Aasland A, Flatø B, Vandvik I H
Division of Child and Adolescent Psychiatry, National Hospital, Oslo, Norway.
Clin Exp Rheumatol. 1997 Sep-Oct;15(5):561-8.
To describe the long-term psychosocial outcome in a prospectively followed cohort of patients with juvenile chronic arthritis (JCA), to assess the associations between psychosocial outcome and disease variables and to explore family stressors as predictors of long-term psychosocial and physical outcome.
Fifty-two patients with JCA were assessed psychosocially at first admission to a pediatric rheumatology clinic and were reassessed 9 years later. Assessment methods included semi-structured psychiatric interviews and standardized parental questionnaires and self-reports.
At follow-up, 9 patients (17%) fulfilled the criteria for a psychiatric diagnosis and 8 (15%) had mild to moderate impairment in psychosocial functioning (children's or adult Global Assessment Scale). Mental health and psychosocial functioning were significantly improved from the first hospital admission to follow-up. In patients < 18 years of age (n = 26), psychosocial functioning at follow-up correlated with physical disability according to the Childhood Health Assessment Questionnaire (r = -0.52, p < 0.01). Psychosocial outcome was unrelated to other measures of disease severity. Chronic family difficulties in the disease course predicted psychosocial functioning at follow-up in patients < 18 years old (R2 = 0.22). Chronic family difficulties at disease onset, together with gender and chronic family difficulties in the disease course, predicted psychosocial functioning at follow-up in patients > or = 18 years old (R2 = 0.61). Family stressors were unrelated to the physical outcome.
The long-term psychosocial outcome was favorable in most of the patients. Psychosocial outcome was predicted by chronic family difficulties, but was not closely related to disease severity at follow-up.
描述一组前瞻性随访的青少年慢性关节炎（JCA）患者的长期心理社会结局，评估心理社会结局与疾病变量之间的关联，并探讨家庭压力源作为长期心理社会和身体结局的预测因素。
52例JCA患者在首次入住儿科风湿病诊所时接受心理社会评估，并在9年后进行重新评估。评估方法包括半结构化精神科访谈、标准化的家长问卷和自我报告。
随访时，9例患者（17%）符合精神科诊断标准，8例（15%）在心理社会功能方面有轻度至中度损害（儿童或成人整体评估量表）。从首次入院到随访，心理健康和心理社会功能有显著改善。在年龄<18岁的患者（n = 26）中，根据儿童健康评估问卷，随访时的心理社会功能与身体残疾相关（r = -0.52，p < 0.01）。心理社会结局与其他疾病严重程度指标无关。疾病过程中的慢性家庭困难可预测<18岁患者随访时的心理社会功能（R2 = 0.22）。疾病发作时的慢性家庭困难，连同性别和疾病过程中的慢性家庭困难，可预测≥18岁患者随访时的心理社会功能（R2 = 0.61）。家庭压力源与身体结局无关。
大多数患者的长期心理社会结局良好。心理社会结局可由慢性家庭困难预测，但与随访时的疾病严重程度无密切关系。
