The Association Between Family Impact and Health-Related Quality of Life of Children With Idiopathic Central Precocious Puberty

DOI: https://doi.org/10.21203/rs.3.rs-211762/v1

Abstract

Background

Idiopathic central precocious puberty (ICPP) reduces patient health-related quality of life (HRQoL). The impacts of disease and treatment on families are also an important concern. This study aimed to assess the impact of ICPP on the HRQoL of children and parents; its impact on family functioning; and to determine the association between patient HRQoL and family impact, comprising the HRQoL of parents and family functioning.

Methods

We conducted a case-control study in Chongqing, China. A case group of 134 children with ICPP aged 5 to 12 years and their caregivers was recruited from a children’s hospital in Chongqing. A total of 210 gender- and age-matched subjects from two schools were selected as controls. Patient HRQoL was assessed by administering the PedsQLTM4.0 Generic Core Scales (GCS). Impacts of ICPP on parental HRQoL and family functioning were evaluated by the PedsQLTM Family Impact Module (FIM).

Results

A total of 344 subjects were enrolled, with 134 in the case group and 210 in the control group. Children with ICPP scored lower than controls in all HRQoL domains except physical functioning. In particular, the two groups were significantly different in emotional functioning scores (77.39±17.97 vs 84.12±14.35, P<0.001). Compared with controls, ICPP families had lower scores in all dimensions of the PedsQLTM4.0 FIM scale. In the case group, patient HRQoL was significantly correlated with family impact scores (r= 0.224, P<0.05), but not with the dimensions of social functioning, communication, worry, and family relationships.   

Conclusions

ICPP worsens the HRQoL of patients and their parents, and also impairs family functioning. In addition, parents with higher HRQoL scores and family functioning generally reported higher HRQoL of children with ICPP. These findings suggest that health care professionals should identify and monitor ICPP patients’ psychosocial problems proactively, and provide targeted interventions to reduce family impact and thereby improve patient HRQoL.  

Background

Idiopathic central precocious puberty (ICPP) has become a common endocrinopathy in China, with an annual incidence of 43/10,000 population [1], which exceeds the global incidence of 1/5000 to 1/10,000 [2]. ICPP is defined as the development of secondary sexual characteristics following the activation of the hypothalamic-pituitary-gonadal axis before age 8 in girls and age 9 in boys [2] of unknown etiology after a diagnostic evaluation. Since the mid-1980s, gonadotropin releasing hormone agonists (GnRHa) have become gold-standard treatments for ICPP, with main therapeutic goal of improving final height [3].

Currently, the medical model has shifted to a bio-psycho-social model, leading clinic staff to recognize the value of all dimensions of health that go beyond physical well-being [4, 5]. previous studies found that children with ICPP undergoing treatment may suffer persistent physical and mental health complications, and also experience adverse psychosocial outcomes that reduce HRQoL. GnRHa therapy can improve final height [6, 7], but may also result in increased body mass index [810]. Girls with ICPP have demonstrated significantly higher emotional reactivity, but similar cognitive and psychosocial functioning as controls [11]. Through semi-structured interviews, Baumann et al. [12] found that girls who experienced precocious puberty tended to be shy, lonely, and often feel inferior, moody, or sad. A Chinese study demonstrated body image dissatisfaction in children with ICPP that persisted after 12 months of GnRHa treatment [13]. A cross-sectional study in Korea found that children with ICPP had a more obese body image and an exaggerated sense of breast development compared to controls [14].

Parents of children with ICPP are confronted by the challenges of chronic disease management, such as prolonged illness, frequent re-examinations, and cost burdens. A qualitative study in China found that caregivers expressed anxiety and guilt when caring for children with ICPP [15]. An American study reached similar conclusions; caregivers reported anxiety and guilt while explaining the diagnosis and treatment process to their child, as well as to other family members, and also expressed a desire to affiliate with others experiencing similar struggles [16]. A study using the World Health Organization quality of life questionnaire found that parents of children with ICPP had lower scores on physical and mental health subscales than controls [17].

