title: Stress and incidence of bleeding in children and adolescents with hemophilia.
abstract: OBJECTIVE
  To examine the relationship of stress and incidence of bleeding in boys with hemophilia.
  
  
  METHODS
  We conducted a 6-month longitudinal study of 97 subjects (ages 4 to 16 years) from six hemophilia centers. Diaries recorded bleeding episodes (including site and history of previous trauma) and both child and parent daily stress. Parent and child stressful life event measures were obtained monthly. Socioeconomic data and clotting factor level were determined at enrollment. Logistic regression models examined the influence of recent stress on likelihood of bleeding on each day, controlling for factor level and socioeconomic data. We also determined associations of aggregated previous month's events with bleeding likelihood in the succeeding month.
  
  
  RESULTS
  Fifty-eight percent of study participants had severe hemophilia. The sample population averaged nine bleeding episodes per 6 months; of these; two thirds of bleeding incidents occurred into joints and 44% after injury. Factor level strongly predicted bleeding incidence (p < 0.0001). Increased parent stress was associated with increased bleeding in general (odds ratio = 1.37, p < 0.003) and with injury (odds ratio = 1.65, p < 0.001), but not bleeding into joints. Similar findings followed parent reports of positive life events. Increased parent negative life events in 1 month were associated with increased bleeding in the succeeding month (p < 0.05).
  
  
  CONCLUSIONS
  Short- and long-term parental stress may lead to increased bleeding incidence in hemophilia, although factor level much more strongly predicts bleeding.
authors.affiliation: Children's Service, Massachusetts General Hospital, Boston 02114, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Perrin
authors.forename: W E
authors.initials: WE
authors.lastname: MacLean
authors.forename: R L
authors.initials: RL
authors.lastname: Janco
authors.forename: S L
authors.initials: SL
authors.lastname: Gortmaker
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006467:Hemophilia A / Q000150:complications*; D006470:Hemorrhage / Q000523:psychology*; D006801:Humans; D015994:Incidence; D008016:Life Change Events; D008137:Longitudinal Studies; D008297:Male; D009035:Mothers / Q000523:psychology; D016017:Odds Ratio; D012649:Self Concept; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000150:complications*