Self-Compassion Among Caregivers of Children with Complex Chronic Conditions: A Cross-Sectional Study in a Pediatric Ward

Self-Compassion Among Caregivers of Children with Complex Chronic Conditions: A Cross-Sectional Study in a Pediatric Ward | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Self-Compassion Among Caregivers of Children with Complex Chronic Conditions: A Cross-Sectional Study in a Pediatric Ward Camila Padula Domingues, Aline Maria de Oliveira Rocha, Rafaela Moura de Souza, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9125155/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Objective To assess levels of self-compassion among caregivers of children with chronic conditions admitted to a pediatric ward, exploring associated sociodemographic and contextual factors. Methods An observational, cross-sectional study with a quantitative approach was conducted between November 2023 and March 2024, involving 24 caregivers of children admitted to the Clinical Pediatrics Ward of a tertiary hospital. Participants completed the Self-Compassion Scale (SCS) and sociodemographic data were collected through structured questionnaires. Descriptive statistics were used to analyze the domain sof self-compassion and caregivers’ characteristics. Results The overall mean score on the SCS was 3.13 (SD ± 0.52), ranging from 1.8 to 4.1. The domain with the greatest impairment was excessive self-criticism (mean = 2.94; SD ± 0.69), followed by feelings of isolation. Most caregivers were mothers (91.3%), with a mean age of 35.2 years (SD ± 9.87). A support network was reported by 62.5%, and 87.5% declared religiosity. Additionally, the majority had low to medium socioeconomic status, with prolonged involvement in daily care of their children. Conclusions Caregivers of hospitalized children with chronic conditions showed moderate levels of self-compassion, with a predominance of self-criticism and isolation. These findings highlight the importance of institutional strategies that foster emotional support and resilience among family members, contributing to more comprehensive and compassionate pediatric care. Self-compassion Chronic Diseases Palliative Care Caregivers Pediatrics Mental Health Figures Figure 1 INTRODUCTION Advances in medicine and technology in recent decades have contributed significantly to increased survival rates among children with complex chronic conditions, which require continuous and specialized care 1 , 2 . One of the most widely used definitions to characterize children with complex chronic conditions (CCC) is that proposed by Feudtner et al., which considers: (1) the presence of a health condition with a minimum expected duration of 12 months (unless death occurs before that period) and (2) involvement of more than one organ system, or a single system with sufficient severity to require specialized care and, likely, tertiary-level hospitalizations 1 . These conditions, generally characterized by multisystem involvement and prolonged evolution, dependence on technologies, and frequent and prolonged hospitalizations, have a significant impact on the functionality and quality of life of patients and their families² , 3 . Their very definition reinforces the clinical and care complexity of these children and highlights the need for comprehensive, coordinated, and continuous care. In pediatric hospital settings, caregivers and guardians play a central role in daily care, often immersed in routines marked by uncertainty, emotional overload, and subjective suffering 3 , 4 . The experience of caring for a child with a chronic illness imposes a restructuring of family life, requiring the abandonment of work activities, the redirection of social roles, and the confrontation of profound existential issues 5 . The effects of this often prolonged and unpredictable experience are associated with high levels of stress and can trigger significant damage to caregivers' mental health, such as symptoms of anxiety, depression, physical and emotional exhaustion, as well as feelings of guilt, inadequacy, and loneliness. In this context, identifying protective factors and internal resources becomes essential to mitigate negative impacts and promote well-being. Self-compassion emerges as a relevant emotional skill, related to affective regulation and the reduction of psychological distress 6 . The care of children with CCC is not restricted to the period of hospitalization but extends to all levels of health care. The primary level, which is preventive in nature, involves actions carried out mainly in