Barker David H, Quittner Alexandra L
Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island; Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island; and
Department of Psychology, University of Miami, Miami, Florida.
Pediatrics. 2016 Feb;137(2):e20152296. doi: 10.1542/peds.2015-2296. Epub 2016 Jan 5.
Treatment adherence in cystic fibrosis (CF) is often poor, however, less is known about adherence to pancreatic enzymes, a critical component of the CF treatment regimen. Parent caregivers often report elevations in depression, and parental depression may adversely affect children's adherence.
This prospective study evaluated adherence to pancreatic enzymes in 83 patients (1-13 years) . Adherence was measured across 3 months with electronic pill-caps . Weight was measured at baseline and a 3-month follow-up. Parental depressive symptoms were evaluated by using the Center for Epidemiologic Studies Depression Scale (CES-D).
Adherence to pancreatic enzymes was 49.4% ± 3.4%. Adherence was higher at school (94.4% ± 6.1%) than at home (42.3% ± 3.1%), and higher for toddlers (50.6% ± 5.2%) than for school-aged children (37.5% ± 3.7%). Parents reported high rates of depressive symptoms (30% in the clinical range, 18% with moderate symptoms). Children of parents with symptoms of depression versus those without were less adherent (34.8% ± 4.5% vs 48.5% ± 4.1%), and adherence to enzymes was significantly related to 3-month weight outcomes. Average gain in weight z scores across 3 months was 0.5 ± 0.2for children who were >50% adherent and -0.1 ± 6.1for children who were <33% adherent. Parental depression had a signifcant, indirect effect on weight via adherence (-0.005 ± 0.003 gain in weight z score per CES-D unit ).
High rates of parental depressive symptoms, coupled with its negative effects on adherence, suggest that measuring and treating parental depression may improve children's adherence to therapy.
囊性纤维化（CF）患者的治疗依从性通常较差，然而，对于CF治疗方案的关键组成部分——胰酶的依从性了解较少。家长护理人员常报告有抑郁情绪加重的情况，而父母的抑郁可能会对孩子的依从性产生不利影响。
这项前瞻性研究评估了83名1至13岁患者对胰酶的依从性。通过电子药帽在3个月内测量依从性。在基线和3个月随访时测量体重。使用流行病学研究中心抑郁量表（CES-D）评估父母的抑郁症状。
对胰酶的依从性为49.4%±3.4%。在学校时的依从性（94.4%±6.1%）高于在家时（42.3%±3.1%），幼儿的依从性（50.6%±5.2%）高于学龄儿童（37.5%±3.7%）。家长报告有较高比例的抑郁症状（30%处于临床范围，18%有中度症状）。有抑郁症状的父母的孩子与没有抑郁症状的父母的孩子相比，依从性更低（34.8%±4.5%对48.5%±4.1%），并且对胰酶的依从性与3个月时的体重结果显著相关。3个月内体重z评分的平均增加量，依从性>50%的儿童为0.5±0.2，依从性<33%的儿童为-0.1±6.1。父母的抑郁通过依从性对体重有显著的间接影响（每单位CES-D体重z评分增加-0.005±0.003）。
父母抑郁症状发生率高，及其对依从性的负面影响表明，测量和治疗父母的抑郁可能会提高儿童对治疗的依从性。
