アトピー性皮膚炎と子どもの精神健康状態の関連の検討：北海道スタディ

目的　小児期のアトピー性皮膚炎は，かゆみによる睡眠障害，外遊び・水泳などの行動制限などに加え，学業，人間関係など生活に幅広く関係する可能性が示唆されている。子どもの皮膚アレルギー疾患やかゆみと，勉学や生活の質の関係の検討はされているが，まだ十分とはいえない。とくに我が国での幼少期，未就学児での検討は少ない。そこで本研究では，小児期のアトピー性皮膚炎の有無と子どもの精神健康状態との関係を検討することを目的とした。方法　出生コーホート研究「北海道スタディ」の参加者20,926人のうち，2008年4月以降に生まれた7,386人のうち，4歳での追跡調査でアトピー性皮膚炎に関する日本語版Internat...

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Published in日本公衆衛生雑誌 Vol. 67; no. 10; pp. 745 - 751
Main Authors 須山, 聡, 湊屋, 街子, 岸, 玲子
Format Journal Article
LanguageJapanese
Published 日本公衆衛生学会 15.10.2020
Subjects
SDQ
アトピー性皮膚炎
子ども
精神健康
Online AccessGet full text
ISSN0546-1766
2187-8986
DOI10.11236/jph.67.10_745

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Abstract 目的　小児期のアトピー性皮膚炎は，かゆみによる睡眠障害，外遊び・水泳などの行動制限などに加え，学業，人間関係など生活に幅広く関係する可能性が示唆されている。子どもの皮膚アレルギー疾患やかゆみと，勉学や生活の質の関係の検討はされているが，まだ十分とはいえない。とくに我が国での幼少期，未就学児での検討は少ない。そこで本研究では，小児期のアトピー性皮膚炎の有無と子どもの精神健康状態との関係を検討することを目的とした。方法　出生コーホート研究「北海道スタディ」の参加者20,926人のうち，2008年4月以降に生まれた7,386人のうち，4歳での追跡調査でアトピー性皮膚炎に関する日本語版International Study of Asthma and Allergies in Childhood（ISAAC）の質問項目に回答があった4,228人かつ，5歳で行動発達に関する調査Strengths and Difficulties Questionnaire（SDQ）の回答を得た3,862人を本研究対象とした。アトピー性皮膚炎の有無とSDQの4つの下位項目（情緒，行為，仲間関係，多動），下位項目の合計得点（Total Difficulties Score：TDS）について平均点を比較し，得点を連続値として重回帰分析を行った。さらにアトピー性皮膚炎の有無と，SDQの4つの下位項目，TDSの得点が「支援の必要がおおいにあり」となることの関係を検討した。調整因子には，両親のアトピー性皮膚炎の既往歴を用いた。結果　4歳でアトピー性皮膚炎を有する子どもは799人（20.7%）であった。情緒，行為，TDSの平均得点は，アトピー性皮膚炎を有する子どもで，有さない子どもと比較して有意に高かった。4歳でアトピー性皮膚炎を有することは，5歳での情緒，行為，TDSの得点が高いことと関係した。また5歳で行為について，「支援の必要がおおいにあり」となるオッズ比が有意に高いことと関係した。結論　本研究から4歳でアトピー性皮膚炎を有することは，5歳での情緒，行為，全体的な支援の必要性といった精神健康と関連することが明らかになった。引き続き，アトピー性皮膚炎の重症度が，子どもの精神健康と関連するかを検討することで，より詳細な関係が明らかになると考えられる。
AbstractList 目的　小児期のアトピー性皮膚炎は，かゆみによる睡眠障害，外遊び・水泳などの行動制限などに加え，学業，人間関係など生活に幅広く関係する可能性が示唆されている。子どもの皮膚アレルギー疾患やかゆみと，勉学や生活の質の関係の検討はされているが，まだ十分とはいえない。とくに我が国での幼少期，未就学児での検討は少ない。そこで本研究では，小児期のアトピー性皮膚炎の有無と子どもの精神健康状態との関係を検討することを目的とした。方法　出生コーホート研究「北海道スタディ」の参加者20,926人のうち，2008年4月以降に生まれた7,386人のうち，4歳での追跡調査でアトピー性皮膚炎に関する日本語版International Study of Asthma and Allergies in Childhood（ISAAC）の質問項目に回答があった4,228人かつ，5歳で行動発達に関する調査Strengths and Difficulties Questionnaire（SDQ）の回答を得た3,862人を本研究対象とした。アトピー性皮膚炎の有無とSDQの4つの下位項目（情緒，行為，仲間関係，多動），下位項目の合計得点（Total Difficulties Score：TDS）について平均点を比較し，得点を連続値として重回帰分析を行った。さらにアトピー性皮膚炎の有無と，SDQの4つの下位項目，TDSの得点が「支援の必要がおおいにあり」となることの関係を検討した。調整因子には，両親のアトピー性皮膚炎の既往歴を用いた。結果　4歳でアトピー性皮膚炎を有する子どもは799人（20.7%）であった。情緒，行為，TDSの平均得点は，アトピー性皮膚炎を有する子どもで，有さない子どもと比較して有意に高かった。4歳でアトピー性皮膚炎を有することは，5歳での情緒，行為，TDSの得点が高いことと関係した。また5歳で行為について，「支援の必要がおおいにあり」となるオッズ比が有意に高いことと関係した。結論　本研究から4歳でアトピー性皮膚炎を有することは，5歳での情緒，行為，全体的な支援の必要性といった精神健康と関連することが明らかになった。引き続き，アトピー性皮膚炎の重症度が，子どもの精神健康と関連するかを検討することで，より詳細な関係が明らかになると考えられる。
