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Annotated Abstracts of Journal Articles
2014, 1st Quarter

Pediatric Psychosomatic Medicine

Annotations by Audrey Walker, MD, FAPM
March 2014

PUBLICATION #1 — Pediatric Psychosomatic Medicine
The contribution of neurocognitive functioning to quality of life after childhood acute lymphoblastic leukemia

Kunin-Batson A, Kadan-Lottick N, Neglia JP
Psychooncology 2014 Feb 4 [Epub ahead of print]

ANNOTATION (Audrey Walker)

The Finding: In this multi-site, cross-sectional study, 263 ALL survivors between the ages of 7-17 at the time of evaluation who did not receive cranial irradiation received a comprehensive neuropsychological assessment and completed the Pediatric Quality of Life Inventory. The study found that survivors of ALL in childhood and adolescence who have neurocognitive defects are at risk for poor quality of life.

Strengths and Weaknesses: This was a large study, composed of 263 subjects. However, the race/ethnicity composition showed a preponderance (81%) of white/non-Hispanic subjects, resulting in an under-representation of racial minority patients. In this study, ALL survivors from lower income households had lower QOL scores, highlighting the fact that stressors related to lower income may contribute to the association between ALL diagnosis/treatment and subsequent poor QOL. The cross-sectional design limited the ability to discern the effect that treatment of ALL has on QOL over time, an important issue in developing children.

Relevance: Due to recent, dramatically improved treatment, Acute Lymphoblastic Leukemia in children and adolescents now has survival rates exceeding 85%. This study finds that survivors of ALL in childhood and adolescence who have neurocognitive defects are at risk for poor quality of life, with important and broad implications for their physical, social, and academic functioning. Surveillance for neurocognitive difficulties in these survivors is necessary to aid in early detection and provision of support services.


Background: Neurocognitive late effects after childhood acute lymphoblastic leukemia (ALL) are well-documented, but their impact on quality of life (QOL) is not well understood. In this multi-site study, we examined the relative influence of neurocognitive functioning, steroid randomization (prednisone vs. dexamethasone), and demographic characteristics on QOL in first-remission survivors of childhood ALL.

Methods: Participants included 263 ALL survivors (ages 7-17 years at the time of evaluation; mean age at diagnosis 3.9 years) who were treated on similar legacy Children's Cancer Group chemotherapy protocols and did not receive cranial radiation. Children completed detailed neuropsychological performance tests. The Pediatric QOL Inventory was completed by children and their parents. Participants were a mean of 9 years from diagnosis at the time of assessment (with a range of 4 to 13 years).

Results: Children and their parents reported lower mean child psychosocial QOL than healthy population norms (p<0.05), but were not in the impaired range. Physical QOL was similar to population norms. Though neurocognitive difficulties were predominantly mild for the sample as a whole, neurocognitive deficits, specifically problems in verbal cognitive abilities and visual-motor integration skills, were significantly associated with poor physical (p<0.01) and Psychosocial QOL (p<0.01). QOL was not associated with previous steroid randomization.

Conclusions: ALL survivors with neurocognitive deficits are at risk for poor QOL, with broad implications for their physical, social, and school functioning.


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PUBLICATION #2 — Pediatric Psychosomatic Medicine
Vitamin D and depressive symptoms in children with cystic fibrosis

Smith BA, Cogswell A, Garcia G
Psychosomatics 2014 Jan-Feb; 55(1):76-81

ANNOTATION (Audrey Walker)

The Finding: In this cross-sectional pilot study, a cohort of 38 children and adolescents ages 7-17 with CF were tested for depressive symptoms and serum 25(OH)D concentration as a measure of vitamin D serum levels. 59% of patients had insufficient vitamin D levels; 28% of patients had significant levels of depressive symptomotology based on the Children’s Depression Inventory (CDI). Serum 25(OH)D was negatively associated with CDI scores and the subgroup with insufficient 25(OH)D levels indicated more depressive symptoms.

Strengths and Weaknesses: This is a small pilot study, comprising 38 subjects. The percent of patients with insufficient 25(OH)D concentrations, 59%, is significantly lower than previous studies which have found insufficiencies in up to 90% of their CF samples.

Relevance: A growing literature is demonstrating a link between insufficient vitamin D levels and depressive symptoms. Children and adolescents with CF are particularly vulnerable to insufficiencies in vitamin D levels. This is the first study which demonstrates the rationale for attending to vitamin D levels in children and adolescents with CF as a means of prevention and treatment of depressive disorders in this population.


Background: Vitamin D deficiency has been hypothesized to play a role in the development of depression. Hypovitaminosis D is almost universal in patients with cystic fibrosis (CF). No studies to date have explored associations between serum concentrations of 25-hydroxyvitamin D (25(OH)D), a standard measure of vitamin D, and depression in patients with CF.

Objective: This pilot study aimed to explore the relationship between 25(OH)D and the presence of depressive symptoms among youth with CF.

Methods: A cross-sectional study was conducted at an ambulatory Cystic Fibrosis Center clinic. Serum 25(OH)D and Children's Depression Inventory (CDI) scores were analyzed from 38 youths with CF ages 7-17 years. Child depressive symptoms were measured using the CDI, with scores above 12 indicating a significant level of depressive symptoms. Serum 25(OH)D concentration were measured using the liaison 25 OH vitamin D assay. Insufficient vitamin D status was defined as a circulating 25(OH)D concentration less than 30 ng/mL.

Results: Insufficient vitamin D levels were found in 59% of patients; 28% of patients had significant levels of depressive symptoms on the CDI (scores >12). Serum 25(OH)D was negatively associated with CDI scores (r = -0.55; p < 0.001), and the group of patients with insufficient 25(OH)D levels indeed reported significantly more depressive symptoms (t = 4.26; p < 0.001).

Conclusions: 25(OH)D insufficiency was associated with depressive symptoms in this cohort of youth with CF. Future rigorous studies investigating vitamin D and depression in CF are warranted with larger sample sizes using confirmatory methods to diagnose depressive disorders.

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