Abstract
Objective: Our study focused on assessing the anxiety levels of children and adolescents being monitored for hypertension (HTN), as well as the burnout levels experienced by their caregivers.
Material and Methods: The study included 67 patients, aged 12 and older, who were monitored for HTN as the study group, and 60 children and adolescents, matched for gender and age, without chronic illnesses, were selected from the pediatric outpatient clinic for routine check-ups to serve as the control group. The State Anxiety Inventory (STAI-1), Trait Anxiety Inventory (STAI-2), and Beck Anxiety Inventory (BAI) were applied to the children, while the Maslach Burnout Inventory (MBI) was applied to their parents.
Results: We found the mean STAI-1 scores of the study group lower than the control group (43.6±6.4 vs. 51.6±15.4; p <0.001). However, no difference was detected between these groups in terms of the STAI-2 scores (p= 0.140). The median BAI scores were higher in study group than control group (10.0 vs.6.5; p=0.010) but no significant difference have been found in terms of severity of anxiety (p=0.170). There was no difference in caregivers between the emotional exhaustion (MBI-EE) and personal accomplishment (MBI-PA) subscale scores of the MBI of the caregivers (p=0.280, p=0.340 respectively).
Conclusion: Our study revealed low anxiety levels among HTN patients and low burnout scores in their families. However, we believe that continuous psychiatric support for both patients and their families may be essential for managing chronic conditions, indicating the need for further research in this area regard.
Keywords: Anxiety, caregiver burden, children, hypertension
References
- Macumber IR., Flynn JT. Chapter 494 - Systemic Hypertension. Twenty Second Edition. Nelson Textbook of Pediatrics, 2-Volume Set. Elsevier Inc.;2025;2910-2920.e2.
- Falkner B, Daniels SR. Summary of the fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Hypertension. 2004;44(4):387-8. https://doi.org/10.1161/01.HYP.0000143545.54637.af
- Göknar N, Çalışkan S. New guidelines for the diagnosis, evaluation, and treatment of pediatric hypertension. Turk Pediatri Ars. 2020;55(1):11-22.
- Avner D, Harmon W, Niaudet P, Yoshikawa N, Emma F. Evaluation of Hypertension in Childhood Diseases in Pediatric Nephrology Awazu M. 2016;9:1997-2023. https://doi.org/10.1007/978-3-662-43596-0
- Thomas J, Stonebrook E, Kallash M. Pediatric hypertension: Review of the definition, diagnosis, and initial management. Int J Pediatr Adolesc Med. 2022;9(1):1-6. https://doi.org/10.1016/j.ijpam.2020.09.005
- Lurbe E, Álvarez J, Redon J. Diagnosis and treatment of hypertension in children. Curr Hypertens Rep. 2010 ;12(6):480-6. https://doi.org/10.1007/s11906-010-0155-x
- Ruan X, Zhu A, Wang T, et al. Global Prevalence of Hypertension in Children and Adolescents Younger Than 19 Years: A Systematic Review and Meta-Analysis. JAMA Pediatr. 2025;179(9):987-99. https://doi.org/10.1001/jamapediatrics.2025.2206
- Beesdo K, Knappe S, Pine DS. Anxiety and anxiety disorders in children and adolescents: developmental issues and implications for DSM-V. Psychiatr Clin North Am. 2009;32(3):483-524. https://doi.org/10.1016/j.psc.2009.06.002
- Pao M, Bosk A. Anxiety in medically ill children/adolescents. Depress Anxiety. 2011;28(1):40-9. https://doi.org/10.1002/da.20727
- Gouveia PADC, Ribeiro MHC Neta, Aschoff CAM, Gomes DP, Silva NAFD, Cavalcanti HAF. Factors associated with burnout syndrome in medical residents of a university hospital. Rev Assoc Med Bras. 2017;63(6):504-11. https://doi.org/10.1590/1806-9282.63.06.504
- Van Bakel HJA, Van Engen ML, Peters P. Validity of the Parental Burnout Inventory among dutch employees. Front Psychol. 2018;9:1-9. https://doi.org/10.3389/fpsyg.2018.00697
- Macumber IR, Weiss NS, Halbach SM, Hanevold CD, Flynn JT. The Association of Pediatric Obesity With Nocturnal Non-Dipping on 24-Hour Ambulatory Blood Pressure Monitoring. Am J Hypertens. 2016;29(5):647-52. https://doi.org/10.1093/ajh/hpv147
- Soergel M, Kirschstein M, Busch C, Danne T, Gellermann J, Holl R, et al. Oscillometric twenty-four-hour ambulatory blood pressure values in healthy children and adolescents: A multicenter trial including 1141 subjects. J Pediatr. 1997;130(2):178-84. https://doi.org/10.1016/S0022-3476(97)70340-8
- Wühl E, Witte K, Soergel M, Mehls O, Schaefer F, German Working Group on Pediatric Hypertension. Distribution of 24-h ambulatory blood pressure in children: normalized reference values and role of body dimensions. J Hypertens. 2002;20(10):1995-2007. https://doi.org/10.1097/00004872-200210000-00019
- Özusta HŞ. Çocuklar İçin Durumluk- Sürekli Kaygı Envanteri Uyarlama, Geçerlik ve Güvenirlik Çalışması. Türk Psikoloji Dergisi. 1995; 10:32-44.