Author 岸, 玲子
湊屋, 街子
須山, 聡
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  fullname: 岸, 玲子
  organization: 北海道大学環境健康科学研究教育センター
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References 26) Park J, Kim BJ, Kwon JW, et al. Patterns of psychosocial adaptation and allergic disorders in Korean schoolchildren. International Archives of Allergy and Immunology 2011; 154: 249-257.
6) Schmitt J, Apfelbacher C, Chen CM, et al. Infant-onset eczema in relation to mental health problems at age 10 years: results from a prospective birth cohort study (German Infant Nutrition Intervention plus). Journal of Allergy and Clinical Immunology 2010; 125: 404-410.
30) Buske-Kirschbaum A, Schmitt J, Plessow F, et al. Psychoendocrine and psychoneuroimmunological mechanisms in the comorbidity of atopic eczema and attention deficit/hyperactivity disorder. Psychoneuroendocrinology 2013; 38: 12-23.
19) Apfelbacher CJ, Diepgen TL, Schmitt J. Determinants of eczema: population-based cross-sectional study in Germany. Allergy 2011; 66: 206-213.
21) Zirngibl A, Franke K, Gehring U, et al. Exposure to pets and atopic dermatitis during the first two years of life. A cohort study. Pediatric Allergy and Immunology 2002; 13: 394-401.
31) Buske-Kirschbaum A, Trikojat K, Tesch F, et al. Altered hypothalamus-pituitary-adrenal axis function: a relevant factor in the comorbidity of atopic eczema and attention deficit/hyperactivity disorder? Psychoneuroendocrinology 2019; 105: 178-186.
28) Liao TC, Lien YT, Wang S, et al. Comorbidity of atopic disorders with autism spectrum disorder and attention deficit/hyperactivity disorder. Journal of Pediatrics 2016; 171: 248-255.
1) Mallol J, Crane J, von Mutius E, et al. The International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three: a global synthesis. Allergologia et Immunopathologia 2013; 41: 73-85.
5) Genuneit J, Braig S, Brandt S, et al. Infant atopic eczema and subsequent attention-deficit/hyperactivity disorder—a prospective birth cohort study. Pediatric Allergy and Immunology 2014; 25: 51-56.
9) Strom MA, Fishbein AB, Paller AS, et al. Association between atopic dermatitis and attention deficit hyperactivity disorder in U.S. children and adults. The British Journal of Dermatology 2016; 175: 920-929.