Basic Health Units, such as home visits and care by family health teams. The secondary level comprises specialized care in areas such as neurology, cardiology and pediatric gastroenterology, usually performed in outpatient clinics or medium-complexity hospitals. The tertiary level focuses on highly complex care, involving the use of advanced technologies and high-cost treatments, such as chemotherapy and prolonged hospitalizations. The comprehensiveness and coordination between these levels are essential to reduce acute complications, minimize hospitalizations and, above all, ensure quality of life inside and outside the hospital environment 7 , 8 . In this scenario, recognizing the family as a key player in care becomes a fundamental principle. Family-centered care values the caregiver as an active participant in the therapeutic plan, responsible for decisions, interventions and emotional support for the child 4 , 9 . The healthcare team must understand that the family carries with it unique values, beliefs and histories, which must be respected and considered in the construction of shared care. The primary caregiver plays the role of a reference figure, being responsible for decisions and the daily management of the child's condition. Secondary caregivers, such as grandparents, uncles, aunts and siblings, participate in a complementary manner. Recognizing this network and its specificities is essential for strengthening the therapeutic bond and planning emotional and social support strategies 9 . Self-compassion, as mentioned, presents itself in this context as a powerful internal resource. Conceptualized by Kristin Neff as the ability to treat oneself with kindness in difficult situations, recognizing suffering as part of the human experience and maintaining a balanced perspective on emotions, self-compassion has been associated with improved mental health, strengthened resilience, and promoted subjective well-being. It is commonly measured using the Self-Compassion Scale (SCS), an instrument validated for Portuguese and composed of six domains: self-judgment, over-identification, isolation, common humanity, self-kindness and mindfulness. Although the literature on the effects of self-compassion is growing in the fields of psychology and health, there is still a scarcity of studies investigating this construct specifically in caregivers of children hospitalized with chronic diseases 6 . Thus, understanding the levels of self-compassion among caregivers of children with complex chronic conditions who are hospitalized can provide important insights for the development of clinical interventions, public policies and institutional strategies that promote more humane, welcoming, and comprehensive care. Recognizing and valuing the suffering of these caregivers is the first step toward building practices that not only treat the disease but also “care for the caregivers.” This study aims to assess the levels of self-compassion among caregivers of children with complex chronic conditions who are hospitalized, analyzing contextual factors that may influence this construct. METHODS Study design This is a cross-sectional observational study with a quantitative approach. Location and period The research was conducted in the Pediatric Ward, and data collection took place between November 2023 and March 2024, after approval by the Research Ethics Committee. Population and sample The study included primary caregivers (mothers, fathers, grandparents) of children and adolescents hospitalized in the unit during the collection period, whose children had chronic diseases with at least 12 months of evolution. The sample was non-probabilistic, for convenience, composed of 24 participants who met the inclusion criteria and agreed to voluntarily participate in the study by signing the Free and Informed Consent Form. Exclusion criteria included difficulties in understanding the instrument for linguistic or cognitive reasons, as well as refusal to participate in the interview. Instrument To assess levels of self-compassion, we used the translated and validated version of the Self-Compassion Scale (SCS), developed by Neff et al 6 . The scale consists of 26 items distributed across six domains: • Severe self-criticism (self-judgment), • Over-identification, • Isolation, • Common humanity, • Self-kindness, • Mindfulness. Each item is answered on a 5-point Likert scale, ranging from 1 (“almost never”) to 5 (“almost always”). Domains with negative scores (self-criticism, over-identification, and isolation) were recoded according to