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Psychological Morbidity and Caregiver Burden in Parents of Children With Tourette's Disorder and Psychiatric Comorbidity

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ABSTRACT

Objective

To investigate the mental health and caregiver burden in parents of children with Tourette's disorder (TD) compared with parents of children with asthma.

Method

A cross-sectional cohort survey was conducted at TD and pediatric asthma hospital outpatient clinics over a 6-month period. Main outcome measures were parent mental health (General Health Questionnaire [GHQ]-28) and caregiver burden (Child and Adolescent Impact Assessment) scores.

Results

The response rate achieved was 89.7%. Of the parents of children with TD, 76.9% achieved caseness on the GHQ-28 compared with 34.6% of the parents of children with asthma; this effect remained significant after controlling for demographic variables. Parents of children with TD also experienced greater caregiver burden, and this burden was significantly correlated with GHQ caseness.

Conclusions

Parents of children with TD are at risk of psychiatric morbidity; an intervention targeting caregiver burden might be helpful in reducing this.

Section snippets

Subjects

Parents of consecutive patients with TD aged 7 to 16 attending the outpatient TD clinic at the National Hospital for Neurology and Neurosurgery were interviewed at the clinic by a researcher (C.C.). All psychiatric diagnoses were made by M.M.R., according to DSM-III-R criteria (American Psychiatric Association, 1987), using the National Hospital Interview Schedule. This is a semistructured interview with established psychometric properties for the evaluation of TD and related behaviors (

Parental Characteristics

The parents of children with asthma were ethnically more diverse and less likely to come from social class 1 or 2 (Table 1). As would be expected due to shared genetic and environmental risk factors, siblings of children with TD were more likely to have a mental illness, and siblings of children with asthma were more likely to have a physical illness.

Child Characteristics

The children with asthma were slightly younger, had been ill for longer, and had been hospitalized five times more often than the TD group (Table 2

DISCUSSION

Parents of children with TD were more likely to be psychologically ill than parents of children with asthma. They also experienced greater burden, specifically in the domains of relationships, well-being, and activities. Although there were demographic differences between the two populations, the only predictor of parental psychological morbidity was diagnosis of TD in the child. The TD parents had a lesser likelihood of minority ethnic status and higher socioeconomic status, and thus the

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      Additionally, psychosocial stress and depression were independent predictors of future tic severity. Parents of children with TS have been found to have parental stress (Lee et al., 2007; Stewart et al., 2015), higher caregiver burden, lower self-esteem (Edell-Fisher and Motta, 1990) and to be at greater risk of mental disorders (Cooper et al., 2003). Patients report that their family members argue more frequently (Eddy et al., 2011).

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    The authors thank Dr. A. Angold for copyright permission to use the Child and Adolescent Impact Assessment; Dr. E. Chung, Consultant Paediatrician, University College London, for assistance in recruitment of subjects; and Caroline Greenwell, Development Worker at Islington Family Resource Centre.

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