Associations of eczema phenotypes with emotional and behavioural problems from birth until school age. The Generation R Study

Abstract

Summary Background Eczema phenotypes and emotional and behavioural problems are highly prevalent in childhood, but their mutual relationship is not fully clear. Objectives To examine the associations of eczema phenotypes with school‐age emotional and behavioural problems, and the bidirectional associations of eczema and emotional and behavioural problems from birth until 10 years. Methods This study among 5265 individuals was embedded in a prospective population‐based cohort study. Never, early transient, mid‐transient, late transient and persistent eczema phenotypes were identified based on parent‐reported, physician‐diagnosed eczema from age 6 months until 10 years. Emotional (internalizing) and behavioural (externalizing) problems were measured repeatedly using the Child Behavior Checklist from age 1·5 to 10 years. Cross‐lagged models were applied for bidirectional analyses. Results All eczema phenotypes were associated with more internalizing problems and attention problems at age 10 years, compared with never having eczema: range of Z‐score differences 0·14 [95% confidence interval (CI) 0·01–0·27] to 0·39 (95% CI 0·18–0·60). Children with early transient eczema had more aggressive behaviour symptoms at age 10 years (Z = 0·16, 95% CI 0·05–0·27). Bidirectional analysis showed that eczema at 0–2 years was associated with more internalizing and externalizing problems at ages 3–6 and 10 years, while, inversely, only internalizing problems at 0–2 years were associated with an increased risk of eczema at age 10 years. Conclusions Eczema phenotypes are very modestly associated with more somatic symptoms and attention problems at school age. Early transient eczema is associated with more aggressive behaviour symptoms. Directional effects seem to occur from early‐life eczema to later‐life internalizing and externalizing problems, rather than the reverse.

The Role of the Environment and Exposome in Atopic Dermatitis

“…There is great inter-individual variability in the neurally mediated responses to psychological stress and subsequent AD flares [116]. The converse also holds true, with recent evidence demonstrating a higher incidence of later life behavioural problems in children with AD [117]. The latter may be explained in part by an immuno-psychiatric hypothesis, stemming from an enhanced understanding of immune processes in regulating CNS homeostasis and individual resilience [118] (Fig.…”

Associations between T cells and attention problems in the general pediatric population: The Generation R study

“…However, the following limitations should be taken into consideration. T CELLS AND CHILD ATTENTION PROBLEMS -7 of 10 attention problems dimensionally, as used previously in epidemiological studies (Hu et al, 2019;Katsuki et al, 2020;Mian et al, 2019;Modesto et al, 2015). This method has a higher feasibility than daily ADHD symptom measurements but might be less accurate (Mian et al, 2019).…”

Association between nasal and nasopharyngeal bacterial colonization in early life and eczema phenotypes

“…All analyses were adjusted for potential confounders, which were first selected from literature including known potential underlying biological mechanisms. 2,[16][17][18] Next, confounders were selected if they were associated with both the exposure (bacterial nasal/nasopharyngeal carriage) and the outcome (eczema phenotypes), and were not within the causal pathway based on epidemiological concept. Additionally, they were included if they changed the effect estimates or the unadjusted analyses with ≥10% in adjusted analyses.…”

“…As a sensitivity analyses for increased statistical power, we applied generalized estimating equation (GEE) models with an unstructured and autoregressive correlation matrix to examine the associations between bacterial nasal and nasopharyngeal carriage at age 6 weeks with repeated measures of eczema from 6 months until 10 years. All analyses were adjusted for potential confounders, which were first selected from literature including known potential underlying biological mechanisms 2,16–18 . Next, confounders were selected if they were associated with both the exposure (bacterial nasal/nasopharyngeal carriage) and the outcome (eczema phenotypes), and were not within the causal pathway based on epidemiological concept.…”