Sischo Lacey, Clouston Sean A P, Phillips Ceib, Broder Hillary L
Department of Cariology and Comprehensive Care, New York University College of Dentistry.
Program in Public Health and Department of Preventive Medicine, Stony Brook University.
Health Psychol. 2016 May;35(5):474-82. doi: 10.1037/hea0000262. Epub 2015 Aug 17.
This study sought to understand caregivers' (CGs') responses to early cleft lip/palate care for their infants.
A prospective, mixed methods multicenter longitudinal study was conducted among CGs (N = 118) seeking treatment for their infants' cleft lip and palate or cleft lip only at 1 of 6 cleft treatment centers in the United States. Participants were in 1 of 2 treatment groups: traditional care only or nasoalveolar molding (NAM) plus traditional care. The CGs completed semistructured interviews and standardized questionnaires assessing psychosocial well-being and family impact at 3 time points: the beginning of treatment (∼1 month of age), prelip surgery (∼3-5 months of age), and postpalate surgery (∼12-13 months of age). Multilevel modeling was used to longitudinally assess CGs' psychosocial outcomes.
Although the first year was demanding for all CGs, NAM onset and the child's lip surgery were particularly stressful times. CGs used optimism, problem-solving behavior, and social support to cope with this stress. Qualitatively, CGs' ability to balance cleft treatment demands with their psychosocial resources and coping strategies influenced family adaptation. Qualitative and quantitative results indicated CGs of NAM-treated infants experienced more rapid declines in anxiety and depressive symptoms and better coping skills over time than CGs whose infants had traditional care.
CGs of NAM-treated infants experienced more positive psychosocial outcomes than CGs whose infants had traditional care. Results from the mixed model support the family adjustment and adaptation response model as used in pediatric chronic condition research.
本研究旨在了解照顾者(CGs)对其婴儿早期唇腭裂护理的反应。
在美国6个唇腭裂治疗中心之一,对118名寻求为其婴儿治疗唇腭裂或仅唇裂的照顾者开展了一项前瞻性、混合方法的多中心纵向研究。参与者分为2个治疗组之一:仅接受传统护理或鼻牙槽塑形(NAM)加传统护理。照顾者在3个时间点完成了半结构化访谈和标准化问卷,以评估心理社会幸福感和家庭影响,这3个时间点分别为:治疗开始时(约1月龄)、唇裂手术前(约3 - 5月龄)和腭裂手术后(约12 - 13月龄)。采用多层次建模纵向评估照顾者的心理社会结果。
尽管第一年对所有照顾者来说都很艰巨,但开始鼻牙槽塑形和孩子的唇裂手术是特别有压力的时期。照顾者采用乐观、解决问题的行为和社会支持来应对这种压力。从质的方面来看,照顾者平衡唇腭裂治疗需求与其心理社会资源和应对策略的能力影响了家庭适应。定性和定量结果表明,随着时间的推移,接受鼻牙槽塑形治疗婴儿的照顾者比接受传统护理婴儿的照顾者焦虑和抑郁症状下降得更快,且应对技能更好。
接受鼻牙槽塑形治疗婴儿的照顾者比接受传统护理婴儿的照顾者经历了更积极的心理社会结果。混合模型的结果支持了儿科慢性病研究中使用的家庭调整和适应反应模型。