Associations of psychosocial factors with health outcomes among youth with cystic fibrosis

Abstract

Summary. Purpose: The purpose of this study was to examine the relationship of strains, resources, feelings, and behaviors about treatment adherence reported by youth with cystic fibrosis (CF) with repeated clinic measures of their pulmonary function and nutritional status. Methods: Linear mixed models, stratified by gender, adjusting for age, were used to examine the effects of strains, resources, and adherence behaviors on repeated pulmonary function and nutritional status measures. All 10-21 years old with CF at the Minnesota Cystic Fibrosis Center were invited by mail to participate. Of these 177 youth, 51% (43 boys, 47 girls) returned surveys. Forced expiratory volume in 1 sec and predicted weight-for-height were extracted from participants' clinic records for the 18 months following receipt of the survey. Results: Females showed significantly greater variability in repeated measures of pulmonary function and nutritional status compared to males. Parent-youth strains, physical strains, activity limitations, and cough suppression had significant effects on the 18-month mean of pulmonary function measures for females, but only physical strains had a significant effect for males. Conclusion: Compared to males, females experienced more strains and poorer treatment adherence, which may be factors associated with declines in pulmonary function observed among females with CF during the adolescent years.

Anxiety and depression in adolescents with CF and their caregivers

“…This might be a crucial issue, as it has been shown that the right amount of parental supervision is important for health outcomes in adolescents with CF [40]. Additionally it has been shown, that tensions between adolescents and parents might have negative effects on the adolescent patients' lung function [13,41]. Therefore, it seems crucial to further examine the impact of psychological symptoms on family functioning and its reciprocal effect on health outcomes and to provide adequate referrals when necessary.…”

Effects of Gender and Age at Diagnosis on Disease Progression in Long-term Survivors of Cystic Fibrosis

“…Equally worrisome are reports of gender-related psychological and behavioral attributes of young female patients with CF that could place them at a disadvantage compared with their male peers. These include increased difficulty in coping with the disease, increased illness-related strains and worries, greater depression, decreased quality of life scores, greater treatment discouragement, and greater acceptance of being underweight (45)(46)(47)(48)(49)(50)(51)(52), which may contribute to decreased treatment adherence and worse outcomes (45-47, 49, 64-66). The phenomenon of decreased survival in females appears to be confined to patients of age 1-20 years (30,33,76).…”

“…The underlying cause of the CF gender gap likely represents the summation of genetic modifications imposed by sex, as well as the socioenvironmental effects of gender (34). Various biological mechanisms have been identified that can result in a disadvantage for women (25,(35)(36)(37)(38)(39)(40)(41)(42)(43)(44), and from a psychosocial perspective, young females have been found to cope less effectively with the disease, and to be less adherent to therapy (45)(46)(47)(48)(49)(50)(51)(52)(53). However, these conclusions have been reached from analysis of children and adolescents; thus studies of longterm survivors of CF may help clarify the impact of sex and gender on disease progression.…”

Family Functioning and Treatment Adherence in Children and Adolescents with Cystic Fibrosis

“…1 Oppositional child behaviors, difficulty swallowing pills, managing therapies in the context of daycare and school, and lack of time have been identified as barriers to treatment compliance in CF. [2][3][4] As highlighted by a family systems perspective, the child's environment plays an important role in child health outcomes and child well-being. 5 The association between family functioning and treatment adherence has been studied extensively in some pediatric conditions, including diabetes and asthma.…”