Emotional, hyperactivity and inattention problems in adolescents with immunocompromising chronic diseases during the COVID-19 pandemic

Campos, Reinan T.; Lindoso, Livia; Sousa, Renan A. de; Helito, Alberto C.; Ihara, Bianca P.; Strabelli, Claudia A.A.; Paradelas, Levi M.V.; Carneiro, Beatriz O.L.; Cardoso, Maria Paula R.; Souza, Jean Paulo V. de; Freire, Marianna R. de M.; Astley, Camilla; Laurentino, Moisés F.; Buscatti, Izabel M.; Kozu, Katia; Aikawa, Nadia E.; Sallum, Adriana M.E.; Ferreira, Juliana CO.; Simon, Juliana R.; Viana, Vivianne S.L.; Queiroz, Ligia B.; Gualano, Bruno; Roschel, Hamilton; Pereira, Rosa Maria R.; Toma, Ricardo K.; Watanabe, Andréia; Grangeiro, Patricia M.; Casella, Caio B.; Farhat, Sylvia C.; Polanczyk, Guilherme V.; Campos, Lucia Maria A.; Silva, Clovis A.

doi:10.1016/j.clinsp.2023.100167

Brasil

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Original articles • Clinics 78 • 2023 • https://doi.org/10.1016/j.clinsp.2023.100167 linkcopy

Emotional, hyperactivity and inattention problems in adolescents with immunocompromising chronic diseases during the COVID-19 pandemic

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective: To assess factors associated with emotional changes and Hyperactivity/Inattention (HI) motivated by COVID-19 quarantine in adolescents with immunocompromising diseases.

Methods: A cross-sectional study included 343 adolescents with immunocompromising diseases and 108 healthy adolescents. Online questionnaires were answered including socio-demographic data and self-rated healthcare routine during COVID-19 quarantine and validated surveys: Strengths and Difficulties Questionnaire (SDQ), Pittsburgh Sleep Quality Index (PSQI), Pediatric Quality of Life Inventory 4.0 (PedsQL4.0).

Results: The frequencies of abnormal emotional SDQ scores from adolescents with chronic diseases were similar to those of healthy subjects (110/343 [32%] vs. 38/108 [35%], p = 0.548), as well as abnormal hyperactivity/inattention SDQ scores (79/343 [23%] vs. 29/108 [27%], p = 0.417). Logistic regression analysis of independent variables associated with abnormal emotional scores from adolescents with chronic diseases showed: female sex (Odds Ratio [OR = 3.76]; 95% Confidence Interval (95% CI) 2.00–7.05; p < 0.001), poor sleep quality (OR = 2.05; 95% CI 1.08–3.88; p = 0.028) and intrafamilial violence during pandemic (OR = 2.17; 95% CI 1.12–4.19; p = 0.021) as independently associated with abnormal emotional scores, whereas total PedsQL score was inversely associated with abnormal emotional scores (OR = 0.95; 95% CI 0.93–0.96; p < 0.0001). Logistic regression analysis associated with abnormal HI scores from patients evidenced that total PedsQL score (OR = 0.97; 95% CI 0.95–0.99; p = 0.010], changes in medical appointments during the pandemic (OR = 0.39; 95% CI 0.19–0.79; p = 0.021), and reliable COVID-19 information (OR = 0.35; 95% CI 0.16–0.77; p = 0.026) remained inversely associated with abnormal HI scores.

Conclusion: The present study showed emotional and HI disturbances in adolescents with chronic immunosuppressive diseases during the COVID-19 pandemic. It reinforces the need to promptly implement a longitudinal program to protect the mental health of adolescents with and without chronic illnesses during future pandemics.

Keywords: COVID-19; Mental health; Adolescent; Chronic disease

HIGHLIGHTS

The frequencies of abnormal emotional SDQ scores from adolescents with chronic diseases were significantly lower than those of healthy controls during the COVID-19 pandemic.

The frequencies of abnormal hyperactivity and inattention SDQ scores from adolescents with chronic diseases were significantly lower than those of healthy controls.

Abnormal emotional scores from adolescents with chronic diseases were as independently associated with female sex, poor sleep quality, and intrafamilial violence during the pandemic.

