Marija Ljubičić

Ime i prezime: dr. sc. MARIJA LJUBIČIĆ, dr. med.
 
Naslov disertacije: „STRES I KVALITETA ŽIVOTA RODITELJA DJECE S TEŠKOĆAMA U RAZVOJU I DIJABETESOM TIPA 1“
 
Mentor: izv. prof. dr. sc. IVANA KOLČIĆ
 
Datum obrane: 12. ožujka 2021.
 
Poveznica: https://library.foi.hr/lib/knjiga.php?B=419&H=&E=&V=&lok=&zbi=&item=3545&nivo=&upit=ljubi%E8i%E6%20marija


Kvalifikacijski znanstveni radovi za doktorsku disertaciju:


Ljubicic M, Bakovic L, Coza M, Pribisalic A, Kolcic I. Awakening cortisol indicators, advanced glycation end products, stress perception, depression and anxiety in parents of children with chronic conditions. Psychoneuroendocrinology. 2020;117:104709.
 
Ljubicic M, Saric MM, Rumbak I, Baric IC, Komes D, Satalic Z, et al. Knowledge about dietary fibre and its health benefits: A cross-sectional survey of 2536 residents from across Croatia. Med Hypotheses. 2017;105:25-31. 
 
Ljubicic M, Saric MM, Baric IC, Rumbak I, Komes D, Satalić Z, et al. Consumer knowledge and attitudes toward healthy eating in Croatia: A cross-sectional study. Arh Hig Rada Toksikol. 2017;68:153-8.
 
 
SAŽETAK:
 
