Relationship between quality of life and behavioural disorders in children with persistent asthma: a Multiple Indicators Multiple Causes (MIMIC) model

Laura Montalbano, Giuliana Ferrante, Silvia Montella, Giovanna Cilluffo, Antonio Di Marco, Sara Bozzetto, Emanuela Di Palmo, Amelia Licari, Lucia Leonardi, Valeria Caldarelli, Michele Ghezzi, Stefania La Grutta, Franca Rusconi, Italian Pediatric Severe Asthma Network (IPSAN) Program of Italian Paediatric Respiratory Society (IPRS), S Amarri, S Barni, A Capizzi, F Cardinale, S Carraro, S Cazzato, R Cutrera, S Di Pillo, M Duse, G Fenu, A Kantar, S Leonardi, E Lombardi, G L Marseglia, L Nosetti, E Novembre, M F Patria, G Piacentini, G Pisi, G Ricci, O Sacco, F Santamaria, L Tenero, M A Tosca, M C Tripodi, A Volpini, Laura Montalbano, Giuliana Ferrante, Silvia Montella, Giovanna Cilluffo, Antonio Di Marco, Sara Bozzetto, Emanuela Di Palmo, Amelia Licari, Lucia Leonardi, Valeria Caldarelli, Michele Ghezzi, Stefania La Grutta, Franca Rusconi, Italian Pediatric Severe Asthma Network (IPSAN) Program of Italian Paediatric Respiratory Society (IPRS), S Amarri, S Barni, A Capizzi, F Cardinale, S Carraro, S Cazzato, R Cutrera, S Di Pillo, M Duse, G Fenu, A Kantar, S Leonardi, E Lombardi, G L Marseglia, L Nosetti, E Novembre, M F Patria, G Piacentini, G Pisi, G Ricci, O Sacco, F Santamaria, L Tenero, M A Tosca, M C Tripodi, A Volpini

Abstract

Knowledge on multiple interdependences between quality of life (QoL) and behavioural problems in relation to asthma severity and control is undetermined. The aims of the study were: (i) to assess the relationship of QoL and behavioural problems with asthma severity and control (ii) to predict children's "abnormal/borderline" status with variation in QoL. For these purposes a multicenter case-control study on 47 Severe Asthma (SA) and 94 Moderate Asthma (MA) children was performed. The MIMIC approach was applied to investigate the effect of SA and non-controlled asthma (NC) on QoL and behavioural disorders. Logistic regression was used to estimate probabilities of having an "abnormal/borderline" status with variation in QoL. The MIMIC model showed that the magnitude of the effect of SA and NC was larger on QoL (β = -0.37 and β = -0.30, respectively) than on behavioural problems (β = 0.27). With regards to the probability of having a borderline status, in MA a QoL of 1 returned a probability of 0.81, whereas in SA a QoL of 1 returned a probability of 0.89. In conclusion, SA children are highly affected by impaired QoL and behavioural problems. The MIMIC model allowed us to obtain a comprehensive assessment of QoL and behavioural problems with asthma severity and control.

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Multiple Indicator Multiple Causes (MIMIC) model showing the impact of background variables on the two factors.
Figure 2
Figure 2
Estimated probabilities from logistic regression model of having a “borderline” SDQ total score (between 14 and 16) with variation in QoL in SA (black curve) and in MA (grey curve).

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