Poster #105 - Examining Predictors and Consequences of Adherence in a Multidisciplinary Pediatric Pain Clinic

• In Event: 2-110 - Poster Session 07
  In Poster Session: PS 07 Section - Health, Growth, Injury

Integrative Statement

Headache is the most prevalent chronic pain complaint in pediatric populations and is associated with physical and psychological impairment, particularly when symptoms are ineffectively managed (Perquin et al., 2000). Given the biological, psychological, and psychosocial influences on children’s chronic pain, multidisciplinary treatment encompasses medical, psychological, and lifestyle modification interventions (Simons et al., 2010). While literature links children’s chronic pain to increased depressive and anxious symptoms (Rapoff, 1996), less is known about children’s psychological symptoms in relation to treatment adherence and functional outcomes.

Patients aged 8-17 years who underwent multidisciplinary evaluation at a tertiary headache clinic participated in this study. From the larger sample (N = 457), 240 patients returned for follow-up and were included in the longitudinal analysis (Mage= 14.1, SD = 2.3; 69.2% female; 95.6% Caucasian). Parents and children completed questionnaires at the child’s initial appointment and again at follow-up. Children underwent evaluation by a neurologist and clinical psychologist, following which families were provided with treatment recommendations. The medical provider recorded patients’ adherence to medical, psychological, and lifestyle recommendations at follow-up.

Correlation analyses were first conducted. Psychological adherence and lifestyle adherence were significantly correlated with child-reported anxiety (r = 0.23, -0.23, respectively, p < .01; Revised Children’s Manifest Anxiety Scale–2; Reynolds, 2008) and depression (r = 0.22, -0.38, respectively, p < .01; Children’s Depression Inventory-2; Kovacs, 2011) at initial visit and with child-reported functional disability (r = 0.23, -0.26, respectively, p < .01) and parent-reported school absence (r = 0.19, p < .05; r = -0.23, p < .01, respectively) at follow-up. Medical adherence was not associated with the predictor or outcome variables, and was excluded from subsequent analyses.

Next, models were tested using structural equation modeling (SEM), specifically, path analysis (Kline, 2010). Due to the high correlation (r = .76) between depression and anxiety, these exogenous variables were entered into separate mediation models.

Results revealed child depressive symptoms (Figure 1) as negatively predicting lifestyle adherence (β = -0.32, SE = 0.003) and positively predicting psychology treatment adherence (β = 0.20, SE = 0.004). Depressive symptoms positively predicted functional disability (β = 0.24, SE = 0.09) but did not significantly predict school absence at follow-up. Regarding indirect effects, child depressive symptoms partially mediated (21.3% mediated; Preacher & Kelley, 2011) school absence at follow-up through lifestyle adherence.

Child anxiety symptoms (Figure 2) negatively predicted lifestyle adherence (β = -0.16, SE = 0.002) and positively predicted psychology treatment adherence (β = 0.24, SE = 0.004). Anxiety positively predicted functional disability (β = 0.18, SE = 0.07), but did not significantly predict school absence at follow-up. Child anxiety partially mediated school absence at follow-up through lifestyle adherence (9.27% mediated).

Results highlight child depression and anxiety symptoms as predicting long-term functional impairment in children with chronic headache. Examining treatment adherence as a mediator, however, paints a more comprehensive picture of how depression and anxiety impact children’s adherence, which in turn, affects health outcomes. Findings underscore the importance of interdisciplinary treatment in understanding the interplay of psychological factors on symptom management and functioning.

Authors

• Alessandra Caruso, Clark University
  Presenting Author

• Jonathan Rabner, Boston Children's Hospital
  Non-Presenting Author

• Alyssa LeBel, Boston Children's Hospital
  Non-Presenting Author