Fatigue among children with a chronic disease: a cross-sectional study

Abstract

ObjectiveTo determine: (1) which biological/lifestyle, psychological and/or social factors are associated with fatigue among children with a chronic disease and (2) how much each of these factors contributes to explaining variance in fatigue.Design and settingThis was a cross-sectional study across two children’s hospitals.PatientsWe included children aged 8–18 years who visited the outpatient clinic with cystic fibrosis, an autoimmune disease or postcancer treatment.Main outcome measuresFatigue was assessed using the PedsQL Multidimensional Fatigue Scale. Generic biological/lifestyle, psychological and social factors were assessed using clinical assessment tools and questionnaires. Multiple linear regression analyses were used to test the associations between these factors and fatigue. Finally, a multivariable regression model was used to determine which factor(s) have the strongest effect on fatigue.ResultsA total of 434 out of 902 children were included (48% participation rate), with a median age of 14.5 years; 42% were male. Among these 434 children, 21.8% were severely fatigued. Together, all biopsychosocial factors explained 74.6% of the variance in fatigue. More fatigue was uniquely associated with poorer physical functioning, more depressive symptoms, more pressure at school, poorer social functioning and older age.ConclusionsFatigue among children with a chronic disease is multidimensional. Multiple generic biological/lifestyle, psychological and social factors were strongly associated with fatigue, explaining 58.4%; 65.8% and 50.0% of the variance in fatigue, respectively. Altogether, almost three-quarters of the variance in fatigue was explained by this biopsychosocial model. Thus, when assessing and treating fatigue, a transdiagnostic approach is preferred, taking into account biological, psychological and social factors.

Methodology of the DCCSS later fatigue study: a model to investigate chronic fatigue in long-term survivors of childhood cancer

“…They suggest a trans-diagnostic approach for understanding fatigue in patients with chronic health conditions. Contributing to these results, Nap-van der Vlist et al [ 68 ] suggest a trans-diagnostic approach in children with chronic conditions as well. By including several comorbidity categories in the presented multi-factorial fatigue model, we aim to determine the precise role of these health conditions in perpetuating fatigue symptoms in CCS.…”

Role of parents in fatigue of children with a chronic disease: a cross-sectional study

“…Although parental factors did not explain as much of the variance in paediatric fatigue as child factors, this exploratory study adds to our knowledge of associated factors with fatigue in paediatric chronic disease. 7 …”

“…Although parental factors did not explain as much of the variance in paediatric fatigue as child factors, this exploratory study adds to our knowledge of associated factors with fatigue in paediatric chronic disease. 7 Fatigue is highly prevalent in paediatric chronic disease and associated with various factors on the biological, psychological and social domains. 7 As parents form a major part of the child's social environment, our finding that both physical and psychosocial parental factors are associated with paediatric fatigue is in line with our hypothesis.…”

“…7 Fatigue is highly prevalent in paediatric chronic disease and associated with various factors on the biological, psychological and social domains. 7 As parents form a major part of the child's social environment, our finding that both physical and psychosocial parental factors are associated with paediatric fatigue is in line with our hypothesis. First, for physical parental factors, an association between more parental fatigue or bodily symptoms and more paediatric fatigue was also found in children with CFS.…”

“…5 7-12 Although child factors explain a considerable amount of variance in fatigue, part of the variance of fatigue cannot be explained by child factors. 7 Interpersonal factors, family environment and parental functioning are important contributors to how the child functions with his or her disease, especially for younger children. 3 13 As parents have a major impact on their child's well-being, we hypothesise that parental factors, both physical and What is known about the subject?…”