Lim Crystal S, Karlson Cynthia, Edmond Sara N, Welkom Josie S, Osunkwo Ifeyinwa, Cohen Lindsey L
Departments of Psychiatry and Human Behavior.
Pediatrics, University of Mississippi Medical Center, Jackson, MS.
J Pediatr Hematol Oncol. 2019 Apr;41(3):194-201. doi: 10.1097/MPH.0000000000001429.
Sickle cell disease (SCD) is associated with pain and decreased health-related quality of life (HRQOL). Coping strategies influence pain but have not been evaluated as mediating the relation between pain and HRQOL in pediatric SCD. The current study examined whether pain-related coping mediates the association between pain and HRQOL in children and adolescents with SCD. In total, 104 children and adolescents 8 to 18 years of age (Mage=12.93 y) with SCD attending outpatient clinics completed pain intensity, HRQOL, and pain-related coping measures. Multiple mediation analyses were used to examine whether pain-related coping mediated the pain and HRQOL relation and whether types of coping (ie, approach, emotion-focused avoidance, problem-focused avoidance) were independent mediators. Total indirect effects for models examining physical and psychosocial HRQOL were not significant. After controlling for covariates, emotion-focused avoidance significantly mediated the association between pain and physical HRQOL (effect: -0.023; bootstrapped SE: 0.018; 95% confidence interval: -0.0751, -0.0003) but not the pain and psychosocial HRQOL relation. Approach and problem-focused avoidance were not significant mediators. Coping with pain in pediatric SCD is an important avenue for clinical intervention and additional research. Among children with SCD reporting high pain intensity, interventions should emphasize negative impacts of emotion-focused avoidance coping and integrate other empirically supported coping strategies to improve HRQOL.
镰状细胞病（SCD）与疼痛及健康相关生活质量（HRQOL）下降有关。应对策略会影响疼痛，但尚未被评估为在小儿SCD中疼痛与HRQOL之间关系的中介因素。本研究探讨了疼痛相关应对是否在患有SCD的儿童和青少年中介导疼痛与HRQOL之间的关联。共有104名8至18岁（平均年龄=12.93岁）的患有SCD的儿童和青少年在门诊完成了疼痛强度、HRQOL及疼痛相关应对措施的评估。采用多重中介分析来检验疼痛相关应对是否介导了疼痛与HRQOL的关系，以及应对类型（即积极应对、情绪聚焦回避、问题聚焦回避）是否为独立中介因素。检验身体和心理社会HRQOL的模型的总间接效应不显著。在控制协变量后，情绪聚焦回避显著介导了疼痛与身体HRQOL之间的关联（效应：-0.023；自抽样标准误：0.018；95%置信区间：-0.0751，-0.0003），但未介导疼痛与心理社会HRQOL的关系。积极应对和问题聚焦回避不是显著的中介因素。应对小儿SCD中的疼痛是临床干预和进一步研究的重要途径。在报告疼痛强度高的SCD患儿中，干预措施应强调情绪聚焦回避应对的负面影响，并整合其他经实证支持的应对策略以改善HRQOL。