14) Asher MI, Keil U, Anderson HR, et al. International Study of Asthma and Allergies in Childhood (ISAAC): rationale and methods. The European Respiratory Journal 1995; 8: 483-491.
8) Chen MH, Su TP, Chen YS, et al. Is atopy in early childhood a risk factor for ADHD and ASD? a longitudinal study. Journal of Psychosomatic Research 2014; 77: 316-321.
32) Lewis-Jones S. Quality of life and childhood atopic dermatitis: the misery of living with childhood eczema. International Journal of Clinical Practice 2006; 60: 984-992.
25) Chang HY, Seo JH, Kim HY, et al. Allergic diseases in preschoolers are associated with psychological and behavioural problems. Allergy Asthma Immunology Ressearch 2013; 5: 315-321.
20) Kantor R, Kim A, Thyssen JP, et al. Association of atopic dermatitis with smoking: a systematic review and meta-analysis. Journal of the American Academy of Dermatology 2016; 75: 1119-1125.
3) Chamlin SL. The psychosocial burden of childhood atopic dermatitis. Dermatologic Therapy 2006; 19: 104-107.
11) Kishi R, Sasaki S, Yoshioka E, et al. Cohort profile: the Hokkaido study on environment and children's health in Japan. International Journal of Epidemiology 2011; 40: 611-618.
22) Williams H, Robertson C, Stewart A, et al. Worldwide variations in the prevalence of symptoms of atopic eczema in the International Study of Asthma and Allergies in Childhood. Journal of Allergy and Clinical Immunology 1999; 103: 125-138.
29) Schmitt J, Chen CM, Apfelbacher C, et al. Infant eczema, infant sleeping problems, and mental health at 10 years of age: the prospective birth cohort study LISAplus. Allergy 2011; 66: 404-411.
10) Johansson EK, Ballardini N, Kull I, et al. Association between preschool eczema and medication for attention-deficit/hyperactivity disorder in school age. Pediatric Allergy and Immunology 2017; 28: 44-50.
15) Goodman R. The Strengths and Difficulties Questionnaire: a research note. Journal of Child Psychology and Psychiatry and Allied Disciplines 1997; 38: 581-586.
18) Hammer-Helmich L, Linneberg A, Obel C, et al. Mental health associations with eczema, asthma and hay fever in children: a cross-sectional survey. BMJ Open 2016; 6: e012637.
12) Kishi R, Kobayashi S, Ikeno T, et al. Ten years of progress in the Hokkaido birth cohort study on environment and children's health: cohort profile—updated 2013. Environmental Health and Preventive Medicine 2013; 18: 429-450.
24) Kuniyoshi Y, Kikuya M, Miyashita M, et al. Severity of eczema and mental health problems in Japanese schoolchildren: The ToMMo Child Health Study. Allergology International 2018; 67: 481-486.
16) 厚生労働省．Strengths and Difficulties Questionnaire. https://www.mhlw.go.jp/bunya/kodomo/boshi-hoken07/h7_04d.html.（2020年3月18日アクセス可能）
23) Morikawa E, Sasaki M, Yoshida K, et al. Nationwide survey of the prevalence of wheeze, rhino-conjunctivitis, and eczema among Japanese children in 2015. Allergology International 2020; 69: 98-103.
27) Meldrum SJ, D'Vaz N, Dunstan JA, et al. Allergic disease in the first year of life is associated with differences in subsequent neurodevelopment and behaviour. Early Human Development 2012; 88: 567-573.
17) Matsuishi T, Nagano M, Araki Y, et al. Scale properties of the Japanese version of the Strengths and Difficulties Questionnaire (SDQ): a study of infant and school children in community samples. Brain & Development 2008; 30: 410-415.
4) Chamlin SL, Chren MM. Quality-of-life outcomes and measurement in childhood atopic dermatitis. Immunology and Allergy Clinics of North America 2010; 30: 281-288.
