Impact of enuresis nocturna on health-related quality of life in children and their mothers
Introduction
Nocturnal enuresis (NE) is a frequently encountered disorder in the clinical practice of child psychiatry, and is thought to substantially influence the lives of the affected children and their families. Primary NE is defined as: unintentional bedwetting for at least two nights in a week, in three successive months, in children who are five years of age or are developmentally five years old. Secondary nocturnal enuresis (SNE) is bedwetting that develops after at least six months of consistent dryness [1], [2]. The etiology is likely to be multifactorial [3]. Studies have reported that the prevalence of NE in children at five years of age is 20%; this decreases by 15% for each year of age, and drops to 6% in children of 11 years old [4], [5]. However, researchers have found that family expectations regarding taking responsibility and self-control skills increase as the child grows older, and this situation increases the stress on the child [6]. It is thought that increased stress with age leads to unfavorable outcomes for the child's self-image and social development [7]. Moreover, studies have shown that parents might also feel under pressure, may question their parental skills and are at risk in terms of psychiatric problems due to disappointment [8]. Butler believed that additional washing, ridding the room of the smell, setting up alarm clocks and waking up several times during the night may lead the caregiver to feel angry and hostile toward the child and may cause punitive behaviors. The activities of extra waking up and additional washing have negative effects on the caregiver's quality of life (QoL) [9].
Since the second half of the 20th century, a new parameter: health-related quality of life (HRQoL), has arisen in health-related evaluations, along with the observation that individuals with similar clinical characteristics have a distinct perception of satisfaction with their lives and about disease-related wellbeing. Although QoL is generally summarized as how an individual perceives his or her status, within the context of cultural characteristics and values, HRQoL is defined as an individual's perception of the impact of a disease and/or treatment. HRQoL investigates the aspects of QoL influenced by diseases [10], [11].
Only a few studies on NE have examined children's and parents' QoL together, and the results show that both QoL are negatively affected [12]. In the present study, the aim was to assess the QoL of children who had been diagnosed with NE, and their mothers. It was hypothesized that NE has negative effects on the Qol of both the children and their mothers.
Section snippets
Materials and methods
This case control study included 87 children between the ages of 8 and 12 years who had been diagnosed with NE, and their mothers, and who presented to the Bakırköy Prof. Dr. Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery Child and Adolescent Psychiatry outpatient clinic between January 2012 and June 2013.
The children had to meet the DSM-IV-TR diagnostic criteria for NE, which was confirmed with a clinical interview, and should have had no other chronic
Results
The mean age ± standard deviation (SD) of the sample was 9.63 ± 1.31 years, which consisted of 49 (59.8%) boys and 33 (40.2%) girls. The mean age of the control group was 9.54 ± 1.23 years, and 51 (54.8%) of the children in the control group were boys. No significant differences were found between the patients and the control group in terms of age, gender and maternal education. The mean age ±SD at the completion of toilet training was 27.84 ± 11.16 months in the NE group and 25.56 ± 7.28
Discussion
The results of the present study suggest that NE negatively affects the QoL of children with NE, and their mothers. There are limited number of papers on NE and QoL. In Japan, Natioh et al. conducted a study with 139 children with NE, and their mothers, and found that compared to the control group, the perceived QoL in the children with NE was significantly lower only in the family subscale [18]. In the present study, the QoL scores of the children with NE were lower in all QoL aspects. There
Conflict of interest
None declared.
Role of funding source
None sought.
References (27)
- et al.
The standardization of terminology of lower urinary tract function in children and adolescents: report from the Standardisation Committee of the International Children's Continence Society
J Urol
(2006) - et al.
Attaining nocturnal urinary control, nocturnal enuresis, and behavioral problems in Chinese children aged 6 through 16 years
J Am Acad Child Adolesc Psychiatry
(2000) - et al.
Maternal attributions and tolerance for nocturnal enuresis
Behav Res Ther
(1986) - et al.
Self-image and performance in children with nocturnal enuresis
Eur Urol
(2002) Childhood nocturnal enuresis: developing a conceptual framework
Clin Psychol Rev
(2004)- et al.
The linkage between pediatric quality of life and health conditions: establishing clinically meaningful cut off scores for the PedsQL
Value Health
(2009) - et al.
Health related quality of life for monosymptomatic enuretic children and their mothers
J Urol
(2012) - et al.
Factors influencing quality of life in children with urinary incontinence
J Urol
(2011) - et al.
Quality of life and self-esteem for children with urinary urge incontinence and voiding postponement
J Urol
(2009) Diagnostic and statistical manual of mental disorders
(1994)
Nocturnal enuresis
Br J Urol
Bedwetting in US children: epidemiology and related behavior problems
Pediatrics
The burden of nocturnal enuresis
Acta Paediatr
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2017, Journal of Pediatric UrologyEditorial comment: “Psychiatric dimensions in mothers of children with primary nocturnal enuresis: A controlled study”
2017, Journal of Pediatric Urology