Cilj ove studije bio je ispitati razinu stresa i kvalitetu života u roditelja djece s teškoćama u razvoju, uključujući Down sindrom, poremećaje iz spektra autizma i cerebralnu paralizu te u roditelja djece s dijabetesom tipa 1, u usporedbi s roditeljima zdrave djece. Dodatno, cilj nam je bio ispitati povezanost roditeljskog stresa, koncentracije kortizola i uznapredovalih produkata glikacije (engl. advanced glycation end-products; AGEs) s anksioznošću i depresivnom simptomatologijom roditelja.
Provedeno je presječno istraživanje u razdoblju od ožujka 2018. do ožujka 2019. godine, pri čemu je uključeno 244 roditelja djece u dobi od 4 do 12 godina, s područja Zadarske županije. Prikupljeni su socio-demografski i anamnestički podaci, a roditelji su ispunili upitnik kojim su ispitane životne navike, samopoštovanje, percepcija izazovnog ponašanja djeteta, depresivnost, anksioznost te razina općeg i roditeljskog stresa, otpornost na stres, kao i kvaliteta života. Dodatno, roditeljima smo izmjerili antropometrijske pokazatelje, krvni tlak, puls i AGEs, koje smo smatrali indikatorom oksidativnog stresa, korištenjem neinvazivnog uređaja AGE Mu Reader (DiagnOptics, Groningen, Nizozemska). Konačno, koncentracija kortizola je izmjerena u pet zasebnih uzoraka sline tijekom jednog radnog dana korištenjem Salivetta (Sarstedt, Nümbrecht, Germany). Roditelji su prikupili prvi uzorak sline prije odlaska na spavanje (oko 22:00), a preostale uzorke sutradan ujutro nakon buđenja (u 0., 15., 30. i 60. minuti nakon buđenja). Temeljem pojedinačnih koncentracija kortizola izračunati su izvedeni parametri koji opisuju odgovor kortizola na buđenje (engl. cortisol awakening response; CAR), poput površine ispod krivulje u odnosu na početnu vrijednost (engl. area under the curve with respect to the ground; AUCG) i površine ispod krivulje u odnosu na trenutak porasta kortizola (engl. area under the curve with respect to the increase; AUCI).
U analizi podataka korišteni su hi-kvadrat test, ANOVA test ili Kruskal-Wallisov test, ovisno o razdiobi podataka, Pearsonov test korelacije ili Spermanov test te multivarijatna linearna regresija.
Korištenjem modela multivarijatne linearne regresije dobivena je povezanost između roditeljstva djeteta s kroničnim stanjem i AUCI. U usporedbi s roditeljima zdrave djece, roditelji djece s dijabetesom tipa 1 imali su veću vjerojatnost za niži AUCI (ß=-0,25; P=0,028), isto kao i roditelji djece s Down sindromom (ß=-0,24; P=0,040), dok su roditelji djece s poremećajem iz spektra autizma imali granično neznačajan rezultat (ß=-0,21; P=0,081). Za razliku od AUCI, AUCG je bio statistički značajno povezan s anksioznošću (ß=0,21; P=0,004) i depresijom (ß=0,16; P=0,034) te granično neznačajno s općim stresom (ß=0,13; P=0,088). Percipirani opći stres bio je povezan s depresivnom simptomatologijom (ß=0,56; P<0,001) i anksioznošću (ß=0,64; P<0,001), dok je roditeljski stres bio povezan s općim stresom (ß=0,22; P=0,015). Roditelji djece sa dijabetesom tipa 1 imali su izraženije depresivne simptome nego roditelji kontrolne skupine (ß=0,18; P=0,039), dok su roditelji djece s cerebralnom paralizom imali granično neznačajno veću prisutnost depresivnih simptoma (ß=0,14; P=0,058). Akumulacija AGEs u koži ispitanika bila je povezana s dobi roditelja (ß=0,42; P<0,001) i s AUCG (ß=0,22; P=0,013).
Roditelji djece s Down sindromom i roditelji djece s poremećajem iz spektra autizma imali su veću vjerojatnost za narušenu obiteljsku kvalitetu života u gotovo u svim domenama u odnosu na kontrolnu skupinu. Roditelji djece s dijabetesom tipa 1 imali su veću vjerojatnost za narušenu percepciju roditeljstva (ß=-0,31; P=0,034), narušeno obiteljsko emocionalno blagostanje (ß=-0,27; P=0,046) te nižu ukupnu obiteljsku kvalitetu života (ß=-0,25; P=0,038). Pronađena je negativna povezanost između depresivnosti i domene roditeljstva (ß=-0,26; P=0,045), tjelesno-materijalne dobrobiti (ß=-0,31; P=0,012) i ukupne obiteljske kvalitete života (ß=-0,23; P=0,042). Percepcija sveukupne individualne kvalitete života bila je narušena u roditelja djece s poremećajem iz spektra autizma (ß=-0,16; P=0,024) i roditelja djece s cerebralnom paralizom (ß=-0,13; P=0,040). Roditelji djece s poremećajem iz spektra autizma imali su veću vjerojatnost za narušene socijalne odnose (ß=-0,19; P=0,026), a domena okruženja bila je negativno povezana s roditeljstvom djece s cerebralnom paralizom (ß=-0,16; P=0,010). Samopoštovanje je bilo povezano s psihološkom domenom individualne kvalitete života (ß=0,59; P<0,001), socijalnim odnosima (ß=0,42; P<0,001), domenom tjelesnog zdravlja (ß=0,27; P=0,001) i okruženja (ß=0,26; P=0,001), kao i s boljom obiteljskom interakcijom (ß=0,38; P<0,001), roditeljstvom (ß=0,23; P=0,013) i ukupnom obiteljskom kvalitetom života (ß=0,24; P=0,003). Opći stres je bio negativno povezan sa svim domenama obiteljske i individualne kvalitete života.
Rezultati ovog istraživanja pokazuju promijenjen odgovor kortizola na buđenje i narušenu kvalitetu života roditelja djece s kroničnim stanjima, što ih svrstava u populacijsku skupinu s povećanim rizikom za negativne zdravstvene posljedice. Ovi rezultati ujedno pružaju važne smjernice za buduća istraživanja, a ukazuju i na potrebu za pružanjem dodatne pomoći i podrške roditeljima koji skrbe za djecu s kroničnim zdravstvenim poteškoćama. Najvažnije, rezultati ovog istraživanja ističu potrebu za razvojem odgovarajuće intervencije za primjereno nošenje roditelja sa stresom, što bi se odrazilo i na usporavanje procesa starenja, kao i na prevenciju daljnjeg pogoršanja njihovog zdravlja i na smanjenje rizika za razvoj kroničnih bolesti, u čemu bi važnu ulogu mogle imati upravo medicinske sestre.
 
SUMMARY:
 