Although some researchers have focused on the impact of ICPP on the HRQoL of both patients and their caregivers and on family functioning, associations between patient HRQoL and family impact have heretofore undergone limited study. Consequently, the aim of this study was to assess the impact of ICPP on the HRQoL of children and their parents and on family functioning in Chongqing, China, by comparing PedsQLTM4.0 Generic Core Scales (GCS) and PedsQL™ Family Impact Module (FIM) scores with those of controls, and to determine the association between patient HRQoL and family impact. Study findings could potentially provide a family-centric perspective to inform the development of clinical interventions to improve the HRQoL of children with ICPP.

Methods

Participants and setting

To achieve the power (1-β) of 0.80 under the probability of type I error (α) of 0.05, hypothetical mean scores of Psychosocial Health Summary Score were 82.0 and 87.0 in the case and control groups, respectively, with a standard deviation of 10. The sample size was determined by using the formula of n = (σ((z1α/2 + z1β)/(μAμB)))2. A minimum of 139 subjects was required for the case and control groups, respectively. A cohort of 134 children with ICPP and their primary caregivers was recruited from a Triple A children’s hospital from April to September 2019 in Chongqing by using the convenience sampling method, and 210 gender- and age-matched subjects were selected concurrently from two primary schools in Chongqing by the stratified sampling method.

The case group met the following inclusion criteria: 1) new diagnosis of ICPP, 2) previously diagnosed ICPP undergoing treatment, and 3) age of 5 to 12 years. Exclusion criteria were: 1) chronic illnesses such as asthma, kidney or heart diseases, epilepsy, or other comorbidities that influence HRQoL; 2) a history of psychological trauma such as the death of a family member; or 3) refusal of either the patient or their primary caregivers to participate. The control group met the following inclusion criteria: 1) age of 5 to 12 years, and 2) voluntary participation of the patient and their caregivers. Children with recent or past diagnoses of ICPP or who had other diseases that influence HRQoL were excluded from the control group. This study was approved by the Ethics Committee of Children’s Hospital of Chongqing Medical University. All caregivers provided written informed consent.

Procedure

The investigators were trained before data collection to ensure the quality of clinical research practices. In the case group, parents completed a demographic questionnaire and the PedsQLTM FIM, whereas patients completed the PedsQLTM4.0 GCS at the time of diagnosis or during outpatient follow-up. In the control group, children completed the PedsQLTM4.0 GCS and brought the demographic questionnaire and the PedsQLTM4.0 FIM to their parents for completion, which were returned to the head teacher on the following day, and were then collected by the investigators.

Measures

Demographic variables included age, gender, weight, height; number of children in the family; and caregiver relationship (e.g., parents or grandparents). The caregivers’ basic information included living environment (e.g., urban, rural), educational level (primary school, middle school, high school, or university and higher), employment status (employed, unemployed/housewives) and monthly income (<5000, 5,000-10,000, >10,000 Chinese Yuan [CNY]). Clinical characteristics of children with ICPP included whether they were newly diagnosed or already undergoing follow-up; age at diagnosis; disease duration; type of treatment (e.g., GnRHa or GnRHa combined with growth hormone); route of administration (e.g., intramuscular or subcutaneous injection); and duration of treatment.

The PedsQLTM GCS questionnaire was developed by Varin et al. [18] to assess the impact of disease and treatment on pediatric patients’ HRQoL during the preceding month. It consists of 23 items divided into four dimensions including physical (8 items), emotional (5 items), social (5 items) and school (5 items) functioning. A 5-point Likert scale was used to estimate problem frequencies: 0=never, 1=almost never, 2= sometimes, 3=often, 4=always. Items are then reverse scored and transformed into a scale of 0-100 (0=100, 1=75, 2=50, 3=25, 4=0), with higher scores representing better HRQoL status. The Total Summary Score was calculated as the sum of all 23 items divided by the number of items answered. The Total Summary Score can be further divided into the subscales of Physical Health Summary Score and Psychosocial Health Summary Score. The Psychosocial Health Summary Score was computed as the sum of 15 items of emotional, social and school functioning divided by the number of items answered. This study used self-reports of the Chinese version of the PedsQLTM GCS, which was cross-culturally adapted by Hao et al [19]. The instrument showed good internal consistency and reliability, with Cronbach’ s alpha coefficients of 0.862 in the case group and 0.745 in the control group.