the original author’s guidelines, enabling the calculation of the overall self-compassion score. Data collection procedures The interviews were conducted in a private room to ensure the privacy and comfort of the participants. The questionnaires were administered in person, with the assistance of the researcher, after reading and signing the informed consent form. The average duration of the application was 30 minutes. In addition to the Self-Compassion Scale (SCS), a sociodemographic characterization form was administered, containing information such as age, gender, degree of kinship with the child, number of children, education level, presence of a support network, and religiosity. Data analysis The data were organized in a spreadsheet (Microsoft Excel®) and analyzed using descriptive statistics, using measures of central tendency (mean), dispersion (standard deviation), and absolute and relative frequencies. The overall mean of the self-compassion scale and the scores for each of its domains were presented in tabular and graphical formats. Ethical aspects The project was approved by the institution's Research Ethics Committee under CAAE No. 66131322.1.0000.5505. All participants signed the TCLE, ensuring the principles of autonomy, confidentiality, and voluntary participation, in accordance with Resolution No. 466/2012 of the National Health Council. RESULTS Twenty-four primary caregivers of children and adolescents hospitalized with chronic health conditions participated in the study. The mean age of participants was 35.2 years (SD ± 9.87), with a predominance of females (95.8%). Most caregivers were mothers (91.3%), followed by grandparents (8.7%). The average number of children per caregiver was 2.67 (SD ± 1.43). Regarding religiosity, 87.5% reported having a religion, with 52.3% being Catholic, 42.8% Evangelical and 4.7% belonging to other denominations. Regarding the support network, 62.5% reported receiving support, mainly from parents, grandparents and aunts, as described in Table 1 . Table 1 Demographic data of caregivers. Age group (years) n Percentage (%) Support network n Percentage (%) 25–30 10 41.7 Yes 15 62.5 31–41 10 41.7 No 9 37.5 > 41 4 16.6 Degree of kinship n Percentage (%) Religion n Percentage (%) Mother 21 87.5 Catholic 11 45.8 Grandmother 2 8.3 Evangelical 9 37.5 Father 1 4.2 Protestant 1 4.2 None 3 12.5 Table 1 Demographic issues related to the hospitalized children themselves were also analyzed, as shown in Table 2 and Fig. 1 below. Table 2 Demographic data of hospitalized children and adolescents. Age group (years) n Percentage (%) 10 5 20.8 Duration of illness leading to hospitalization (years) n Percentage (%) 1–4 17 70.8 5–10 5 20.8 > 10 2 8.4 Illness leading to hospitalization (medical specialty) n Percentage (%) Hematology 6 25.0 Urology/Nephrology 5 20.8 Gastroenterology 4 16.7 Pulmonology 3 12.5 Neurology 3 12.5 Others (genetics, rheumatology, otorhinolaryngology) 3 12.5 Table 2 Figure 1 Scores on the Self-Compassion Scale (SCS) The overall mean score on the Self-Compassion Scale was 3.13 (SD ± 0.52), ranging from 1.8 to 4.1. Among the six domains assessed, greater impairment was observed in the domain of severe self-criticism (mean = 2.94; SD ± 0.69). The other domains had the following means: • Over-identification: 3.03 (SD ± 0.82) • Isolation: 3.43 (SD ± 1.07) • Common humanity: 3.34 (SD ± 0.74) • Self-kindness: 3.06 (SD ± 0.70) • Mindfulness: 3.00 (SD ± 0.68 Table 3 Table 3 Mean scores obtained in the Self-Compassion Scale questionnaire. Items rated on a Likert scale ranging from 1 (almost never) to 5 (almost always). Item Mean 1 I disapprove of and judge myself for my mistakes and inadequacies. 3.125 2 When I’m feeling down, I tend to obsess and fixate on everything that’s wrong. 3.083 3 When things go wrong, I see difficulties as part of life that everyone goes through. 3.125 4 When I think about my flaws and inadequacies, I feel more separate and disconnected from the rest of the world. 3.541 5 I try to be caring toward myself when I’m experiencing emotional pain. 3.125 6 When I fail at something important to me, I beat myself up with feelings of inadequacy. 2.958 7 When I’m feeling down, I remind myself that many others feel the same way. 3.500 8 When going through tough times, I tend to be very hard and demanding on myself. 2.291 9 When something upsets or saddens me, I try to keep my emotional balance. 3.041 10 When I feel inadequate in some way, I try to remind myself that most people feel that way at times. 