Impact of psychosocial intervention for pediatric atopic dermatitis on immunological response and well-being : a randomized control trial of the parent-child dyad

Abstract

Background: This study aimed at investigating the effectiveness of Integrated Body Mind Spirit (IBMS) approach which is based on Eastern philosophies with various therapeutic techniques, on primary school-aged children with atopic dermatitis (AD) and their parents in Hong Kong. Children with AD reported various mood issues and developmental problems, while their parents reported that AD diminished the family’s quality of life (QoL). Despite extant literature on the effectiveness of parent- focused interventions on alleviating symptoms of children with AD, little is known about whether a more holistic approach, which offers body-mind-spirit support to the parent-child dyad, would (a) alter the immunological response of the child; (b) improve the general well-being of both parent and child. Methods: A randomized controlled study, in which data were collected before and after the 6-week 3-hour IBMS intervention in parents-and-children groups, was conducted. One hundred and fifty pairs of children (aged 6-11) with AD and their parents were recruited. Self-administrated questionnaires were used by children and their parents to assess their stress, anxiety, depressive mood, holistic well-being, family functioning and quality of life. Moreover, children’s AD severity was assessed by dermatologists, while biomarkers including blood immunoglobulin E (IgE), interleukins (IL-1beta, IL-4, IL-6 &, IL-10), and transforming growth factor (TGF- beta 1) were measured in the blood samples of children with AD. The effectiveness of the intervention was evaluated by comparing before and after intervention and between the intervention and the waitlist control group. Key Findings: AD severity was broadly associated with many aspects of the QoL of the child, including physical, psychological, social and functional well-being, and it also impacted family-related QoL. IgE level positively correlated with AD severity, while IL-4 and IL-6 serum levels in the child were negatively correlated with their QoL, specifically personal relationship (with IL-4) and sleep (IL-6). Interestingly, IL- 6 was also negatively correlated with the parent’s afflictive emotion. The IBMS intervention was found to be effective in reducing parents’ perceived stress, depression, anxiety, and afflictive sensation, as well as the family well-being. The intervention also improved leisure-related QoL measure of children with AD. In addition, baseline AD severity level moderated the intervention effect on AD severity and IL-6 level, such that the intervention effect was greater for both children with less severe AD. Changes in AD severity were accompanied by corresponding changes in the child’s and family’s QoL, and self-report parent anxiety. Finally, after the intervention, AD severity was correlated less strongly with parental anxiety and depression in IBMS group participants compared to waitlist control. Implications: AD is a multi-factorial disease highly related to the interplay of physical and psychological factors. A holistic intervention for children with AD would be able to address the parent-child dyad’s mind-body connection, which further addresses the family’s needs. The result provided groundbreaking insight into the mind-body connection and the interpersonal processes among parent-child dyads.