STRESS AND INCIDENCE OF BLEEDING IN CHILDREN AND ADOLESCENTS WITH HEMOPHILIA

Objective: To examine the relationship of stress and incidence of blee ding in boys with hemophilia. Study design: We conducted a 6-month lon gitudinal study of 97 subjects (ages 4 to 16 years) from six hemophili a centers. Diaries recorded bleeding episodes (including site and hist ory of previous trauma) and both child and parent daily stress. Parent and child stressful life event measures were obtained monthly, Socioe conomic 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 s ocioeconomic data. We also determined associations of aggregated previ ous month's events with bleeding likelihood in the succeeding month. R esults: Fifty-eight percent of study participants had severe hemophili a. The sample population averaged nine bleeding episodes per 6 months; of these, two thirds of bleeding incidents occurred into joints and 4 4% after injury. Factor level strongly predicted bleeding incidence (p <0.0001). Increased parent stress was associated with increased bleed ing in general (odds ratio = 1.37, p <0.003) and with injury (odds rat io = 1.65, p <0.001), but not bleeding into joints. Similar findings f ollowed parent reports of positive life events. Increased parent negat ive life events in 1 month were associated with increased bleeding in the succeeding month (p <0.05). Conclusion: Short- and long-term paren tal stress may lead to increased bleeding incidence in hemophilia, alt hough factor level much more strongly predicts bleeding.