3.375 11 I am intolerant and impatient with aspects of my personality I don’t like. 3.250 12 When I go through a truly difficult time, I give myself the tenderness and care I need. 3.083 13 When I’m feeling down, I tend to think that most people are probably happier than I am. 3.625 14 When something painful happens, I try to have a balanced view of the situation. 3.083 15 I try to see my mistakes and flaws as part of the human condition. 3.375 16 When I see aspects of myself I don’t like, I feel really down. 3.166 17 When I fail at something important to me, I try to keep things in perspective (not dramatize). 3.083 18 When I feel overwhelmed, I tend to think others have it easier than I do. 3.500 19 I am tolerant and affectionate toward myself when I experience suffering. 2.958 20 When something upsets or saddens me, I let myself get carried away by my feelings. 3.000 21 I can be quite cold and harsh with myself when I’m suffering. 2.875 22 When I’m feeling down, I try to look at my feelings with curiosity and openness. 2.541 23 I am tolerant of my mistakes and inadequacies. 3.083 24 When something painful happens, I tend to exaggerate its significance. 3.083 25 When I fail at something important to me, I feel alone in my failure. 3.083 26 I try to be understanding and patient with aspects of my personality I don’t like. 3.250 The domains related to self-deprecating feelings (self-criticism, over-identification, and isolation) had scores equal to or above 3, suggesting significant levels of emotional distress among participants. In contrast, domains related to emotional self-regulation and self-empathy had moderate averages, with no predominance of high scores, which may indicate less internalization of positive self-compassion strategies. DISCUSSION This study sought to assess levels of self-compassion among caregivers of children with chronic conditions admitted to pediatric wards. The results show that, although the overall mean score on the Self-Compassion Scale was moderate (3.13), the severe self-criticism domain had the lowest scores, indicating greater emotional fragility in this dimension. These findings are consistent with the literature that points to the presence of feelings of inadequacy, guilt and self-punishment among family caregivers of children with chronic diseases, especially in prolonged hospital settings 9 , 10 . The predominance of women (mothers) in the role of caregivers, as observed in this study, has also been described as a factor associated with greater emotional overload and lower levels of self-care 10 , 11 . International studies show that self-compassion, understood as the ability to offer oneself understanding and acceptance in the face of suffering, is strongly associated with a reduction in anxiety and depressive symptoms in populations exposed to chronic stress situations, such as family members of hospitalized patients 12 , 13 , 14 . In the present study, the domains related to self-kindness and mindfulness had scores close to the overall average, suggesting that, although emotional suffering is present, caregivers maintain, to some extent, internal resources for affective regulation 14 . The dimension of “common humanity,” which represents the perception that pain is part of the shared experience among human beings, showed preserved scores, which may be related to the presence of religiosity (87.5% of participants) and the perception of community belonging, often associated with spirituality. The literature points out that faith can be an important coping strategy and promote resilience among family members of children with complex illnesses 10 , 12 , 15 . On the other hand, high scores in the domains of isolation and over-identification reflect the impact of the hospital experience on caregivers, who, in assuming the role of emotional and practical reference for the sick child, may neglect their own emotional needs and experience feelings of loneliness, even when inserted in family contexts. This split between the care offered and the care received is one of the main gaps observed in family-centered pediatric care 16 , 17 , 18 . The data obtained reinforce the importance of institutional actions that promote compassionate care also directed at caregivers, recognizing their suffering as an integral part of the care process. Strategies such as support groups, psychological support and training of health professionals in empathic communication can contribute to mitigating subjective suffering and favoring the preservation of caregivers' mental health in the hospital environment. CONCLUSION Caregivers of children with