The PedsQLTM FIM was developed by Varin et al [20] as a parent-reported instrument to measure the impact of pediatric chronic disease on parents’ HRQoL and family functioning. The questionnaire consists of 36 items divided into 8 dimensions including physical functioning (6 items), emotional functioning (5 items), social functioning (4 items), cognitive functioning (5 items), communication (3 items), worry (5 items), daily activities (3 items), and family relationships (5 items). The former 6 dimensions measure parents’ self-reported HRQoL, whereas the latter 2 dimensions measure parent-reported family functioning. Each item has five Likert response options to assess the frequency of problems: 0 (never), 1 (almost never), 2 (sometimes), 3 (often), and 4 (almost). Items are then linearly transformed to a 0-100 scale (0 = 100, 1 = 75, 2 = 50, 3 = 25, 4 = 0), so that higher scores indicate lower family impact. The total score is calculated as the sum of all 36 items divided by the number of items answered. The parents’ HRQoL Summary Score is calculated as the sum of the 20 items of physical, emotional, social, cognitive functioning subscales divided by the number of items answered, and the family functioning summary score is calculated as the sum of the 8 items of daily activities and family relationships subscales divided by the number of items answered. We used the Chinese version of PedsQLTM FIM translated by Chen et al [21]. It has shown good internal consistency and reliability, with Cronbach’ s alpha coefficients of 0.969 in the case group and 0.943 in the control group.

Statistical analyses

All data were analyzed using IBM SPSS version 25.0. Continuous and categorical variables were described as mean ± standard deviation (SD) and frequency (percentage n [%]), respectively. First, t-test and Chi-square (χ2) test analyses were used to compare the demographic characteristics of the two groups. Second, the t-test was used to examine differences of the PedsQLTM GCS and PedsQLTM FIM scores between the two groups. Finally, Pearson correlation coefficients (r values) were calculated to explore the association between patients’ HRQoL and family impact of case group. P-value<0.05 (two-sided) was considered statistically significant.

Results

The demographic characteristics of the case and control groups are summarized in Table 1. A total of 377 participates were enrolled. We excluded 20 participants with incomplete demographic information. A total of 344 participants were included in the final analysis, of whom 134 were in study group and 210 were controls. The mean age of the study group was 9.05 ± 1.07 years compared to 8.84 ± 1.02 years in controls. One hundred and thirty patients (97.0%) were females, whereas 195 controls (92.9%) were females. The mean ages and sex distributions did not differ significantly between the two groups (Table 1). However, height, weight, number of children, parents’ educational level, employment status, and family monthly income were significantly different between the two groups (P < 0.05) (Table 1).

Table 2 summarizes the clinical characteristics of the case group. Most (91.8%) were newly diagnosed, half were diagnosed at age 8 to 12 years old, and a majority (64.9%) reported a disease duration of less than one year. Most (79.9%) had received intramuscular injection, and had been treated for less than 1 year (73.1%).

Table 3 summarizes the PedsQLTM4.0 GCS scores of the two groups. Children with ICPP scored significantly lower than controls in all HRQoL domains except physical functioning. In particular, the two groups were significantly different in emotional functioning scores (77.39 ± 17.97 vs 84.12 ± 14.35, P < 0.001).

Table 4 summarizes the PedsQL™ FIM scores of the two groups. Caregivers of ICPP patients had lower HRQoL and family functioning scores than those caring for healthy children.

Table 5 summarizes correlations between the HRQoL of children and family impact in the case group. There was a significant positive correlation between the HRQoL of children with ICPP and family impact scores (r = 0.224, P < 0.05), but not with dimensions of social functioning, communication, worry, and family relationships.

