Predicting quality of life in children with food allergy: The roles of anaphylaxis, posttraumatic stress symptoms and protective parenting behaviors

Abstract

Background: Children with food allergy report lower quality of life compared to healthy peers and children coping with other chronic health conditions. However, the factors contributing to lower quality of life in children with food allergy have yet to be understood. Aims: To fill this gap in the literature, the aim of the current study was to predict quality of life in children with food allergy by examining childrenÕs and caregiversÕ emotional responses to childrenÕs potentially life-threatening allergic reactions (anaphylaxis). It was predicted that increased child and caregiver posttraumatic stress symptoms, protective parenting behaviors, and caregiver perceived illness burden would relate to poorer child quality of life. Method: Data were collected at two time points: online (Stage 1) and over the phone 2-4 weeks after completing the online survey (Stage 2). 162 children between the ages of 9-16 (M age = 11.26) and 206 caregivers participated in Stage 1. Children reported on their food allergy history, posttraumatic stress symptoms related to their most severe food allergy reaction and quality of life. Caregivers reported on their own posttraumatic stress symptoms, protective parenting behaviors, food allergy knowledge, and perceived illness burden. Six children who endorsed a history of anaphylaxis and symptoms of posttraumatic stress and their caregivers participated in the Stage 2 semi-structured interview. Results: 40 children (26% of the sample) but only 12 caregivers (7% of the sample) reported symptoms suggestive of a probable diagnosis of Posttraumatic Stress Disorder. As expected, after controlling for covariates, child anaphylaxis predicted increased child posttraumatic stress symptoms (?R2 = .08, p = .031), which in turn, were associated with poorer child disease-specific quality of life (?R2 =.13, p = .003) and child general quality of life (?R2 = .26, p < .001). Caregiver posttraumatic stress symptoms also predicted poorer child disease-specific quality of life (?R2 = .13, p = .044) and increased child posttraumatic stress symptoms (?R2 = .05, p = .004). However, child anaphylaxis did not relate to caregiver posttraumatic stress symptoms. In fact, none of the hypothesized variables (e.g., food allergy knowledge) predicted caregiver posttraumatic stress symptoms. Analyses testing the mediational impact of caregiver protective parenting behaviors on the relations between caregiver subjective emotional factors and child quality of life were largely not significant but were underpowered. The two models that were significant showed negative indirect effects of caregiver posttraumatic stress symptoms and perceived illness burden on child quality of life through protective parenting. Qualitative interview data suggested two emotional pathways for both children and caregivers as a result the childÕs reaction: heightened vigilance in response to threat (e.g., anxiety at mealtimes) and increased confidence to prevent and handle a future reaction (e.g., child confidence to self-inject their EpiPen). Children also reported novel emotional responses that were not described by caregivers, such as feelings of guilt about being responsible for the reaction. Conclusions: Caregivers reported fewer symptoms of posttraumatic stress than expected. It is possible that adaptive coping in response to the childÕs reaction (e.g., increased confidence) played a protective role buffering against the development of posttraumatic stress symptoms in caregivers. On the other hand, quantitative and qualitative results showed that a substantial proportion of children endorsed symptoms of posttraumatic stress, which were found to negatively relate to their quality of life. While some degree of vigilance is necessary to prevent accidental exposures, children endorsing symptoms of anxiety or posttraumatic stress may benefit from early identification and intervention to reduce the potential impact on their day-to-day socioemotional functioning. ?