chronic conditions who are hospitalized showed moderate levels of self-compassion, with lower scores in the domains of self-criticism and isolation. These data indicate significant emotional vulnerability, which is often overlooked in the hospital setting but can affect both the caregiver's well-being and the quality of care provided to the child. Recognizing these emotional patterns is essential for implementing more humane and family-centered interventions. Understanding the limitations and internal resources of these caregivers enables the development of more sensitive emotional support strategies, promoting mental health and strengthening the bond between caregiver and child. In view of this, it is recommended that health services also extend their attention to family members through psychological support, qualified listening, and compassionate care. Incorporating these actions into the hospital routine is essential for truly comprehensive and humanized pediatric care. Declarations Funding Statement: One of the authors (CPD) receives scientific initiation scholarship to carry out this work. The funding sources had no influence on the study design, data collection, analysis and interpretation or the writing of the manuscript. We believe that this declaration covers all relevant interests related to the research presented in our manuscript. We assure you that we have taken utmost care to maintain the objectivity and scientific integrity of our study. Ethics approval and consent to participate: This study was conducted in accordance with the Declaration of Helsinki. Ethical approval was obtained from the Research Ethics Committee of the Federal University of São Paulo (UNIFESP) (CAAE No. 66131322.1.0000.5505). All participants were informed about the objectives and procedures of the study and provided written informed consent prior to data collection, in accordance with Resolution No. 466/2012 of the Brazilian National Health Council. Consent for publication: Not applicable. Clinical trial number: Not applicable. Conflict of interest: The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article. Author Contribution Camila Padula Domingues. Contribution: Conceptualization, Study Design, Data Collection, Data Analysis, Manuscript Writing.-Aline Maria de Oliveira Rocha. Contribution: Data analysis, Manuscript writing, Study supervision.-Rafaela Moura de Souza. Contribution: Conceptualization, Study design, Data collection, Data analysis, Manuscript review, Study supervision.-Simone Brasil de Oliveira Iglesias. Contribution: Conceptualization, Study design, Data analysis, Manuscript review, Study supervision. Acknowledgement We would like to thank the team at the Pediatric Ward of UNIFESP, Hospital São Paulo and the study participants. References Feudtner, C.; Hays, R.M.; Haynes, G.; Geyer, J.R.; Neff, J.M.; Koepsell, T.D. Deaths attributed to pediatrics complex chronic conditions: national trends and implications for supportive cara services. Pedriatr 2001; 107 (6): E99. Cohen, E.; Kuo, D.Z.; Agrawal, R.; Berry, J.G.; Bhagat, S.K.M.; Simon, T.D. et al. Children With Medical Complexity: An Emerging Population for Clinical and Research Initiatives. Pediatr. 2011; 127(3):529-538. Passone CGB, Grisi SJ, Farhat SC, et al. Complexity of Pediatric Chronic Disease: Cross‑Sectional Study with 16 237 Patients Followed by Multiple Medical Specialties. Rev Paul Pediatr. 2020;38:e2018101. doi:10.1590/1984‑0462/2020/38/2018101. Pereira IC. Cuidadores familiares de crianças com doenças crónicas: o impacto da doença [dissertação de mestrado]. Lisboa: ISPA – Instituto Universitário; 2021. Jones BL, Contro N, Koch KD. The duty of the physician to care for the family in pediatric palliative care: context, communication, and caring. Pediatrics. 2014 Feb;133 Suppl 1:S8-15. doi: 10.1542/peds.2013-3608C. PMID: 24488541. Neff KD. Self-compassion: An alternative conceptualization of a healthy attitude toward oneself. Self Identity. 2003;2(2):85–101. Junior, Helvécio Miranda Magalhães. "Redes de Atenção à Saúde: rumo à integralidade." Divulgação em saúde para debate [on-line] 52 (2014): 15-37. Araújo YB, Collet N, Gomes IP, Nóbrega RD. Enfrentamento do adolescente em condição crônica: importância da rede social. Rev Bras Enferm. 2011 Mar-Abr; 64(2):281-6. 6. Pizzignacco TMP, Mello Peterson-Carmichael SL, Cheifetz IM. The chronically critically ill patient: pediatric considerations. Respiratory Care. 2012 Jun; 57(6):993-1002. Souza LE, Rocha RG, Santos MJ. Espiritualidade como estratégia de enfrentamento em contextos de doença pediátrica crônica. Psicol Saúde Doenças. 