Discussion

This case-control study in Chongqing, China revealed that children with ICPP had lower HRQoL scores than controls, and suggests that the disease and its treatment have negative effects on parental HRQoL and family functioning. In particular, our study suggests that lower family impacts are associated with better HRQoL of children with ICPP.

Using the PedsQLTM4.0 GCS instrument, our study revealed that children with ICPP performed worse than healthy peers in emotional functioning, social functioning, school functioning, psychosocial health summary scores, and total summary scores. Similarly, a study using an Inventory of Subjective Life Quality Scale found that ICPP patients had worse scores on subdomains of school life, depression, anxiety, and body satisfaction than healthy controls [22]. However, a study in Australia showed that children who experienced early puberty scored poorly only on PedsQL™ psychosocial health summary scores, but had similar scores in other dimensions as controls [23]. These discrepant results may be related to the different cultural adaptations of the instruments. The highly significant difference in the emotional functioning of the two groups can be attributed to physical changes caused by the premature development of secondary sexual characteristics. Earlier studies have supported this conclusion. Qiao XH et al., using the Achenbach Child Behavior Checklist, found that girls with ICPP manifested psychological and behavioral problems that included depression, withdrawal, somatization, social problems, and delinquent and aggressive behaviors. Premature breast development may exacerbate the risk of behavioral problems [24]. Another study also found that children with ICPP were burdened by physical changes such as abnormally tall stature, and precocious breast development and menarche in girls. These may lead to self-perceptions of being different from peers, resulting in a lack of confidence and low self-concept [25]. Although physical differences that are caused by secondary sexual characteristics may be temporary, the impact on the child’s self-esteem and feelings of alienation from the peer group may be significant [26]. These psychological and behavioral problems of children with ICPP may impair their social development and functioning. A qualitative research study found that children with ICPP experienced feelings of isolation and being bullied, and displayed aggressive bullying behavior [16]. In addition, children with ICPP require therapeutic injections at 4 to 5-week intervals and examinations every three months that may subsequently impede school attendance. Another potential factor is that chronic illnesses of children may lower parental expectations of academic performance. In our study, the physical functioning scores were similar in the two groups. This finding may be related to physical changes in children with ICPP that may be advantageous in physical activities such as sports, such as taller height caused by bone maturation.

Consequently, the PedsQLTM4.0 GCS instrument can discriminate healthy children from ICPP patients. Further studies using the PedsQLTM4.0 GCS instrument in children with ICPP are needed to improve the understanding of the impact of ICPP on patient HRQoL. Clinic staff should be attentive to the psychosocial changes of children with ICPP during medical treatment and offer crucial mental and social health interventions.

The impact of chronic diseases of children such as cancer [27], sickle cell disease [28], chronic pain [29], and functional constipation [30] on parents’ HRQoL and family functioning has been demonstrated repeatedly. This study also demonstrated that caring for a child with ICPP is associated with lower parental HRQoL and impaired family functioning in all dimensions of the FIM. A study using SCL-90 measurements found that parents caring for a child with precocious puberty experienced physical discomfort [31]. Parents also expressed negative emotions and reported stressors such as medication side effects, diagnostic uncertainly, and financial costs that increased their psychological burden [15]. In addition, primary caregivers must balance the management of illness; which may require the daily administration of growth hormone injections, as well as supervision of the activities of daily life that include diet, sports, and sleep; with social activities, which may influence parents’ social life. Parental HRQoL was impaired in this study. Our study also found that parents of patients had lower family functioning scores than controls. In China, older relatives including fathers may misperceive ICPP as a normal developmental process, and conclude that medical treatment is unnecessary, while mothers may advocate timely treatment for their children; consequently, family members may disagree on the child’s treatment. Another probable explanation for lower HRQoL and family functioning may be that family members must sacrifice family activities to take care of their child with ICPP.

