Pediatric Pain and Palliative Care Program, David Geffen School of Medicine at UCLA.
McLean Hospital.
J Pediatr Psychol. 2020 May 1;45(4):359-369. doi: 10.1093/jpepsy/jsz098.
Pediatric chronic pain evaluation includes self-reports and/or caregiver proxy-reports across biopsychosocial domains. Limited data exist on the effects of caregiver-child discrepancies in pediatric pain assessment. In children with chronic pain, we examined associations among discrepancies in caregiver-child reports of child anxiety and depressive symptoms and child functional impairment.
Participants were 202 children (Mage=14.49 ± 2.38 years; 68.8% female) with chronic pain and their caregivers (95.5% female). Children and caregivers completed the Revised Child Anxiety and Depression Scale (RCADS) and RCADS-Parent, respectively. Children also completed the Functional Disability Inventory. Mean difference tests examined caregiver-child discrepancies. Moderation analyses examined whether associations between child self-reported anxiety and depressive symptoms and functional impairment varied as a function of caregiver proxy-report.
Children reported more anxiety and depressive symptoms compared with their caregivers' proxy-reports (Z = -4.83, p < .001). Both informants' reports of child anxiety and depressive symptoms were associated with child functional impairment (rs = .44, rs = .30, p < .001). Caregiver proxy-report moderated associations between child-reported anxiety and depressive symptoms and functional impairment (B = -0.007, p = .003). When caregiver proxy-report was low, child self-reported anxiety and depressive symptoms were positively related to functional impairment (B = 0.28, SE = 0.07, 95% CI [0.15, 0.41], p < .001).
Discrepant caregiver-child perceptions of child anxiety and depressive symptoms may be associated with functioning in children with chronic pain, especially when caregivers report less child internalizing symptoms. These findings highlight the need for further examination of the effects of caregiver-child discrepancies on pediatric chronic pain outcomes and may indicate targets for intervention.
儿科慢性疼痛评估包括跨生物心理社会领域的自我报告和/或照顾者代理报告。关于儿科疼痛评估中照顾者与儿童差异的影响，数据有限。在患有慢性疼痛的儿童中，我们研究了儿童焦虑和抑郁症状以及儿童功能障碍报告中照顾者与儿童差异之间的关联。
参与者为 202 名患有慢性疼痛的儿童（Mage=14.49±2.38 岁；68.8%为女性）及其照顾者（95.5%为女性）。儿童和照顾者分别完成了修订后的儿童焦虑和抑郁量表（RCADS）和 RCADS-父母版。儿童还完成了功能障碍问卷。均值差异检验用于检验照顾者与儿童的差异。调节分析检验了儿童自我报告的焦虑和抑郁症状与功能障碍之间的关联是否随照顾者代理报告而变化。
与照顾者的代理报告相比，儿童报告的焦虑和抑郁症状更多（Z=-4.83，p<.001）。两个知情者报告的儿童焦虑和抑郁症状均与儿童功能障碍相关（rs=.44，rs=.30，p<.001）。照顾者代理报告调节了儿童报告的焦虑和抑郁症状与功能障碍之间的关联（B=-0.007，p=.003）。当照顾者代理报告较低时，儿童自我报告的焦虑和抑郁症状与功能障碍呈正相关（B=0.28，SE=0.07，95%CI[0.15，0.41]，p<.001）。
照顾者与儿童对儿童焦虑和抑郁症状的感知差异可能与慢性疼痛儿童的功能有关，尤其是当照顾者报告儿童内部症状较少时。这些发现强调了进一步研究照顾者与儿童差异对儿科慢性疼痛结果的影响的必要性，并可能表明干预的目标。