7) Teyhan A, Galobardes B, Henderson J. Child allergic symptoms and well-being at school: findings from ALSPAC, a UK Cohort Study. PLOS ONE 2015; 10: e0135271.
2) Futamura M, Ohya Y, Akashi M, et al. Age-related prevalence of allergic diseases in Tokyo schoolchildren. Allergology International 2011; 60: 509-515.
13) Kishi R, Araki A, Minatoya M, et al. The Hokkaido Birth Cohort Study on Environment and Children's Health: cohort profile-updated 2017. Environmental Health and Preventive Medicine 2017; 22: 46-61.
References_xml – reference: 14) Asher MI, Keil U, Anderson HR, et al. International Study of Asthma and Allergies in Childhood (ISAAC): rationale and methods. The European Respiratory Journal 1995; 8: 483-491.
– reference: 13) Kishi R, Araki A, Minatoya M, et al. The Hokkaido Birth Cohort Study on Environment and Children's Health: cohort profile-updated 2017. Environmental Health and Preventive Medicine 2017; 22: 46-61.
– reference: 32) Lewis-Jones S. Quality of life and childhood atopic dermatitis: the misery of living with childhood eczema. International Journal of Clinical Practice 2006; 60: 984-992.
– reference: 8) Chen MH, Su TP, Chen YS, et al. Is atopy in early childhood a risk factor for ADHD and ASD? a longitudinal study. Journal of Psychosomatic Research 2014; 77: 316-321.
– reference: 3) Chamlin SL. The psychosocial burden of childhood atopic dermatitis. Dermatologic Therapy 2006; 19: 104-107.
– reference: 11) Kishi R, Sasaki S, Yoshioka E, et al. Cohort profile: the Hokkaido study on environment and children's health in Japan. International Journal of Epidemiology 2011; 40: 611-618.
– reference: 15) Goodman R. The Strengths and Difficulties Questionnaire: a research note. Journal of Child Psychology and Psychiatry and Allied Disciplines 1997; 38: 581-586.
– reference: 26) Park J, Kim BJ, Kwon JW, et al. Patterns of psychosocial adaptation and allergic disorders in Korean schoolchildren. International Archives of Allergy and Immunology 2011; 154: 249-257.
– reference: 2) Futamura M, Ohya Y, Akashi M, et al. Age-related prevalence of allergic diseases in Tokyo schoolchildren. Allergology International 2011; 60: 509-515.
– reference: 16) 厚生労働省．Strengths and Difficulties Questionnaire. https://www.mhlw.go.jp/bunya/kodomo/boshi-hoken07/h7_04d.html.（2020年3月18日アクセス可能）．
– reference: 18) Hammer-Helmich L, Linneberg A, Obel C, et al. Mental health associations with eczema, asthma and hay fever in children: a cross-sectional survey. BMJ Open 2016; 6: e012637.
– reference: 7) Teyhan A, Galobardes B, Henderson J. Child allergic symptoms and well-being at school: findings from ALSPAC, a UK Cohort Study. PLOS ONE 2015; 10: e0135271.
– reference: 6) Schmitt J, Apfelbacher C, Chen CM, et al. Infant-onset eczema in relation to mental health problems at age 10 years: results from a prospective birth cohort study (German Infant Nutrition Intervention plus). Journal of Allergy and Clinical Immunology 2010; 125: 404-410.
– reference: 27) Meldrum SJ, D'Vaz N, Dunstan JA, et al. Allergic disease in the first year of life is associated with differences in subsequent neurodevelopment and behaviour. Early Human Development 2012; 88: 567-573.
– reference: 22) Williams H, Robertson C, Stewart A, et al. Worldwide variations in the prevalence of symptoms of atopic eczema in the International Study of Asthma and Allergies in Childhood. Journal of Allergy and Clinical Immunology 1999; 103: 125-138.
– reference: 30) Buske-Kirschbaum A, Schmitt J, Plessow F, et al. Psychoendocrine and psychoneuroimmunological mechanisms in the comorbidity of atopic eczema and attention deficit/hyperactivity disorder. Psychoneuroendocrinology 2013; 38: 12-23.