Health care professionals should provide disease-related information to parents of children with ICPP. Community hospitals and pediatric clinics could provide mental health courses to encourage parents to express their negative feelings. A medical integration and cooperation model in endocrinology outpatient clinics also offers an effective approach to improve the ability of parents to manage chronic illnesses of their children.

Finally, we found a positive association between the HRQoL of children with ICPP and family impact, which suggests that the lower impact of illness on parents’ HRQoL and family functioning, the better HRQoL of children with ICPP. Parents have an essential role in their children’s personality development. Parental adverse emotional reactions, negative attitudes towards disease, and impaired family functioning may reduce patient HRQoL. Unhealthy emotions of parents can arouse emotional sensitivity and guilt in their children, and can also reduce the children’s HRQoL [32] However, the dimensions of social functioning, communication, worry, and family relationships were not significantly related to patient HRQoL. A possible explanation is that parents may have been ashamed of discussing their children’s condition with others; consequently, patients may not have been aware of their parents’ psychological burdens. This finding indicates that health care professionals can provide targeted interventions to reduce family impact and thereby improve patient HRQoL.

However, this study had several limitations. First, the PedsQLTM4.0 GCS is a general questionnaire and may lack of precision and sensitivity in assessing HRQoL of children with ICPP. However, this Chinese version of PedsQLTM4.0 GCS has acceptable psychometric properties, and many researchers have used it to evaluate patients with other endocrinopathies such as obesity and short stature. Second, because our case group was recruited primarily from a triple A children’s hospital in Chongqing, their HRQoL may not be representative of those of children with ICPP from other regions. However, our study found that ICPP impacts the HRQoL of both patients and their parents, as well as family function. Similar studies are needed in other regions of China.

Conclusion

We conclude that ICPP and its treatment not only reduced patient HRQoL, but also the HRQoL of parents, as well as family functioning. In addition, the HRQoL of children with ICPP was positively associated with parental HRQoL and family functioning. These findings suggest that health care professionals should identify and monitor the psychosocial problems of children with ICPP proactively, and initiate health education and mental health interventions to improve parent HRQoL and family functioning and thereby improve the HRQoL of patients with ICPP.

Abbreviations

ICPP: idiopathic central precocious puberty; HRQoL: health-related quality of life; PedsQLTM GCS: PedsQLTM Generic Core Scales; FIM: Family Impact Module; GnRHa: gonadotropin releasing hormone agonists; CNY: Chinese Yuan; SD: standard deviation; GH: growth hormone.

Declarations

Acknowledgements

The authors wound like to thank the Children’s Hospital of Chongqing Medical University, the teachers of outpatient injection, and the participants from the Children’s Hospital and local schools.

Authors’ contributions

Study design: LSQ, LXH; guide for investigation: LQ; Data collection: CT, TF, WD, ZL; Analysis and interpretation of data: YH; First drafting of the manuscript: YH; revision for data and important content: LSQ, LXH. All authors are responsible for their work. All authors read and approved the final manuscript.

Funding

The study was financed by Children’s Hospital of Chongqing Medical University (CHCQMU2019.11).

Availability of data and materials

The data used or analyzed during the current study are available from the corresponding author on reasonable request.

Ethics approval and consent to participate

The Ethics Review Board of Children’s Hospital of Chongqing Medical University approved this study. Before investigation, written consents and assents were obtained from both caregivers and subjects who were willing to participate.

Consent for publication

Not Applicable.

Competing interests

The authors declare that they have no competing interests.