Abnormal hyperactivity and inattention SDQ scores from patients were inversely associated with total PedsQL score, changes in medical appointments during the pandemic, and reliable COVID-19 information remained.

SDQ domains (score)	Adolescents with chronic diseases (n = 343)	Healthy adolescentes (n = 108)	p
Current age	14(10–18)	15 (10–18)	0.733
Female sex	67 (60)	44 (40)	0.970
Total difficulties score (0–40)	14 (0–32)	14 (1–36)	0.519
Abnormal total difficulties score	103 (30)	34 (32)	0.775
Peer problems (0–10)	2 (0–10)	2 (0–10)	0.359
Emotional problems (0–10)	4 (0–10)	5 (0–10)	0.164
Emotional disorders	110(32)	38 (35)	0.548
Conduct problems (0–10)	2 (0–9)	2 (0–8)	0.321
Hyperactivity/inattention (0–10)	5 (0–10)	5 (0–9)	0.046
Hyperactivity/inattention disorder	79 (23)	29 (27)	0.417
Prosocial (0–10)	8 (0–10)	8(1–10)	0.957
Impact score (0–10)	0 (0–10)	1 (0–8)	0.052

Variables	Adolescents with chronic diseases and abnormal emotional score (n = 110)	Adolescents with chronic diseases and normal/borderline emotional score (n = 233)	p
Socio-demographic
Current age	15 (10–18)	14 (10–18)	0.082
Female sex	89 (81)	122 (52)	<0.001
Caucasians	57 (52)	119 (51)	0.897
> 5 rooms in the residence	46 (42)	102 (44)	0.732
> 3 household’s members in the residence	83 (75)	151 (65)	0.048
Educational data
Attending school before COVID-19 pandemic	95 (86)	119 (85)	0.813
Level of schooling			0.132
Elementary school	58 (52)	114 (62)
Middle school	46 (42)	68 (29)
High school	4 (4)	14 (6)
Not studying	2 (2)	7 (3)
Public school adolescents	90 (81)	165 (71)	0.029
School homework during COVID-19 pandemic			0.071
No homework	25 (23)	32 (14)
≤ 3 hours/day	46 (42)	96 (41)
> 3 hours/day	39 (35)	105 (45)
Healthcare routine during the pandemic
Medical appointment during the pandemic			0.343
Discontinued	37 (36)	76 (34)
Decreased	44 (43)	83 (38)
Unchanged	21 (21)	62 (28)
Forgetting to take your medication			0.016
Without forgetting	58 (59)	152 (74)
1–2 days	32 (33)	48 (23)
3 days	8 (8)	6 (3)
General information on the COVID-19 pandemic
COVID-19 information source			0.181
Family and friends	11 (10)	15 (6)
Health professionals	8 (7)	9 (4)
Social media/television/radio	91 (83)	209 (90)
Reliable COVID-19 information	75 (68)	179 (77)	0.232
Compliance to the “stay-home” policy	104 (95)	226 (97)	0.363
VAS (0–10)
Fear of COVID	7 (0–10)	6 (0–10)	0.019
Fear of underlying disease activity/complication	8 (0–10)	5 (0–10)	<0.001
Impact of COVID-19 quarantine
Household members with COVID-19	23 (21)	25 (11)	0.011
Life routine changed after the “physical distancing” policy	104 (95)	213 (91)	0.307
Housework			0.001
No housework	20 (18)	62 (27)
≤ 1 hours/day	42 (38)	116 (50)
> 1 hours/day	48 (44)	55 (23)
Adolescents who take care of elderly people			0.094
Not taking care	86 (78)	173 (74)
≤ 1 hours/day	6 (6)	30 (13)
> 1 hours/day	18 (16)	30 (13)
Physical activity per week	1.3 (0–10)	2.7 (0–10)	0.007
Sleep duration < 8 h/day	51 (46)	68 (29)	0.002
Sleep after midnight	76 (69)	137 (59)	0.067
Sleep quality	6.7 (0–10)	8.8 (0–10)	<0.001
Screen time			0.056
<3 hours/day	11 (10)	24 (10)
4–6 hours/day	40 (36)	115 (49)
≥7 hours/day	59 (54)	94 (41)
Screen time increased during pandemic	101 (92)	195 (84)	0.041
Alcohol use during pandemic			0.381
Increased	1 (1)	0 (0)
Did not change	1 (1)	2 (1)
Decreased	2 (2)	2 (1)
Do not drink alcohol	106 (96)	299 (98)
Financial status during the pandemic			0.096
Worsen	48 (44)	75 (32)
Did not change	58 (53)	151 (65)
Improve	4 (3)	7 (3)
Household members working outside of home	100 (91)	191 (83)	0.059
Intrafamilial violence during pandemic	35 (32)	34 (15)	<0.001

