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Children with Intestinal Failure are at Risk for Psychopathology and Trauma
Lotte E Vlug1, Jeroen S Legerstee2, Merit M Tabbers3
1From the Department of Pediatrics, Division of Gastroenterology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Insights
Children with intestinal failure (IF) experience significant psychopathology, especially school-aged individuals, with high rates of emotional problems and psychiatric diagnoses. Medical traumatic stress is also a concern, highlighting the need for targeted support.
Area of Science:
- Pediatric Gastroenterology
- Child Psychiatry
- Medical Psychology
Background:
- Intestinal failure (IF) significantly impacts children's health and development.
- Psychological well-being and medical traumatic stress are critical but often understudied aspects of IF care.
- Understanding these challenges is vital for comprehensive patient management.
Purpose of the Study:
- To evaluate psychopathology and medical traumatic stress in children with IF.
- To identify risk factors associated with these psychological outcomes.
- To compare findings with normative data and inform clinical practice.
Main Methods:
- A two-center study included 41 children (1.5-17 years) with IF, assessed between 2019-2022.
- Psychopathology was evaluated using interviews and validated questionnaires for emotional and behavioral problems.
- Medical traumatic stress was assessed via a validated questionnaire; statistical analyses identified associated factors.
Main Results:
- One-third of children met criteria for a psychiatric classification, with anxiety and ADHD being most common.
- School-aged children reported significantly increased emotional problems across multiple informants.
- Medical traumatic stress was present in 14%, and lower GI-related quality of life correlated with emotional issues.
Conclusions:
- Children with IF, particularly school-aged ones, are at elevated risk for psychological problems.
- High rates of emotional difficulties and psychiatric diagnoses underscore the need for mental health support.
- Findings emphasize the importance of addressing psychopathology and trauma in IF management.
Objectives:
The objective of this study is to assess the psychopathology and medical traumatic stress in children with intestinal failure (IF) and identify associated risk factors.
Methods:
Two-center study, performed from September 2019 until April 2022 (partly during COVID-19 pandemic), including children (1.5-17 years) with IF, dependent on parenteral nutrition (PN) or weaned off PN, treated by a multidisciplinary IF-team. Psychopathology in children was evaluated with a semi-structured interview assessing psychiatric classifications and validated questionnaires assessing emotional (internalizing) and behavioral (externalizing) problems. Medical traumatic stress was assessed with a validated questionnaire. Problem scores were compared with normative data. Associations between clinical characteristics and outcomes were analyzed with linear regression analyses.
Results:
Forty-one (of 111 eligible) children were included [median age 8.9 years (interquartile range, IQR 5.5-11.8), 54% female, 73% born preterm]. Median PN-duration was 17.3 months (IQR 6.9-54.0); 17 children (41%) were still PN-dependent. One third of the children met criteria for at least 1 psychiatric classification (compared with 14% in age-matched general population). Anxiety disorders and attention deficit hyperactivity disorder were most common. In school-aged children (n = 29, 6-17 years), significantly increased emotional problems were consistently reported by children ( P = 0.011), parents ( P < 0.001), and teachers ( P = 0.004). In preschool children (n = 12, 1.5-5 years), no significant differences with normative data were found. Subclinical or clinical emotional problems were reported in 19 children (46%). Medical traumatic stress was present in 14%, and 22% of children had received psychological help for trauma before. Lower gastrointestinal related quality of life was associated with more emotional problems, but not PN-duration.
Conclusions:
Children with IF, particularly school-aged children, are at risk for psychological problems which is reflected by the high rate of received psychotherapy and the high rate of emotional problems and psychiatric classifications.
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