References

  1. Zhu MQ, Fu JF, Liang L, Gong CX, Xiong F, Liu GL, Luo FH, Chen SK. Epidemiologic study on current pubertal development in Chinese school-aged children. Zhejiang Univ (Medical Sci). 2013;42 (4):396-402.
  2. Latronico AC, Brito VN, Carel JC. Causes, diagnosis, and treatment of central precocious puberty. Lancet Diabetes Endocrinol. 2016;4(3):265-274.
  3. Carel JC, Eugster EA, Rogol A, Ghizzoni L, Palmert MR. Consensus statement on the use of gonadotropin-releasing hormone analogs in children. Pediatrics. 2009;123:e752-62.
  4. Jalali FS, Shojaei FA, Parvin P, et al. Comparison of health-related quality of life (HRQoL) among healthy, obese and chronically ill Iranian children. BMC Public Health. 2018;18(1):1337.
  5. Shafei AME, Hegazy IS, Fadel FI, et al. Assessment of quality of life among children with end-stage renal disease: a cross-sectional study. J Environ Public Health, 2018, 2018(2):1-6.
  6. Swaiss HH, Khawaja NM, Farahid OH, et al. Effect of gonadotropin-releasing hormone analogue on final adult height among Jordanian children with precocious puberty. Saudi Med J. 2017;38(11): 1101-1107.
  7. Ying Y, Tang J, Chen W, et al. GnRH agonist treatment for idiopathic central precocious puberty can improve final adult height in Chinese girls. Oncotarget. 2017;8(65):109061-109067.
  8. Poomthavorn P, Suphasit R, Mahachoklertwattana P. Adult height, body mass index and time of menarche of girls with idiopathic central precocious puberty after gonadotropin-releasing hormone analogue treatment. Gynecol Endocrinol. 2011;27(8):524-528.
  9. Lee HS, Yoon JS, Roh JK, et al. Changes in body mass index during gonadotropin-releasing hormone agonist treatment for central precocious puberty and early puberty. Endocrine. 2016;54: 497-503.
  10. Arrigo T, Luca DF, Antoniazzi F, et al. Reduction of baseline body mass index under gonadotropin-suppressive therapy in girls with idiopathic precocious puberty. Eur J Endocrinol. 2004;150(4):533-537.
  11. Wojniusz S, Callens N, Sütterlin S, et al. Cognitive, emotional, and psychosocial functioning of girls treated with pharmacological puberty blockage for idiopathic central precocious puberty. Front Psychol. 2016;7:1053.
  12. Baumann DA, Landolt MA, Wetterwald R, et al. Psychological evaluation of young women after medical treatment for central precocious puberty. Horm Res. 2001;56(1-2):45-50.
  13. Zheng F, Zhu H, Jiang YJ, et al. Psychological behavior of girls with idiopathic central precocious puberty before and after treatment with gonadotropin-releasing hormone analogue. Zhejiang Univ (Medical Sci). 2008;37(3).
  14. Choi MS, Kim EY. Body image and depression in girls with idiopathic precocious puberty treated with gonadotropin-releasing hormone analogue. Ann Pediatr Endocrinol Metab. 2016; 21(3):155-160.
  15. Zhu S, Yu YZ, Shu S, et al. Qualitative research on load of mother care for children with idiopathic central precocious puberty. Chinese Nurs Res. 2014(34):4342-4345.
  16. Patel PS. Identifying areas of needed support for young girls with central precocious puberty (CPP). Master’s thesis, University of Washington. https://digital.lib.washington.edu/ Researchworks/handle/1773/36710. Accessed 23 Feb 2017.
  17. Xie CH, Tang JY. Investigation of parental stress, social support and quality of life in mothers of children with precocious puberty. Chinese J Modern Nurs. 2017;23(17):2252-2254.
  18. Varni JW, Thompson KL, Hanson V. The Varni/Thompson Pediatric Pain Questionnaire: Chronic musculoskeletal pain in juvenile rheumatoid arthritis. Pain. 1987;28:27–38.
  19. Lu YY, Tian Q, Hao YT, et al. Reliability and validity for Chinese version of pediatric quality of life inventory PedsQL4.0. SUN-Yat-sen Univ (Med Sci). 2008;29(3):328-331.
  20. Varni JW, Sherman SA, Burwinkle TM, et al. The PedsQL™ Family Impact Module: Preliminary reliability and validity. Health Qual Life Outcomes. 2004;2:55.
  21. Chen R, Hao Y, Feng L, et al. The Chinese version of the Pediatric Quality of Life Inventory™ (PedsQL™) Family Impact Module: Cross-cultural adaptation and psychometric evaluation[J]. Health Qual Life Outcomes. 2011;9(1):16.
  22. Liu YY, Ma YP, Jin ZY, et al. A relevant research on quality of life and self-awareness in girls with idiopathic central precocious puberty. Chin J Behav Med & Brain Sci. 2015(2):139-141.
  23. Mensah FK, Bayer JK, Wake M, et al. Early puberty and childhood social and behavioral adjustment. J Adolesc Health. 2013;53(1):118-124.
  24. Qiao XH, Yu J, Xie XT. Case-control Study on behavioral problems of girls with earlier onset of sexual development. Chinese Mental Health J. 2008;(04):12-15.
  25. Ai LL, Jia SM, Zhang YX, et al. Investigation on the self-concept of children with precocious puberty. Chinese J Child Health Care. 2018;26(06):590-593.
  26. Golum MS, Collman GW, Foster PM, Kimmel CA, Rajpert-De Meyts E, Reiter EO, Toppari J. Public health implications of altered puberty timing. Pediatrics. 2008;121(Suppl 3):S218-S230.
  27. Scarpelli AC, Paiva SM, Pordeus IA, et al. The pediatric quality of life inventory (PedsQL) family impact module: Reliability and validity of the Brazilian version. Health Qual Life Outcomes. 2008;6:35.
  28. Panepinto JA, Hoffmann RG, Pajewski NM. A psychometric evaluation of the PedsQL Family Impact Module in parents of children with sickle cell disease. Health Qual Life Outcomes. 2009;7: 32.
  29. Mano KEJ, Khan KA, Ladwig RJ et al. The impact of pediatric chronic pain on parents' health-related quality of life and family functioning: Reliability and validity of the PedsQL 4.0 Family Impact Module. J Pediatr Psychol. 2011;36(5): 517-27.
  30. Wang CJ, Shang L, Zhang YH et al. Impact of functional constipation on health-related quality of life in preschool children and their families in Xi'an, China. PLoS One. 2013;8(10): e77273.
  31. Zhang XX, Yi ZW, Zhang JJ, et al. A preliminary study on mental health in children with precocious puberty and their parents. Chinese J of Clin Psychol. 2005;13(3):348-349.
  32. Ellis BJ, Essex MJ. Family environments, adrenarche, and sexual maturation: a longitudinal test of a life history model. Child Dev. 2007;78(6):1779-1817.