– reference: 20) Kantor R, Kim A, Thyssen JP, et al. Association of atopic dermatitis with smoking: a systematic review and meta-analysis. Journal of the American Academy of Dermatology 2016; 75: 1119-1125.
– reference: 21) Zirngibl A, Franke K, Gehring U, et al. Exposure to pets and atopic dermatitis during the first two years of life. A cohort study. Pediatric Allergy and Immunology 2002; 13: 394-401.
– reference: 10) Johansson EK, Ballardini N, Kull I, et al. Association between preschool eczema and medication for attention-deficit/hyperactivity disorder in school age. Pediatric Allergy and Immunology 2017; 28: 44-50.
– reference: 29) Schmitt J, Chen CM, Apfelbacher C, et al. Infant eczema, infant sleeping problems, and mental health at 10 years of age: the prospective birth cohort study LISAplus. Allergy 2011; 66: 404-411.
– reference: 12) Kishi R, Kobayashi S, Ikeno T, et al. Ten years of progress in the Hokkaido birth cohort study on environment and children's health: cohort profile—updated 2013. Environmental Health and Preventive Medicine 2013; 18: 429-450.
– reference: 25) Chang HY, Seo JH, Kim HY, et al. Allergic diseases in preschoolers are associated with psychological and behavioural problems. Allergy Asthma Immunology Ressearch 2013; 5: 315-321.
– reference: 23) Morikawa E, Sasaki M, Yoshida K, et al. Nationwide survey of the prevalence of wheeze, rhino-conjunctivitis, and eczema among Japanese children in 2015. Allergology International 2020; 69: 98-103.
– reference: 17) Matsuishi T, Nagano M, Araki Y, et al. Scale properties of the Japanese version of the Strengths and Difficulties Questionnaire (SDQ): a study of infant and school children in community samples. Brain & Development 2008; 30: 410-415.
– reference: 1) Mallol J, Crane J, von Mutius E, et al. The International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three: a global synthesis. Allergologia et Immunopathologia 2013; 41: 73-85.
– reference: 31) Buske-Kirschbaum A, Trikojat K, Tesch F, et al. Altered hypothalamus-pituitary-adrenal axis function: a relevant factor in the comorbidity of atopic eczema and attention deficit/hyperactivity disorder? Psychoneuroendocrinology 2019; 105: 178-186.
– reference: 9) Strom MA, Fishbein AB, Paller AS, et al. Association between atopic dermatitis and attention deficit hyperactivity disorder in U.S. children and adults. The British Journal of Dermatology 2016; 175: 920-929.
– reference: 24) Kuniyoshi Y, Kikuya M, Miyashita M, et al. Severity of eczema and mental health problems in Japanese schoolchildren: The ToMMo Child Health Study. Allergology International 2018; 67: 481-486.
– reference: 28) Liao TC, Lien YT, Wang S, et al. Comorbidity of atopic disorders with autism spectrum disorder and attention deficit/hyperactivity disorder. Journal of Pediatrics 2016; 171: 248-255.
– reference: 19) Apfelbacher CJ, Diepgen TL, Schmitt J. Determinants of eczema: population-based cross-sectional study in Germany. Allergy 2011; 66: 206-213.
– reference: 4) Chamlin SL, Chren MM. Quality-of-life outcomes and measurement in childhood atopic dermatitis. Immunology and Allergy Clinics of North America 2010; 30: 281-288.
– reference: 5) Genuneit J, Braig S, Brandt S, et al. Infant atopic eczema and subsequent attention-deficit/hyperactivity disorder—a prospective birth cohort study. Pediatric Allergy and Immunology 2014; 25: 51-56.
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SubjectTerms SDQ
アトピー性皮膚炎
子ども
精神健康
Title アトピー性皮膚炎と子どもの精神健康状態の関連の検討：北海道スタディ
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ispartofPNX 日本公衆衛生雑誌, 2020/10/15, Vol.67(10), pp.745-751
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