The impact of chronic disease

Abstract

Pediatricians caring for children with chronic disease have long appreciated the impact of these diseases and their treatment on social-psychologic well-being. Unfortunately, this is an area which has not been the subject of much scholarly investigation, largely for want of rigorous methods. This can be carefully studied, as shown in this issue of The Journal. Storch and colleagues studied peer victimization in children with a variety of endocrine disorders. They employed a variety of instruments which have been validated in other population-based studies. Peer victimization (“bullying”) was quantitated by an objective measure, the Social Experience Questionnaire. The presence and severity of such victimization was associated with a number of unfortunate social outcomes, including anxiety and loneliness. Physicians caring for children with such disorders need to be aware that their patients can be bullied, and address this concern proactively. Objective measures of quality of life were used in another study by Rüth and associates in a group of children with steroid-sensitive nephrotic syndrome. Not surprisingly, steroid dependency was associated with abnormalities in quality of life as rated both by children and their parents. Importantly, the precise nature of the adjustment problems in these children was not purely a function of disease or treatment; a number of family climate variables were strong modifiers. Again, these are potentially modifiable factors that should be a subject of discussion between children, their families, and the physicians caring for them.