Objective To evaluate the association between eczema and behavioral problems in school-aged children, and to analyze the mediating role of sleep disturbances, so as to provide evidence for the early intervention. Methods A cross-sectional study was conducted from June 2023 to June 2024 using stratified cluster sampling in three primary schools in Minhang District, Shanghai.A total of 1 380 children aged 6 - 12 years were included.Demographic data and eczema status were collected using a general demographic questionnaire.Sleep disturbances and behavioral problems were assessed using the Sleep Disturbance Scale for Children (SDSC) and the Child Behavior Checklist (CBCL/6 - 18), respectively.Multivariate logistic regression was used to analyze the associations, and mediation analysis was performed to test the mediating effect of sleep disturbances. Results The prevalence of reported eczema was 11.4% (157/1 380).Multivariate analysis revealed that compared with children without eczema, those with eczema had a significantly higher risk of somatic complaints (OR=3.81, 95%CI: 2.22 - 6.53), anxiety/depression (OR=2.87, 95%CI: 1.58 - 5.20), social problems (OR=2.42, 95%CI: 1.40 - 4.19), and internalizing behavioral problems (OR=3.68, 95% CI: 2.11 - 6.41) (all P<0.01).The mediated proportion (%) of sleep disturbances in the relationships of eczema with somatic complaints, anxious/depressed, social problems, and internalizing behavioral problems were 28.1% (95%CI: 1.1% - 53.4%, P=0.02), 39.7% (95%CI: 3.1% - 80.3%, P=0.01), 22.3% (95%CI: 2.3% - 60.1%, P=0.04), and 31.5% (95%CI: 2.7% - 57.5%, P=0.01), respectively. Conclusions Eczema is significantly associated with various behavioral problems in school-aged children, and sleep disturbances play a mediating role in this relationship.These findings suggest that clinical management of childhood eczema should extend beyond skin symptom control to include sleep quality improvement and early behavioral screening, so as to promote comprehensive physical and mental health.
Key words
eczema /
sleep disturbances /
behavioral problems /
school-aged children
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References
[1] Zheng J, Jin YJ, Wang CH, et al.Global, regional, and national epidemiology of allergic diseases in children from 1990 to 2021: Findings from the Global Burden of Disease Study 2021[J].BMC Pulm Med, 2025,25(1): 54.
[2] Ma EZ, Hooper SR, Seegan PL, et al.Association of atopic dermatitis with emotional and behavioral problems in childhood[J].J Am Acad Dermatol, 2024,90(6): 1249-1252.
[3] Chang YS, Chiang BL.Sleep disorders and atopic dermatitis: A 2-way street?[J].J Allergy Clin Immunol, 2018,142(4): 1033-1040.
[4] Bao A, Hooper SR, Sterni LM, et al.Association of sleep disorders with higher incidence of mental health and learning disorders in children with atopic dermatitis[J].J Allergy Clin Immunol Pract, 2025,13(7): 1846-1848.
[5] Bruni O, Ottaviano S, Guidetti V, et al.The Sleep Disturbance Scale for Children (SDSC).Construction and validation of an instrument to evaluate sleep disturbances in childhood and adolescence[J].J Sleep Res, 1996,5(4): 251-261.
[6] Huang MM, Qian Z, Wang J, et al.Validation of the Sleep Disturbance Scale for children and prevalence of parent-reported sleep disorder symptoms in Chinese children[J].Sleep Med, 2014,15(8): 923-928.
[7] 戴丽君, 吴庆军, 何林.深圳市中小学生睡眠质量状况[J].中国学校卫生, 2024,45(3): 367-369.
Dai LJ, Wu QJ, He L.Sleep quality among primary and middle school students in Shenzhen City[J].Chin J Sch Health, 2024,45(3): 367-369.(in Chinese)
[8] Achenbach TM, Rescorla LA.Achenbach system of empirically based assessment[M].Burlington, VT: University of Vermont, Research Center for Children, Youth, & Families, 2013.
[9] Achenbach TM, Ruffle TM.The Child Behavior Checklist and related forms for assessing behavioral/emotional problems and competencies[J].Pediatr Rev, 2000,21(8): 265-271.
[10] Petty CR, Rosenbaum JF, Hirshfeld-Becker DR, et al.The Child Behavior Checklist Broad-Band Scales predict subsequent psychopathology: A 5-year follow-up[J].J Anxiety Disord, 2008,22(3): 532-539.
[11] Ha J, Lee SW, Yon DK.Ten-year trends and prevalence of asthma, allergic rhinitis, and atopic dermatitis among the Korean population, 2008-2017[J].Clin Exp Pediatr, 2020,63(7): 278-283.
[12] Song N, Shamssain M, Zhang J, et al.Prevalence, severity and risk factors of asthma, rhinitis and eczema in a large group of Chinese schoolchildren[J].J Asthma, 2014,51(3): 232-242.
[13] Kern C, Wan J, Lewinn KZ, et al.Association of atopic dermatitis and mental health outcomes across childhood: A longitudinal cohort study[J].JAMA Dermatol, 2021,157(10): 1200-1208.
[14] Hu C, Nijsten T, Pasmans S, et al.Associations of eczema phenotypes with emotional and behavioural problems from birth until school age.The Generation R Study[J].Br J Dermatol, 2020,183(2): 311-320.
[15] Radtke S, Grossberg AL, Wan J.Mental health comorbidity in youth with atopic dermatitis: A narrative review of possible mechanisms[J].Pediatr Dermatol, 2023,40(6): 977-982.
[16] Zhang N, Chi H, Jin Q, et al.Prevalence of sleep disorders in atopic dermatitis: A systematic review and meta-analysis[J].Arch Dermatol Res, 2025,317(1): 668.
[17] Yaghmaie P, Koudelka CW, Simpson EL.Mental health comorbidity in patients with atopic dermatitis[J].J Allergy Clin Immunol, 2013,131(2): 428-433.
[18] Aljaid MS.Allergic conditions and their impact on pediatric sleep: A narrative review[J].J Pharm Bioallied Sci, 2024,16(Suppl 5): 4205-4209.
[19] Morales-Munoz I, Gregory AM.Sleep and mental health problems in children and adolescents[J].Sleep Med Clin, 2023,18(2): 245-254.
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