- Ulusoy M, Sahin NH, Erkmen H. Turkish Version of the Beck Anxiety Inventory: Psychometric Properties. J Cogn Psychother. 1998;12(2):163-72.
- Schaufeli WB, Bakker AB, Hoogduin K, Schaap C, Kladler A. on the clinical validity of the maslach burnout inventory and the burnout measure. Psychol Health. 2001;16(5):565-82. https://doi.org/10.1080/08870440108405527
- Roskam I, Raes ME, Mikolajczak M. Exhausted parents: Development and preliminary validation of the parental burnout inventory. Front Psychol. 2017;8:163. https://doi.org/10.3389/fpsyg.2017.00163
- Duygun T, Sezgin N. The Effects of Stress Symptoms, Coping Styles and Perceived Social Support on Burnout Level of Mentally Handicapped and Healthy Children’s Mothers. Türk Psikol Derg. 2003;18(52):37-52.
- Gokcen C, Coskun S, Kutuk MO. Comparison of Depression and Burnout Levels of Mothers of Children with Attention-Deficit Hyperactivity Disorder Before and After Treatment. J Child Adolesc Psychopharmacol 2018;28(5):350-3. https://doi.org/10.1089/cap.2017.00
- Cohen J. Statistical power analysis for the behavioral sciences. Routledge, 2013. https://doi.org/10.4324/9780203771587
- Kumar S, Powars D, Allen J, Haywood LJ. Anxiety, self-concept, and personal and social adjustments in children with sickle cell anemia. J Pediatr. 1976;88(5):859-63. https://doi.org/10.1016/S0022-3476(76)81132-8
- Arabiat DH, Jabery M Al, Wardam L. Screening for anxiety symptoms and social desirability in children and adolescents living with chronic illnesses in Jordan. J Child Heal Care. 2013;17(1):62-71. https://doi.org/10.1177/1367493512450623
- Baki O, Erdogan A, Kantarci O, Akisik G, Kayaalp L, Yalcinkaya C. Anxiety and depression in children with epilepsy and their mothers. Epilepsy Behav. 2004;5(6):958-64. https://doi.org/10.1016/j.yebeh.2004.08.016
- Hergüner S, Kiliç G, Karakoç S, Tamay Z, Tüzün Ü, Güler N. Levels of depression, anxiety and behavioural problems and frequency of psychiatric disorders in children with chronic idiopathic urticaria. Br J Dermatol. 2011;164(6):1342-7. https://doi.org/10.1111/j.1365-2133.2010.10138.x
- Oguz A, Kurul S, Dirik E, Eylül D. Relationship of Epilepsy-Related Factors to Anxiety and Depression Scores in Epileptic Children. J Child Neurol. 2002;17(1):37-40. https://doi.org/10.1177/088307380201700109
- Högberg G. Anxiety in chronic illness: General salutogenic and specific pathological factors. Acta Paediatr Int J Paediatr. 2011;100(8):1066-8. https://doi.org/10.1111/j.1651-2227.2011.02362.x
- Götze H, Friedrich M, Brähler E, Romer G, Mehnert A, Ernst J. Psychological distress of cancer patients with children under 18 years and their partners - a longitudinal study of family relationships using dyadic data analysis. Support Care Cancer . 2017;255-64. https://doi.org/10.1007/s00520-016-3411-z
- Pop-Jordanova N, Gucev Z. Some Psychologıcal Aspects of T1DM In Chıldrenand Adolescents Nada Pop-Jordanova 1 , Zoran Gucev 2 1 2. Pril (Makedon Akad Nauk Umet Odd Med Nauk. 2015;36(3):113-8. https://doi.org/10.1515/prilozi-2015-0086
- Susan H S. A measure of anxiety symptoms among children. Behav Res Ther. 1998;36(5):545-66. https://doi.org/10.1016/S0005-7967(98)00034-5
- Kowalchuk A, Gonzalez SJ, Zoorob RJ. Anxiety Disorders in Children and Adolescents. Am Fam Physician. 2022;106(6):657-64.
- Alexander B, David E, Grills N. High prevalence of anxiety disorders among adolescent Tibetan refugees. Asian J Psychiatr. 2013;6(3):218-21. https://doi.org/10.1016/j.ajp.2012.12.006
- Sagar R, Gupta T. Psychological Aspects of Obesity in Children and Adolescents. Indian J Pediatr. 2018; 85(7):554-9. https://doi.org/10.1007/s12098-017-2539-2
- Lamertz CM, Jacobi C, Yassouridis A, Arnold K, Henkel AW. Are obese adolescents and young adults at higher risk for mental disorders? A community survey. Obes Res. 2002;10(11):1152-60. https://doi.org/10.1038/oby.2002.156
- Duru NS, Civilibal M, Elevli M, Training H, Clin E, Diabetes E, et al. Quality of Life and Psychological Screening in Children with Type 1 Diabetes and their Mothers. Exp Clin Endocrinol Diabetes. 2016;124(2):105-10. https://doi.org/10.1055/s-0035-1555938
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