Unravelling the Bidirectional Associations between Parent and Child Stress, Quality of Life and Perceived Relationships in Coping with Atopic Dermatitis: An APIM Approach

Atopic dermatitis (AD) is a prevalent chronic and episodic skin condition affecting approximately 20% of children globally. Specifically, AD ranks as the second most prevalent allergic condition in Hong Kong, impacting around 160,000 children. While AD is not life-threatening, its burdensome manifestations and persistent itch-scratch cycle have far-reaching implications beyond affected children, impacting their parent-caregivers. However, there remains a notable knowledge gap regarding the reciprocal influence, particularly in the context of childhood AD, where child stress may affect parent-caregivers. Drawing upon the principles of family systems theory, this study aims to investigate the reciprocal influence between children with AD and their parent-caregivers, focusing on perceived stress, health-related quality of life (HQoL) and perceived parent-child relationships among a dyadic Chinese Hong Kong sample. The Actor-Partner Interdependence Model (APIM) was employed to examine these dynamics.

Upon obtaining informed consent, 186 dyads of participants completed a battery of self-reported questionnaires. Perceived stress level were measured using the Perceived Stress Level Scale (α=.89). HQoL was measured using the Family Dermatology Life Quality Index (FDLQI:α=.91; CDLQI:α=.85). Perceived parent-child relationships were measured with the 10-item Personal Relationship subscale of the Chinese version Parent-Child Relationship Questionnaire (α ranging between .68 to .88). Descriptive statistics and preliminary data analyses were conducted using SPSS (v26). The APIM models were implemented with the lavaan package in R, through the APIM_SEM web application framework. Missing data were addressed using maximum likelihood estimation, with significance levels set at α=0.05.

This cross-sectional research study recruited 186 dyads of parent-caregivers (M_age=41.84, SD_age=5.20) and children with AD aged 6-12 (M_age=8.26, SD_age=1.85) across various districts in Hong Kong. Our finding implied that improved HQoL in parent-caregivers corresponded to improved HQoL in children, and vice versa (r=.34; p<.001). Stronger parent-child relationships were associated with more favourable perceptions from both children and parent-caregivers (r=.33; p<.001). Heighten levels of parental perceived stress had adverse effects on how children perceived the influence of AD on their daily lives (β=.14; p<.05, 95% CI [0.02,0.26]); similarly, heighten levels of child perceived stress negatively impacted parents’ assessment of perceived relationship with their child (β=-.17; p<.05, 95% CI[-0.31,-0.03]). However, contrary to our initial expectations, the perceived stress reported by children did not emerge as a significant predictor of parents’ perceived HQoL (β=.07, p=.371, 95%CI[-0.08,0.22]). Similarly, the perceived stress reported by parents did not emerge as a significant predictor of children’s perceptions regarding their relationship with their parents (β=.07, p=.371, 95%CI[-0.08,0.22]). We attempted to provide explanations for these surprising findings.

Our APIM models yielded promising findings, highlighting the reciprocal influence between children with AD and their parent-caregivers. Our findings further indicated that the child’s focus primarily revolve around the self, whereas parents’ attention is more directed towards the dynamic level, specifically the family relationships. These implications call for a paradigm shift in understanding and managing AD, emphasising the need for integrating clinical interventions rooted in a family-centred approach with rigorous research endeavours, healthcare professionals and researchers can make substantial contributions towards improving outcomes and enhancing the overall well-being of families navigating the challenges of AD.