEO-IBD are at risk for deficits in HRQOL, many are quite resilient. Psychosocial screening is necessary for providing appropriate referrals to behavioral health services and learning more about psychosocial adjustment in children with VEO-IBD.
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