Academic journal article Journal of Health Population and Nutrition

Psychiatric Morbidity, Stressors, Impact, and Burden in Juvenile Idiopathic Arthritis

Academic journal article Journal of Health Population and Nutrition

Psychiatric Morbidity, Stressors, Impact, and Burden in Juvenile Idiopathic Arthritis

Article excerpt

INTRODUCTION

Population-based studies have shown a two-fold increase in the social adjustment problems and internalizing and externalizing behavioural problems in children and adolescents with a chronic illness compared to healthy children (1,2). More behavioural problems and a lower social competence were reported in a one-year follow-up study in children with juvenile rheumatic diseases (3). Compared to healthy children, those with physical disorders showed an increased risk of overall adjustment problems and internalizing and externalizing symptoms (4).

Juvenile idiopathic arthritis (JIA), one of the most common chronic inflammatory diseases of childhood, is a major cause of disability (5-7). The overall prognosis for most children with chronic arthritis is good. However, 5-10% of children are refractory to conventional therapies (8,9). Treatment-resistant patients can develop severe joint destruction, growth retardation, and various adverse effects from long-term treatment. Chronic physical illnesses, such as JIA, have several consequences, including pain, restriction of physical activities, interruption of daily activities, concern about physical appearance, and lifestyle modification due to intensive treatment protocols that may limit the social, family and peer interactions among children and adolescents (10-12). Generally, lower levels of social competence were found for children with JIA when compared with a normative group of healthy children (13,14).

In Dhaka, Bangladesh, JIA was the ninth disorder in order of frequency accounting for 3% of 4,037 consecutive rheumatology outpatients in a tertiary-care centre (15). An analysis of psychiatric aspect of this disorder has, so far, not been reported. The present communication describes data obtained from this study of prevalence and types of psychiatric disorders, associated psychosocial stressors, and their impact on sufferers and caregivers of JIA patients in a tertiary medical centre in Dhaka city.

MATERIALS AND METHODS

Study population

Bangabandhu Sheikh Mujib Medical University (BSMMU) is a tertiary-care centre in Bangladesh. The Rheumatology Clinic of this centre caters to adult and paediatric rheumatology outpatients referred from secondary-level centres. This study was carried out in the Rheumatology Clinic, Department of Medicine, BSMMU, during January-September 2002. Children and adolescents, aged less than 18 years of either sex, suffering from JIA as per the Durban criteria (16,17) for at least one year were consecutively recruited. JIA subjects with currently inactive disease were excluded. The patient register was the sampling frame. The same number of age- and sex-matched healthy subjects attending the paediatric outpatient department of the university hospital for vaccination or as companions of patients was randomly included as controls.

Instruments

Apretested structured questionnaire was used for recording sociodemographic information and items relating to JIA, including age, type of onset, complaints, complications, and treatment received. A semi-structured case-assessment sheet for clinical psychiatric interview was designed for the study. It has the provision for identifying data, history, and clinical findings, including mental status examination and diagnostic formulation, to assign the psychiatric diagnoses according to multiaxial frame of ICD-10 clinical diagnoses of child and adolescent psychiatric disorder.

The World Health Organization's ICD-10 clinical diagnoses of multiaxial classification of child and adolescent psychiatric disorders (18) were used for assigning psychiatric diagnoses. This validated measure is a part of the International Classification of Diseases (ICD) with proved reliability having six axial diagnoses with diagnostic criteria for each axis. Axis One and Axis Five were used in this study. Axis One is for clinical psychiatric syndromes. …

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