Tables

Table 1 Demographic characteristics of 134 ICPP patients (study group) and 210 controls 

Variables

Study group(N, %)

Control group(N, %)

t/F-value

P-value

Patient characteristics

 

 

 

 

Female sex

130 (97.0)

195 (2.9)

2.710

0.100

Age(years)

9.05±1.07

8.84±1.02

1.783

0.076

Height (cm)

139.84±8.36

133.82±8.13

6.624

<0.001

Weight (kg)

 34.73±8.60

30.37±7.13

5.093

<0.001

Children per family

 

40.970

<0.001

   One-child

 80(59.7)

 53(25.2)

 

 

   Multiple-child

 54(40.3)

157(74.8)

 

 

Caregivers

 

 

3.731

0.053

   Parents

125(93.3)

182(86.7)

 

 

   Grandparents

  9(6.7)

 28(13.3)

 

 

Caregiver characteristics

 

 

 

 

Living environment

 

0.037

0.847

   Urban

127(94.8)

200(95.2)

 

 

   Rural

  7(5.2)

 10(4.8)

 

 

Educational level

 

43.682

<0.001

   Primary school

 8(6.0)

 34(16.2)

 

 

   Middle school

11(8.2)

 54(25.7)

 

 

   High school

56(41.8)

 87(41.4)

 

 

   University or higher

59(44.0)

 35(16.7)

 

 

Employment status

 

6.833

0.009

   Employed

86(64.2)

162(77.1)

 

 

   Unemployed/housewives

48(35.8)

 48(22.9)

 

 

Monthly income (CNY)

 

62.269

<0.001

   <5000

 18(13.4)

 83(39.5)

 

 

   5000-10 000

 46(34.3)

 97(46.2)

 

 

   >10 000

 70(52.2)

 30(14.3)

 

 

The t-test was used to compare age, height and weight. The Chi-square (χ2) test was used to compare other variables. CNY: Chinese Yuan.

