The longitudinal impact of parent distress and behavior on psychological and functional disability outcomes among youth with chronic pain
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OBJECTIVE: To examine how parent factors assessed at a multidisciplinary pain clinic evaluation predict child psychological and functional outcomes at four-month follow-up. After controlling for child baseline functioning, we predicted that parent distress and behavior would significantly predict child pain-related psychological and functional outcomes. METHODS: Among the 321 patients with chronic pain (ages 8-17) and their parents who presented for a multidisciplinary evaluation, 195 completed measures at baseline and at four-month follow-up via REDCap surveys. Patients completed measures of pain catastrophizing, pain-related fear and avoidance, generalized anxiety, depressive symptoms, functional disability, and somatic symptoms. Parents completed measures of pain catastrophizing, pain-related fear and avoidance, protective responses to pain, and child school functioning. Associations between parent and child distress and behavior were examined cross-sectionally at the time of the pain clinic evaluation, and longitudinally (i.e., parent at evaluation and child at follow-up). Lastly, using step-wise hierarchical regression analyses, we controlled for child baseline measures and examined the degree to which parent distress and behaviors predicted child outcomes at four-month follow-up. RESULTS: As hypothesized, parent distress and behavior was correlated with child distress and functioning at the time of evaluation with many of these associations persisting at four-month follow-up. For the regression analyses, after controlling for baseline child depressive symptoms, parent avoidance of activities (b = .24, p < .01) and parent helplessness (b = -.14, p < .10) reported at baseline significantly predicted child depressive symptoms at four-month follow-up. After controlling for baseline child pain catastrophizing, only parent pain-related fear reported at baseline (b = .15, p < .05) emerged as a significant predictor of child pain catastrophizing at four-month follow-up. Lastly after controlling for child school functioning at baseline, parent avoidance of activities (b = -.27, p < .01) and parent protective behavior (b = -.18, p < .05) reported at baseline emerged as significant predictors of child school functioning at four-month follow-up. Parent distress and behavior did not significantly predict child anxiety, pain-related fear, avoidance of activities, somatic symptoms, or functional disability at follow-up, after controlling for baseline functioning. CONCLUSIONS: Across parent factors, parent helplessness, avoidance of activities, pain-related fear, and protective behavior emerged as predictors of child outcomes four months after a multidisciplinary pain clinic evaluation. The results from this study provide initial data regarding the influence of parent emotions and behavior on child function over time. In addition, the results suggest potential targets for pain treatment interventions that go beyond the typical focus on child emotions and behaviors to include influential parent factors.