Evaluation of quality of life and tendency to negative cognitive errors in children with primary nocturnal enuresis

Correspondence (İletişim): Behçet Şimşek, M.D. Saglik Bilimleri Universitesi Hamidiye Tip Fakultesi, Haydarpasa Numune Saglik Uygulama ve Arastirma Merkezi, Cocuk Klinigi, Istanbul, Turkey Phone (Telefon): +90 530 588 11 30 E-mail (E-posta): behcetmd@gmail.com Submitted Date (Başvuru Tarihi): 23.05. 2020 Accepted Date (Kabul Tarihi): 09.06. 2020 Copyright 2020 Haydarpaşa Numune Medical Journal OPEN ACCESS This is an open access article under the CC BY-NC license (http://creativecommons.org/licenses/by-nc/4.0/). 323 Şimşek et al., Cog. Errors in Prim NE / doi: 10.14744/hnhj.2020. 85429 The prevalence of enuresis nocturna varies according to societies. While 33% of five-year-old American children and 7% of 11-year-olds wet their bed; the rate of bed wetting in 5-year-old European children has been reported to be 9-19%[4,5]. In a study conducted in Istanbul in the age group of 6-12, the prevalence in children from low and high socioeconomic regions was found to be 25.5% and 16%, respectively[5]. Although it has not been proven that enuresis is inherently a psychiatric condition; it has been reported that it may result in avoidance of social activities and parental pressure and may be associated with various psychiatric conditions such as sleep disorders, chronical lack of self-esteem and attention disorder[2,6-8]. Following the World Health Organization's definition of health as a state of complete physical, mental and social well-being, the concept “quality of life” has emerged, which cares for what a person feels and takes the individual into consideration as a whole[9]. "Health-related general quality of life" (HRQOL) is expressed as the patient's perception of the effects of a disease and its treatment and indicates the physical, social and mental well-being of the person. "Health-related general quality of life scale" reflects the psychosocial consequences of physical health problems. It is important to know the HRQOL of the person in order to evaluate the treatment before and after and to determine health policies. In this context; scales measuring HRQOL have been developed[9-12]. Cognitive structure may affect the susceptibility to mental disorders as well as personality traits. Studies show that the most important changes occur before the age of 12, and the cognitive structure becomes stable with age. Childhood is critical in terms of investigating the factors that lead to the development of negative cognitive structure[13,14]. It has been reported that negative life events in childhood lead to the development of a negative cognitive structure and are associated with mental problems in adulthood[13,15]. Today, there is a need for reliable scales that can identify high-risk groups at an early stage and prevent childhoodrelated adult problems. Children’s Negative Cognitive Error Questionnaire (CNCEQ) was developed by Leitenberg to identify cognitive distortions in children. Karakaya et al. conducted a validity-reliability study of the scale in Turkish[13,16]. Considering the negative effects of enuresis on children's emotional state, self-esteem and social development; it can be predicted that enuretic children may be at risk in terms of their potential to develop negative thoughts that may affect their HRQOL and adult health[17,18]. This study aims to assess the social and psychological well-being of the patients with primary enuresis nocturna who applied to our unit via the "Pediatric Quality of Life Questionnaire” and the probable negative cognitive structures for the same group via “Children’s Negative Cognitive Error Questionnaire (CNCEQ). ” Materials and Methods A total of 150 children were included in the study consisting of 100 children aged 8-17 with primary enuresis nocturna as a study group, who were followed up in the Pediatric Nephrology Unita tertiary care unitand of 50 healthy children with no chronic diseases and having the similar age and sex with the study group as the control group. Cases with secondary enuresis such as meningomyelocele and neurogenic bladder were excluded from the study. The parents of the candidate children were informed about the study, and the cases with were involved in the study with their written consent. Approval was obtained from the ethics committee of our hospital where the study was conducted. In the evaluation of the level of HRQOL in the cases involved in the study, the "Pediatric Quality of Life Questionnaire (PedsQL)” the validity and reliability for Turkish of which was confirmed by Memik et al.[10-12]. Although the discussion continues on whether children’s quality of life assessments should be made by the parents or by the children themselves, in this study the evaluations were made by the case itself since this way was found to be more valuable in recent years[19]. The questionnaire in the evaluation form consists of 23 questions about the children's health status and activities, emotional state, difficulties faced with their peers and on their school life. The scale was scored in 3 areas. Firstly; “total scale score” (TSS), secondly; the "physical health total score" (PHTS), and thirdly, the "psychosocial health total score" (PSHTS) was calculated, which was obtained through the calculation of item scores evaluating emotional, social and school functionality. The items are scored between 0 and 100. The answers were scored as follows: If it is marked as "never", 0 = 100; as "rarely" 1=75, as “sometimes” was 2 = 50, as “often” 3 = 25, as “almost always” 4 = 0. Adding up the scores and dividing it by the number of marked items, the total score was obtained. If more than 50% of the scale is not filled, the scale is excluded from evaluation. The higher "Total Score for Pediatric Quality of Life Questionnaire”, the better health-related quality of life should be perceived[11]. 324 Şimşek et al., Cog. Errors in Prim NE / doi: 10.14744/hnhj.2020. 85429 The PedsQL, the validity-reliability study of which conducted by Karakaya et al. was used to evaluate possible cognitive distortions in children[13,16]. The scale was filled in by the participant itself. It is a five-point Likert type scale where each item is scored between 1-5. “Almost exactly like my opinion” was evaluated with 5 points, “I never think like that” was evaluated with 1 point. The total scale score ranges between 24-120. The higher the score is, the higher the "cognitive distortions" should be understood[13]. Statistical Analysis The NCSS (Number Cruncher Statistical System) 2007 (Kaysville, Utah, USA) program was used for statistical analysis. In addition to descriptive statistical methods, Student's t-test was used for comparing two groups of quantitative data with normal distribution whereas Mann Whitney U test for comparison of quantitative data and Pearson ChiSquare test for comparison of qualitative data were used. Inter-variable relationships were examined by Pearson correlation analysis and the significance was evaluated at least p<0.05 level.