Table 2 Clinic characteristics of case groupn=134

Variables

N(%)

New diagnosis/Follow-up

 

New diagnosis

11(8.2)

Follow-up

123(91.8)

Age at diagnosis (years)

 

5-7

45(33.6)

8-12

89(66.4)

Disease duration (years)

 

<1

87(64.9)

1-2

34(25.4)

>2

13(9.7)

Type of medical treatment

 

GnRHa

107(79.9)

GnRHa+GH

27(20.1)

Route of administration

 

Intramuscular injection

90(67.2)

subcutaneous injection

44(32.8)

Duration of medical treatment (years)

 

<1

98(73.1)

1-2

29(21.6)

>2

7(5.2)

GnRHa: gonadotropin release hormone agonist; GH: growth hormone

 

Table 3 Comparison of PedsQLTM 4.0 GCS scores between ICPP patients and controls

Scale

ICPP patients(n=134)

Control group(n=210)

t-value

P-value

Mean(SD)

 

Mean(SD)

Physical Health    

Summary Score

85.56±11.81

 

85.54±9.02

0.017

0.986

Psychosocial Health

Summary Score

82.53±12.17

 

87.31±9.23

-3.892

<0.001

Emotional functioning

77.39±17.97

 

84.12±14.35

-3.659

<0.001

Social functioning

89.10±12.35

 

92.12±9.28

-2.421

0.016

School functioning

81.10±14.43

 

85.69±12.72

-3.100

0.002

Total Summary Score

83.28±11.22

210

86.87±7.59

-3.261

0.001

Psychosocial Health Summary Scores integrate emotional, social and school functioning scores.

 

Table 4 Comparison of PedsQLTM FIM scores between ICPP patients and control group

 

ICPP patients(n=134)

  Control group(n=210)

t-value

P-value

Mean(SD)

Mean(SD)

Physical functioning

73.38±16.41

81.79±15.34

-4.822

<0.001

Emotional functioning

69.74±18.02

79.98±16.92

-5.338

<0.001

Social functioning

74.58±17.26

83.48±22.83

-3.862

<0.001

Cognitive functioning

72.50±18.08

77.80±18.73

-2.592

0.010

Communication

77.55±16.48

86.53±16.01

-5.012

<0.001

Worry

58.61±18.15

78.03±19.52

-9.395

<0.001

Parent HRQOL summary score

72.55±15.64

80.76±15.17

-4.836

<0.001

Daily activities

66.98±17.71

73.31±20.54

-3.034

0.003

Family relationships

74.25±17.40

79.69±18.23

-2.745

0.006

Family functioning summary score

70.62±15.95

76.50±17.35

  -3.162

  0.002

Total score

70.95±14.41

80.07±13.98

  -5.833

  <0.001

 

Table 5 Pearson’s rank correlation coefficients of ICCP patient PedQLTM 4.0 GCS and FIM scores

 

Physical Health

Summary Score

Psychological Health

Summary Score

Total Summary Score        

Physical functioning

0.221*

0.256**

0.267**

Emotional functioning

0.193*

0.245**

0.250**

Social functioning

0.162

0.147

0.162

Cognitive functioning

0.198*

0.153

0.177*

Communication

0.135

0.062

0.086

Worry

0.143

0.154

0.164

Parent HRQOL summary score

0.216*

0.222**

0.238**

Daily activities

0.143

0.249**

0.240**

Family relationships

0.081

0.139

0.134

Family functioning summary score

0.124

0.214*

0.206*

Total score

0.193*

0.213*

0.224*

* indicates P-values <0.05, ** indicates P-values<0.01.