2022;23(2):453–66. Hill DL, Nye RT, Boyden JY, Johnston EE, Hinds P, Friebert S, et al. Relationship between parental distress and proxy symptom reports in pediatric palliative care. J Pain Symptom Manage. 2025;69(6):654–62. doi:10.1016/j.jpainsymman.2025.03.007. Mikelyte R, Harrison Dening K, Oliveira D, Vanelli JM, Neves AF, Dekker NL, et al. “It’s my life, it’s my choice and I want to say when” vs “A good death is to be on good terms with God”: Comparing the views of people with dementia in the UK and Brazil about a good death—a cross-cultural qualitative study. BMC Palliat Care. 2025;24:138. doi:10.1186/s12904-025-01771-w. Neff KD, Germer CK. A pilot study and randomized controlled trial of the mindful self‐compassion program. J Clin Psychol. 2013;69(1):28–44. Fontes CM, Polidoro M, Martins MC. A sobrecarga do cuidador de crianças com condições crônicas complexas. Rev Paul Pediatr. 2019;37(4):458–64. Ministério da Saúde (BR). Diretrizes para o cuidado das pessoas com doenças crônicas nas redes de atenção à saúde e nas linhas de cuidado prioritárias. Brasília (DF): MS; 2013. American Academy of Pediatrics. Patient-and family-centered care and the pediatrician’s role. Pediatrics. 2012;129(2):394-404. Contim D, Chaud MN, Fonseca AS. The children and teenagers with chronic disease and family questions: a literature review. Revista Nursing. 2005 Jun; 85: 267-71 Kissane DW. The challenge of family-centered care in palliative medicine. Ann Palliat Med 2016;5(4):319-321. doi: 10.21037/apm.2016.08.04. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 28 Apr, 2026 Reviews received at journal 16 Apr, 2026 Reviewers agreed at journal 10 Apr, 2026 Reviewers agreed at journal 09 Apr, 2026 Reviewers invited by journal 07 Apr, 2026 Editor invited by journal 19 Mar, 2026 Editor assigned by journal 18 Mar, 2026 Submission checks completed at journal 18 Mar, 2026 First submitted to journal 14 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9125155","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":621688001,"identity":"e83d9ec7-e19c-4473-9b99-6a6175f765f7","order_by":0,"name":"Camila Padula Domingues","email":"","orcid":"","institution":"Federal University of São Paulo","correspondingAuthor":false,"prefix":"","firstName":"Camila","middleName":"Padula","lastName":"Domingues","suffix":""},{"id":621688002,"identity":"f8bddf07-b3b7-4a52-96ce-79118d19799d","order_by":1,"name":"Aline Maria de Oliveira Rocha","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABC0lEQVRIie3OMWrDMBSA4ScEKgUnXlUEzhUcBIbSy8hLvYQ2IYuHDoaAsuQACintFTJlNgjSpQfoYEpDwbPBUDp0iJy0FBIUr4Xqn9576AMBuFx/sTOU7QcKkFcpAMF5s+Z2gn8J2qhnQ4hoIz8DBczPpRnaiD/B8q2C18BfTEqGHvRNl2BdD6G4tRGq0bSvYMxpsY7YaKXHhJBrpqC8zGxGI8k8EPGSiojNVzqWvVmEPdChTfQa8rUjyQfr3BtC/Lo+RcKGwI4MOO9kDfGAnSJ9Qy5moeD0ZTDaqHViCImYCksrCZ6mJf1MReCrZJlXd1fxo8Tv9TAtrOT7ewc7Prq0htufuFwu1z9qC97KUy0pmxERAAAAAElFTkSuQmCC","orcid":"","institution":"Centro Universitário São Camilo","correspondingAuthor":true,"prefix":"","firstName":"Aline","middleName":"Maria de Oliveira","lastName":"Rocha","suffix":""},{"id":621688003,"identity":"2d375162-c826-465a-842a-7d65c3ed9551","order_by":2,"name":"Rafaela Moura de Souza","email":"","orcid":"","institution":"Federal University of São Paulo","correspondingAuthor":false,"prefix":"","firstName":"Rafaela","middleName":"Moura","lastName":"de Souza","suffix":""},{"id":621688004,"identity":"85c17777-8cbb-4dad-9aa3-3a5800d2a7da","order_by":3,"name":"Simone Brasil de Oliveira Iglesias","email":"","orcid":"","institution":"Federal University of São Paulo","correspondingAuthor":false,"prefix":"","firstName":"Simone","middleName":"Brasil de Oliveira","lastName":"Iglesias","suffix":""}],"badges":[],"createdAt":"2026-03-14 21:53:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9125155/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9125155/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106871688,"identity":"c3c34d04-9920-4255-ba73-2f2a2875c005","added_by":"auto","created_at":"2026-04-14 09:50:12","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":116173,"visible":true,"origin":"","legend":"\u003cp\u003eProportion of major complex chronic conditions among patients whose caregivers were interviewed.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9125155/v1/f98a2a408efc96ed2555e07a.png"},{"id":106961062,"identity":"8ccce535-fdb5-4532-8605-c0d90deed254","added_by":"auto","created_at":"2026-04-15 09:24:06","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":819596,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9125155/v1/b3ee3fbe-1731-4fbe-a531-449b97a54366.