Domains	Adolescents with chronic diseases and abnormal emotional score (n = 110)	Adolescents with chronic diseases and normal/borderline emotional score (n = 233)	p
PSQI score
PSQI total score (0–21)	6.57±3.66	4.59±3.13	<0.001
Poor sleep quality, total score > 5	53 (56)	64 (30)	<0.001
Sleep latency (0–3)	1.41±1.09	0.99±0.97	0.001
Sleep duration (0–3)	0.25±0.69	0.16±0.57	0.267
Sleep efficiency (0–3)	0.75±1.12	0.43±0.84	0.008
Sleep disturbances (0–3)	1.28±0.54	0.98±0.46	<0.001
Sleep medication use (0–3)	0.70±1.21	0.69±1.18	0.928
Overall sleep quality (0–3)	1.16±0.88	0.75±0.72	<0.001
Day dysfunction due to sleepiness (0–3)	1.02±0.84	0.59±0.73	<0.001
PedsQL score
Total scale score (0–100)	64 (21–89)	78 (29–100)	<0.001
Physical health summary score (0–100)	68 (13–100)	81 (6–100)	<0.001
Psychosocial health summary score (0–100)	58 (13–97)	75 (20–100)	<0.001
Emotional functioning (0–100)	40 (0–100)	70 (15–100)	<0.001
Social functioning (0–100)	80 (10–100)	90 (20–100)	<0.001
School functioning (0–100)	55 (0–100)	70 (0–100)	<0.001

Independent variables	Odds ratio	95% CI	p
Female sex	3.76	2.00–7.05	<0.001
Public School adolescents	0.59	0.31–1.15	0.121
Household members with COVID-19	2.12	0.99–4.51	0.053
Physical activity per week	1.00	0.99–1.01	0.523
Intrafamilial violence during pandemic	2.17	1.12–4.19	0.021
Total PedsQL score	0.95	0.93–0.96	<0.001
Sleep duration < 8 h/day	1.15	0.61–2.17	0.666
Sleep quality	0.99	0.98–1.01	0.409
Poor sleep quality	2.05	1.08–3.88	0.028

