1. Effect of parental stress on management of childhood EGID

Background: Eosinophilic Disorders (EGIDs) are chronic inflammatory diseases of the digestive tract that are associated with intensive treatment and poor health outcomes. EGIDs diagnosed in children require extensive parent involvement in disease management. Previous research on parental-caregiver stress (PCS) suggests that parents of children with chronic illnesses may report increased psychological distress, increased child health-care utilization (HCU), and decreased quality of life. PCS in EGIDs has not been studied empirically. This study aims to evaluate the relationship between PCS, child illness severity, and resulting HCU. Methods: Parents of children with EGIDs were recruited via advertisement to diseasespecific support groups. Eligible participants completed a web-based survey which included: Pediatric Inventory for Parents (PIP) a measure of frequency and difficulty with PCS, demographics, child's symptom frequency, # of food allergies, treatments, and HCU. Separate stepwise linear regression and Factorial ANOVA assessed the relationship between PCS, child clinical data and HCU. Results: 175 parents participated. 98% were female/child's mother, (mean+/-SD) 38.5+/-7.1 yrs old, 93% Caucasian, 47% suburban dwellers, and 89% married. Children with EGIDs were 7.9+/-5.0 yrs old, 72% male, and had 13.6+/-7.5 food allergies. 45% have daily Sxs, 86% were on a restricted diet, 64% on 1-3 daily medications, and 72% had active disease. Mean time since Dx was 6.2+/-4.0 years. Stepwise regression showed that frequent PCS significantly predicts 27.4% of the variance in number of MD appts, 7% in the number of ER visits, and 8% in number of procedures. Frequent PCS related to interactions with medical providers and poorer emotional functioning significantly predicted increased MD visits, while communication challenges with family/friends predicted more ER visits and procedures. Flare frequency significantly predicted increased MD and ER visits. However when combined with frequency of PCS, flare frequency no longer significantly predicts increased HCU. All other clinical variables were not significant predictors. Factorial ANOVA revealed that only parents with 10 or more MD appts/yr reported significantly increased PCS frequency scores. All other differences were nonsignificant. Conclusions: Our preliminary study of the relationship between PCS and HCU demonstrated that frequency of parenting stress related to caring for a child with EGID is the most significant predictor of increased HCU. Child's illness severity was not a significant predictor of HCU when controlling for PCS. Understanding the role frequent parental stress may have in the care of children with EGIDs warrants further investigation.