Current tools measuring anxiety in parents of food‐allergic children are inadequate

Abstract

Background In the context of food allergy, excessive parental anxiety can be maladaptive and lead to unnecessary restriction of social activities. No validated tool exists to measure food allergy–associated anxiety (FAAA). This study sought to explore factors associated with parental FAAA, determine sensitivity and specificity of using generic state anxiety measure—State‐Trait Anxiety Inventory (STAI) versus FAAA, and determine whether validated tools for generalized anxiety or food allergy–specific quality of life (QoL) could be used as surrogates for FAAA. Methods Canadian parents of food‐allergic children completed an online survey. Without a validated tool for FAAA, a visual analogue scale was used to assess parent‐reported FAAA. Multivariable linear regression was performed with FAAA as the outcome. Sensitivity and specificity analysis of state anxiety vs. FAAA, and factor analysis of state anxiety and QOL, was performed to determine whether these could be used as surrogates for FAAA. Results A total of 548 of 1244 parents (44.1%) completed the survey. Factors positively associated with FAAA included parental burden, risk perception, state anxiety, intolerance of uncertainty and perceived severity of child's food allergy; personal/family history of mental health was negatively associated. Sensitivity and specificity of state anxiety were 68.6% and 70.0%. Factor analysis revealed that state anxiety and QOL were correlated (r = 0.54, P < .001) but distinct constructs. Conclusion Our study identified factors associated with FAAA, and determined that generic anxiety and QOL tools do not accurately categorize parents with self‐reported high FAAA. Future research will develop a validated screening tool to help allergists identify anxious parents and provide psychosocial resources.

Food‐allergy‐specific anxiety and distress in parents of children with food allergy: A systematic review

“…The affective and somatic attributes of FAA are similar to those for defined anxiety disorders and general anxiety symptoms, but specific cognitive and behavioral dimensions are not captured by instruments that have been used to date in studies of families of children with FA. Our group has recently demonstrated that currently available general measures of anxiety (such as the STAI), and FA‐specific HRQOL (such as the FAQL‐PB), while frequently used in FA research, do not adequately identify parents who are highly anxious specifically about their child's FA 61 . Capturing of specific FAA dimensions is more likely to aid in the development and monitoring of targeted treatment approaches compared with the global self‐report of FAA used in that study 61 .…”

“…Personal/family history of mental health problems negatively associated with FA-associated anxiety (VAS scale) 61 Self-efficacy Positive Self-efficacy in FA management (FASE-P) correlated with GHQ-12 (overall mental health), and parental burden (FAQL-PB) 106 ; poorer self-efficacy (FASEQ-P) associated with increased parental burden (FAQL-PB) 99,100 bias across studies. This limits the strength and generalizability of conclusions drawn regarding correlates of FAA and effects of interventions, although despite these limitations we have been able…”

“…Reduced parental burden (FAQL-PB) 94 ; reduced maternal anxiety dependent on whether or not the child passed the food challenge (BAI, 91 STAI-S 50 ) None Reduced parental burden following OFC regardless of outcome (FAQL-PB); anxiety and stress scores did not change significantly (PSS, STAI) 101,102 Food allergy severity Positive Greater maternal psychological stress (study-specific questionnaire) 103 ; FA-associated anxiety (VAS scale) 61 History of hospital visit Positive Greater parental burden in parents of children who attended the Emergency Department for FA in the past year (FAQL-PB) 40 Negative Parents whose children had not been to hospital with a FA reported higher anxiety and depression levels compared to those who had been to hospital (HADS) 84 Milk or egg allergy Positive Milk allergy reported as causing the most burden and anxiety (FAQLQ-PF, adapted) 104 ; milk or egg (vs. other allergies including peanut and tree nut) associated with higher parental burden (FAQL-PB). 99,100 Mothers reported more sadness/anxiety (FAQL-PB) in children with milk or egg allergy compared to other FA 56 Comorbid atopic disease Positive History of poorly controlled asthma associated with increased maternal state anxiety (STAI-S) 86 ; lower QOL reported by parents of children with comorbid atopic dermatitis 102…”

“…. FAA was also a separate construct from state anxiety as measured by the STAI 61. Moreover, diagnosed anxiety disorders were not necessarily present at elevated rates in parents of children with FA compared to other populations 62 (Table2), nor did FA-specific worries scores on the Food Allergy Management and…”

Improving asthma care in preschool children

“…The third study highlighted here relates to food allergy by evaluating current tools to address parental anxiety in families with children suffering from food allergies. Lianne Soller et al 16 started from the postulate that excessive parental anxiety can be maladaptive and lead to unnecessary restriction of social activities. They explored factors associated with parental food allergy–associated anxiety (FAAA) and determined sensitivity and specificity by using generic state anxiety measures—State‐Trait Anxiety Inventory (STAI) versus FAAA.…”