Variables	Adolescents with chronic diseases and abnormal HI score (n = 79)	Adolescents with chronic diseases and normal/borderline HI score (n = 264)	p
Socio-demographic
Current age	14 (10–18)	15 (10–18)	0.294
Female sex	55 (70)	156 (59)	0.092
Caucasians	42 (53)	134 (51)	0.707
> 5 rooms in the residence	34 (43)	114 (43)	0.982
> 3 household’s members in the residence	51 (65)	183 (69)	0.425
Educational data
Attending school before COVID-19 pandemic	71 (90)	223 (85)	0.229
Level of schooling			0.197
Elementary school	52 (66)	150 (57)
Middle school	22 (28)	92 (35)
High school	5 (6)	13 (5)
Not studying	0 (0)	9 (3)
Public school adolescents	54 (68)	201 (76)	0.165
School homework during COVID-19 pandemic			0.676
No homework	11 (14)	46 (17)
≤ 3 hours/day	32 (41)	110 (42)
> 3 hours/day	36 (45)	108 (41)
Healthcare routine during the pandemic
Medical appointment during the pandemic			0.014
Discontinued	36 (49)	77 (31)
Decreased	23 (32)	104 (42)
Unchanged	14 (19)	69 (27)
Forgetting to take your medication			0.060
Without forgetting	39 (59)	171 (72)
1–2 days	25 (38)	55 (23)
3 days	2 (3)	12 (5)
General information of COVID-19 pandemic
COVID-19 information source			0.243
Family and friends	6 (8)	20 (8)
Health professionals	1 (1)	16 (6)
Social media/television/radio	72 (91)	228 (86)
Reliable COVID-19 information	48 (61)	206 (78)	0.003
Compliance to “stay-home” policy	75 (95)	226 (97)	0.363
VAS (0-10)
Fear of COVID	7 (0–10)	6 (0–10)	0.339
Fear of underlying disease activity/complication	7 (0–10)	5 (0–10)	0.005
Impact of COVID-19 quarantine
Household members with COVID-19	12 (15)	36 (14)	0.727
Life routine changed after the “physical distancing” policy	74 (94)	243 (92)	0.634
Housework			0.188
No housework	24 (30)	58 (22)
≤ 1 hours/day	30 (38)	128 (48)
> 1 hours/day	25 (32)	78 (30)
Adolescents who take care of elderly people			0.530
Not taking care	60 (76)	199 (76)
≤ 1 hours/day	6 (8)	30 (11)
> 1 hours/day	13 (16)	35 (13)
Physical activity per week	1.1 (0–10)	2.8 (0–10)	0.008
Sleep duration < 8 h/day	40 (51)	79 (30)	0.001
Sleep after midnight	56 (71)	157 (60)	0.067
Sleep quality	6.3 (0–10)	8.7 (0–10)	<0.001
Screen time			0.600
< 3 hours/day	8 (10)	27 (10)
4–6 hours/day	32 (41)	123 (47)
≥ 7 hours/day	39 (49)	114 (43)
Screen time increased during pandemic	71 (90)	225 (85)	0.292
Alcohol use during pandemic			0.316
Increased	0 (0)	1 (0)
Did not change	2 (3)	1 (0)
Decreased	1 (1)	3 (2)
Do not drink alcohol	76 (96)	259 (98)
Financial status during the pandemic			0.007
Worsen	40 (51)	83 (31)
Did not change	37 (47)	172 (65)
Improve	2 (2)	9 (4)
Household members working outside of home	72 (91)	222 (84)	0.116
Intrafamilial violence during pandemic	27 (34)	42 (16)	<0.001

Domains	Adolescents with chronic diseases and abnormal HI score (n = 79)	Adolescents with chronic diseases and normal/borderline HI score (n = 264)	p
PSQI score
PSQI total score (0–21)	6.01±3.35	4.94±3.40	0.019
Poor sleep quality, total score > 5	35 (47)	82 (35)	0.065
Sleep latency (0–3)	1.13±0.95	1.11±1–05	0.860
Sleep duration (0–3)	0.19±0.59	0.18±0.62	0.962
Sleep efficiency (0–3)	0.56±0.95	0.51±0.95	0.693
Sleep disturbances (0–3)	1.23±0.51	1.03±0.49	0.003
Sleep medication use (0–3)	0.77 ±1.27	0.67±1.17	0.540
Overall sleep quality (0–3)	1.15±0.81	0.78±0.77	0.001
Day dysfunction due to sleepiness (0–3)	0.97±0.85	0.65±0.75	0.004
PedsQL score
Total scale score (0–100)	64 (28–94)	75 (21–100)	<0.001
Physical health summary score (0–100)	69 (13–100)	81 (6–100)	<0.001
Psychosocial health summary (0–100)	62 (23–88)	73 (13–100)	<0.001
Emotional functioning (0–100)	45 (5–100)	65 (0–100)	<0.001
Social functioning (0–100)	80 (25–100)	90 (10–100)	<0.001
School functioning (0–100)	50 (0–85)	70 (0–100)	<0.001

Independent variables	Odds ratio	95% CI	p
Physical activity per week	0.99	0.99–1.01	0.657
Total PedsQL score	0.97	0.95–0.99	0.010
Changes in medical appointment during the pandemic	0.39	0.19–0.79	0.021
Reliable COVID-19 information	0.35	0.16–0.77	0.026
Worst financial status during the pandemic	0.31	0.03–2.97	0.097
Fear of underlying disease activity/complication	1.00	0.99–1.02	0.299
Intrafamilial violence during pandemic	1.89	0.92–3.87	0.084
Total PSQI score	0.92	0.82–1.03	0.130
Sleep duration < 8 h/day	1.57	0.77–3.20	0.217
Sleep quality	0.99	0.98–1.00	0.135
Sleep problem	1.19	0.52–2.73	0.677

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[TFN1] Results are presented in n (%), and median (minimum-maximum values).