The aim of this study was to examine the level of stress and quality of life in parents of children with disabilities, including Down syndrome, autism spectrum disorders and cerebral palsy, and in parents of children diagnosed with type 1 diabetes, compared to parents of healthy children. In addition, we aimed to investigate the association between parental stress, cortisol concentrations, and advanced glycation end-products (AGEs) with parental anxiety and depressive symptomatology.
A cross-sectional study was conducted between March 2018 and March 2019, including 244 parents of children aged 4 to 12 years, from Zadar County, Croatia. Socio-demographic and anamnestic data were collected, and parents completed an extensive questionnaire used for estimation of lifestyle habits, self-esteem (Rosenberg Self-Esteem Scale), and parental perception of child’s challenging behavior (Child’s Challenging Behavior Scale). Additionally, we assessed depressive symptoms (Patient Health Questionnaire-9), anxiety (Generalised Anxiety Disorder-7), general stress (Perceived Stress Scale-10) and parental stress levels (Parental Stress Scale-18), stress resilience (Brief Resilience Scale), and quality of life (Beach Center Family Quality of Life Scale; World Health Organization Quality of Life scale - Brief version). Furthermore, we measured anthropometric parameters, blood pressure, pulse, and AGEs in parents, which we considered an indicator of oxidative stress, using a noninvasive AGE Mu Reader device (DiagnOptics, Groningen, The Netherlands). Finally, cortisol concentrations were measured in five separate saliva samples collected during one working day using Salivettes (Sarstedt, Nümbrecht, Germany). Parents collected the first sample of saliva before going to bed (around 22:00) and the remaining samples were provided the next morning after awakening (at 0, 15, 30 and 60 minutes after waking up). Based on individual cortisol concentrations, derived parameters describing the cortisol awakening response (CAR) were calculated, such as the area under the curve with respect to the ground (AUCG) and the area under the curve with respect to the increase (AUCI).
Chi-square test, ANOVA test or Kruskal-Wallis test, depending on the data distribution, Pearson's correlation test or Sperman's test, and multivariate linear regression were used in data analysis. Using a multivariate linear regression model, we showed an association between parenting a child with a chronic condition and AUCI. Compared to parents of healthy children, parents of children with type 1 diabetes were more likely to have lower AUCI (ß=-0.25; P=0.028), the same as parents of children with Down syndrome (ß=-0.24; P=0.040), while parents of children with autism spectrum disorder had a marginally insignificant result (ß=-0.21; P=0.081). In contrast to AUCI, AUCG was statistically significantly associated with anxiety (ß=0.21; P = 0.004) and depression (ß=0.16; P=0.034), and marginally insignificantly with general stress perception (ß=0.13; P=0.088). General psychological stress was associated with depressive symptoms (ß=0.56; P<0.001) and anxiety (ß=0.64; P<0.001), and parental stress was associated with general stress (ß=0.22; P=0.015). Parents of children with type 1 diabetes had more pronounced depressive symptoms compared to control group parents (ß=0.18; P=0.039), while parents of children with cerebral palsy had a marginally insignificantly higher depressive symptoms (ß=0.14; P=0.058). Accumulation of AGEs in the subjects' skin was associated with parental age (ß=0.42; P<0.001) and with AUCG (ß=0.22; P=0.013).
Parents of children with Down syndrome and parents of children with autism spectrum disorder were more likely to have impaired family quality of life in almost all domains compared to the control group. Parents of children with type 1 diabetes were more likely to have impaired parenting perceptions (ß=-0.31; P=0.034), impaired family emotional well-being (ß=-0.27; P=0.046), and lower overall family quality of life (ß=-0.25; P=0.038). A negative association was found between depression and the parenting domain (ß=-0.26; P=0.045), physical-material well- being (ß=-0.31; P=0.012), and overall family quality of life (ß=-0.23; P=0.042). Perception of the overall individual quality of life was impaired in parents of children with autism spectrum disorder (ß=−0.16; P=0.024) and in parents of children with cerebral palsy (ß=−0.13; P=0.040). Parents of children with autism spectrum disorder were more likely to have disturbed social relationships (ß=-0.19; P=0.026), while the environment domain was negatively associated with the parenting of children with cerebral palsy (ß=-0.16; P=0.010). Self-esteem was associated with the psychological domain of the individual quality of life (ß=0.59; P<0.001), social relationships (ß=0.42; P<0.001), the domain of physical health (ß=0.27; P=0.001), and environment (ß=0.26; P=0.001). Furthermore, self-esteem was associated with better family interaction (ß=0.38; P<0.001), parenting (ß=0.23; P=0.013) and overall family quality of life (ß=0.24; P=0.003).
General stress perception was negatively associated with all domains of family and individual quality of life.
The results of this study show that parents of children with chronic conditions had altered CAR and impaired quality of life, which puts them at increased risk for adverse health outcomes. These findings also provide important guidelines for future research, and point to the need for provision of additional help and support to parents caring for children with chronic health problems. Most importantly, the results of this study emphasize the need for developing suitable interventions for the appropriate coping with stress in these parents. This could result in slowing down of aging process, prevention of further health deterioration and ultimately in decreasing risks for development of chronic diseases in parents of children with chronic conditions. Nurses could have an important role in these interventions.
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