Improving Quality of Life of Children with Eczema and Their Parent Caregivers through a Dyadic Integrative Body-Mind-Spirit Intervention: A Randomized-Waitlisted Control Trial

Atopic Dermatitis (Eczema) is a clinically defined, itchy, inflammatory skin condition, characterized by chronic and relapsing episodes. The prevalence of childhood eczema has steadily increased from 15-20% over the past 20 years, especially in urbanized and industrialized countries, emphasizing the importance of lifestyle and environment in the pathogenesis of atopic diseases. Children with eczema experiences sleep deprivation, irritability, emotional stress, psychological disturbance, poor self-esteem and social isolation. Besides, parental caregivers report degrades in quality of life, frustration, exhaustion, helplessness, depressive symptoms, sadness and guilt due to their children’s skin condition. Eczema, therefore, is not merely a disease to be faced by the children, but also a significant life event to be faced by the whole family. The interaction between the parent caregiver and the children’s disease will produce a particular pattern of family interaction in daily life, illness management and recovery process.

In this research, 219 parent-child dyads participated in a randomized-waitlisted controlled trial which examined the efficacy of a dyadic psychosocial intervention for children with eczema and their parental caregivers. The intervention was a parallel six-session program based on Integrative Body-Mind-Spirit (IBMS) approach which aimed to help the parent-child dyads to improve their quality of life and coping capacities in dealing with the disease. Children of ages 6 to 12 with eczema and their parental caregivers were recruited from referrals from dermatologists, paediatricians, social media and Non-Governmental Organisations. The participants were invited to complete an inventory of measurements immediately before (T₀) and after (T₁) the intervention. The measurements were self-administered questionnaires including Children’s Dermatology Life Quality Index (CDLQI), Paediatric Allergic Disease Quality of Life Questionnaire (PADQLQ), and Patient Oriented Eczema Measure (POEM) for children, and Holistic Well-being Scale (HWS), Perceived Stress Scale (PSS), Dermatitis Family Impact (DFI), Patient Health Questionnaire (PHQ9) and Generalised Anxiety Disorder Assessment (GAD7) for parental caregivers. Furthermore, blood samples were drawn from the children at T₀ and T₁, and inflammatory related biomarker, Immunoglobulin E (IgE) was examined with the psychosocial parameters.

Results showed that significant improvements were identified for parents in HWS Non-attachment (F(1,212) = 3.942, p<.05), HWS Bodily Irritability (F(1,211) = 8.850, p<.05), HWS Spiritual Disorientation (F(1,210) = 5.847, p<.05), HWS General Vitality (F(1,213) = 8.666, p<.05), DFI (F(1,212) = 10.972, p<.05), PSS (F(1,212) = 15.418, p<.05), PHQ9 (F(1,211) = 14.348, p<.05), and GAD7 (F(1,214) = 12.142, p<.05) after the intervention. Although no interaction effect has been identified for IgE, a significant correlation was found between IgE and POEM (r=0.2689, p<.05).

This research has adopted a new parameter (IgE) as a clinical outcome in illuminating the efficacy of a non-pharmaceutical intervention for families. The psychosocial intervention based on IBMS also presents a theoretical framework and practice guideline for the social work clinical research studies and community health program development for childhood eczema. The parent-child dyads intervention programme also identified a theory-based and evidence-based psychosocial therapeutic direction in addition to the conventional pharmacological approaches on childhood eczema.