This is the first study utilising a validated measure of stress to report on the magnitude of stress experienced by mothers of young children (5 years old or less) with eczema and to correlate the stress with the severity of the eczema. The results of this study indicate that the mothers of children attending hospital‐based clinics experience significant stress, with 46% having a total stress score stress at a level where it is considered professional consultation is indicated. There was a significant association between maternal stress and severity of eczema, with mothers of children with more severe eczema reporting higher levels of stress. Approximately 20% of the variance in maternal stress scores could be predicted from the variability in eczema severity. In a recent study, Walker et al
utilised the PSI to examine parental stress in asthma and eczema in a group of older children (7–12 years old).23
They did not find increased parental stress levels in either asthma or eczema. However, they pointed out that the eczema sample tended towards less pronounced severity and visibility and highlighted the need for studies in more severe cases. Other studies have found that increasing severity of childhood eczema is associated with greater negative impact upon the family and poorer quality of life.11,12,13,24
Child characteristics that contributed to parental stress were the demands and the direct pressures that were placed upon the mother by the child. Most mothers rated their child as being very demanding (67%). Children were also rated as being inadaptable (56%), that is, unable to adjust to changes in the physical or social environment. Daud et al
found that children with eczema were less adaptable and clingier, and that many had a fear of strangers.10
It is possible that associated conditions such as asthma or food allergies might also contribute to maternal stress as these conditions commonly coexist with eczema. However, Walker et al
found that mothers of children with asthma and eczema did not have significantly different stress levels to those with either condition alone,23
and in the present study total stress scores were similar in children with or without asthma.
A lack of emotional and physical support from spouses contributed to elevated maternal stress. We found 27% of mothers had elevated scores for competency and spouse. Elevated levels of incompetency, coupled with spousal relationship difficulties, suggest a “lack of acceptance and criticism from the child's other parent”.8
Previous studies also found that mothers considered the child's eczema had a detrimental effect on their marriage.10,13
In this study, 46% of mothers also reported feeling incompetent as a parent concerning the management of their child's behaviour. Other studies have also found that parents feel helplessness and experience disciplinary difficulties with their child.10
Mothers with poor spouse support may benefit from educational classes and discussion groups, from which they can learn management techniques and simultaneously experience the emotional support of the group.
Relative to other chronic conditions, mothers of children with eczema reported higher levels of parent domain stress than parents of children with IDDM,18
or recurrent otitis media,25
and experienced similar levels to parents of children on home enteral feeding.21
This group of children comprises a severely disabled population with multiple disabilities including cerebral palsy, developmental delay, failure to thrive, facial structure defects, congenital heart defects and genetic syndromes, with a mean duration of enteral feeding of 48 months.21
Parental stress levels were also of a similar order to those experienced by parents of children with Rett syndrome, a genetic disorder with profound mental retardation, spasticity, seizures, autistic behaviours and sleep disturbance.22
These findings indicate that moderate and severe forms of eczema should be regarded as a disorder which induces high levels of stress in the carers rather than as a trivial and temporary cutaneous disease.
Functional family interactions and social networks have been found to favourably influence the course of atopic disease.26
Depression and mental distress is common in parents of children with eczema.5,10,12
In this study, 24% of mothers had elevated scores for depression. Holm et al
recently reported a significant correlation between maternal depression and parental‐reported eczema severity.27
There is a mutual influence between maternal and child functioning, with maternal depression increasing the risk of adjustment problems in the child.28
A recent study found that parental psychological adjustment, the family impact of eczema and a non‐supportive family environment were predictive of the child's adjustment difficulties.29
Cognitive re‐appraisal of stressful events and supportive social networks may lessen the effects of stress.30,31
What is already known on this topic
- The quality of life of families with children with eczema is poorer than that of families with healthy children.
- The care of a child with moderate or severe eczema has a significantly greater impact on family functioning than the care of children with insulin‐dependent diabetes.
What this study adds
- Stress levels in mothers caring for young children with moderate to severe atopic dermatitis are equivalent to those seen in mothers of children with severe disabilities such as Rett syndrome and children requiring home enteral feeding.
- Maternal stress levels are related to the severity of the atopic dermatitis.
In this study, mothers were recruited from hospital‐based clinics and wards where the more severe cases of eczema are more prevalent. Although the median EASI score of the hospital in‐patients was higher than that of the out‐patients, the difference was not significant; however, it is possible that a significant difference would be observed with larger numbers of subjects. We found a positive correlation between the EASI score and maternal stress. A correlation between a self‐administered form of the EASI score and an eczema family impact scale has also been observed.2
Overall, the median EASI and IGA scores corresponded to moderate eczema. It is possible that comparable findings would apply to cases of eczema of similar severity managed in the community as the stress levels were significantly related to the severity of the dermatitis. Whether or not our results can be extrapolated to cases of similar severity in the community, our findings that almost half (46%) of our hospital‐recruited cases were associated with maternal stress levels for which professional help is recommended, and that maternal stress is related to the eczema severity, highlight the necessity of clinicians caring for such cases to be aware of this issue. Previous studies found that the impact on family score which assessed financial burden, familial/social impact, personal strain and mastery6
and the quality of family life11
was also related to the severity of the dermatitis. As eczema is a common condition, the impact of this disease, when considered on a community basis, is likely to be substantial. Further research is necessary to identify factors that might alleviate this stress.