Psychosomatic symptom burden and family functioning of adolescents with chronic diseases in transition to adult medicine – Implications for psychosocial support
Daniela Choukair, Amelie Beuchert, Cinara Paul, Alexander Fichtner, Georg F. Hoffmann, Hans-Christoph Friederich, Beate WildPurpose
Adolescents with chronic diseases often experience psychosomatic comorbidity. However, systematic evaluation of psychosocial stress is not yet implemented in structured transition programs from pediatric to adult health care. The aim was to evaluate psychosocial burden, family functioning, knowledge of their illnesses and identify needs for support.
Methods
Among n = 92 adolescents with chronic diseases psychosocial stress and family functioning were assessed using validated questionnaires at the beginning of transition: (Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Scale-7 (GAD-7), 8-item Somatic Symptom Scale (SSS-8), Somatic Symptom Disorder-B Criteria Scale (SSD-12), Systemic Clinical Outcome and Routine Evaluation (SCORE-15)). The patient´s disease-specific knowledge and need for counselling were assessed using a transition questionnaire. Semi-structured interviews were conducted in 42 adolescents with increased psychosocial burden and analysed using qualitative content analysis by Kuckartz.
Results
39.6% (95% CI = 29%, 50%) were moderately impaired by somatic complaints (SSS-8) and 6.5% (95% CI = 1%, 12%) raised severe concerns due to somatic symptoms (SSD-12). 20.6% (95% CI = 10.3%, 28%) showed symptoms of moderate or severe depression (PHQ-9), whereas 11.9% (95% CI = 6.8%, 17.5%) suffered from moderate or severe generalized anxiety disorder symptoms (GAD-7). Family functioning was assessed as good (SCORE-15); and a lower family functioning was significantly associated with higher psychosomatic symptom severity (p < 0.05). Qualitative analysis identified four main categories: somatic complaints, psychological aspects, informational aspects, and structural problems.
Discussion
At the beginning of the transition, adolescent patients with chronic diseases suffered from psychosomatic burden and a lower family functioning was associated with higher psychosomatic symptom severity. Therefore, assessment of psychosocial burden and family functioning should be integrated into transition programs to provide specific support and initiate early interventions.