More perceived social support tied to less sickle cell severity: Study
Support from classmates found to be predictive among children in Nigeria
More perceived social support from classmates is associated with less disease severity among children and adolescents with sickle cell anemia, the most common and often the most severe form of sickle cell disease (SCD), according to a new study from researchers in Nigeria.
Social support from parents also was significantly associated with disease severity, the study found. However, only perceived support from classmates emerged as an independent predictor of sickle cell severity among the children and teenagers in the study, who ranged in age from 9 to 17.
Overall, “there is some consensus that social support, on the whole, is beneficial from many different perspectives,” the researchers wrote. “These findings buttress the need for clinicians to consider psychosocial methods (e.g., family and classmates’ support) in improving disease outcomes.”
The researchers noted that the varying symptoms seen among sickle cell anemia patients “cannot be explained by genetic factors alone.” That led the team, from three universities in Nigeria, to investigate correlations to both perceived stress and social support.
While “perceived stress scores had a weak relationship” with disease severity, the researchers found that “parental and classmates’ perceived social support was significantly associated with [sickle cell anemia] severity.”
The study, “Perceived stress and social support as correlates of sickle cell anaemia severity in a low-resource setting,” was published in the journal BMC Pediatrics.
Sickle cell symptoms known to vary widely among patients
SCD is caused by genetic mutations that lead to the production of a faulty version of hemoglobin — the protein responsible for carrying oxygen in red blood cells. Ultimately, the condition causes cells to acquire the sickle-like shape that gives the disease its name.
Sickled cells are more easily destroyed, and are also prone to clump inside blood vessels, blocking blood flow and triggering painful crises.
Symptom severity can vary significantly among patients, with some individuals being nearly asymptomatic and others having marked disability. Disease severity has been associated with several factors, including genetic and biological factors, as well as psychosocial variables, such as perceived stress and social support.
However, “globally, there is [a] paucity of data on the psychological and sociocultural factors that influence [sickle cell anemia],” the researchers wrote.
To learn more, the team launched a study at a pediatric sickle cell clinic in Nigeria, enrolling 60 children and teens with sickle cell anemia. The participants were nearly equally split by sex, and slightly more than half (58.3%) had mild disease severity. The remaining children had moderate disease severity. About three-quarters were in secondary school, and a higher proportion (43.3%) belonged to families from higher socioeconomic classes, About 40% were from lower socioeconomic classes, while 16.7% were middle-class.
Perceived social support of peers, parents found to be key
Perceived social support was assessed using the child and adolescent social support scale, a validated measure of perceived social support from five sources: parents, teachers, classmates, close friends, and people at school. Children are asked to rate how often they perceive support, and how important it is for them.
Overall, higher levels of perceived social support from parents and classmates were significantly associated with lower disease severity. There was also a trend toward less severe disease linked to more support from teachers.
Consistent with a developmental point of view, various facets of adolescent life are more influenced by peer factors/opinions than family factors. … Classmates (peers) provide empathy and emotional support that enables adaptive coping skills and cushion the disease trajectory.
After adjusting data for age, sex, social class, and levels of fetal hemoglobin, perceived support from classmates appeared as a predictor of disease severity among children and adolescents. Fetal hemoglobin is a form of hemoglobin produced during fetal development that is more efficient transporting oxygen than its adult counterpart; it is one of the biological factors that may impact sickle cell severity.
“Consistent with a developmental point of view, various facets of adolescent life are more influenced by peer factors/opinions than family factors,” the researchers wrote. “Furthermore, classmates (peers) provide empathy and emotional support that enables adaptive coping skills and cushion the disease trajectory.”
Stress was assessed using the perceived stress scale, a 10-item questionnaire that evaluates self-reported — for children ages 12 and older — or parent-reported perceived stress levels, with higher scores indicating higher stress levels. Parent reports were used for children younger than 12.
According to the team, lower perceived stress levels were associated with lower disease severity, although the effect was weak and not statistically significant.
Overall, the study revealed the “beneficial effect of classmates’ social support in mitigating adverse disease [outcomes].”
“The findings of this study support the available literature on the possible positive relationship between satisfactory perceived social support and lower [sickle cell anemia] severity,” the researchers concluded.
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