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eSelf-Compassion Among Caregivers of Children with Complex Chronic Conditions: A Cross-Sectional Study in a Pediatric Ward\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eAdvances in medicine and technology in recent decades have contributed significantly to increased survival rates among children with complex chronic conditions, which require continuous and specialized care\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eOne of the most widely used definitions to characterize children with complex chronic conditions (CCC) is that proposed by Feudtner et al., which considers: (1) the presence of a health condition with a minimum expected duration of 12 months (unless death occurs before that period) and (2) involvement of more than one organ system, or a single system with sufficient severity to require specialized care and, likely, tertiary-level hospitalizations\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThese conditions, generally characterized by multisystem involvement and prolonged evolution, dependence on technologies, and frequent and prolonged hospitalizations, have a significant impact on the functionality and quality of life of patients and their families\u0026sup2;\u003csup\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. Their very definition reinforces the clinical and care complexity of these children and highlights the need for comprehensive, coordinated, and continuous care. In pediatric hospital settings, caregivers and guardians play a central role in daily care, often immersed in routines marked by uncertainty, emotional overload, and subjective suffering\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe experience of caring for a child with a chronic illness imposes a restructuring of family life, requiring the abandonment of work activities, the redirection of social roles, and the confrontation of profound existential issues\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. The effects of this often prolonged and unpredictable experience are associated with high levels of stress and can trigger significant damage to caregivers' mental health, such as symptoms of anxiety, depression, physical and emotional exhaustion, as well as feelings of guilt, inadequacy, and loneliness. In this context, identifying protective factors and internal resources becomes essential to mitigate negative impacts and promote well-being. Self-compassion emerges as a relevant emotional skill, related to affective regulation and the reduction of psychological distress\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe care of children with CCC is not restricted to the period of hospitalization but extends to all levels of health care. The primary level, which is preventive in nature, involves actions carried out mainly in Basic Health Units, such as home visits and care by family health teams. The secondary level comprises specialized care in areas such as neurology, cardiology and pediatric gastroenterology, usually performed in outpatient clinics or medium-complexity hospitals. The tertiary level focuses on highly complex care, involving the use of advanced technologies and high-cost treatments, such as chemotherapy and prolonged hospitalizations. The comprehensiveness and coordination between these levels are essential to reduce acute complications, minimize hospitalizations and, above all, ensure quality of life inside and outside the hospital environment\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn this scenario, recognizing the family as a key player in care becomes a fundamental principle. Family-centered care values the caregiver as an active participant in the therapeutic plan, responsible for decisions, interventions and emotional support for the child\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. The healthcare team must understand that the family carries with it unique values, beliefs and histories, which must be respected and considered in the construction of shared care. The primary caregiver plays the role of a reference figure, being responsible for decisions and the daily management of the child's condition. Secondary caregivers, such as grandparents, uncles, aunts and siblings, participate in a complementary manner. Recognizing this network and its specificities is essential for strengthening the therapeutic bond and planning emotional and social support strategies\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eSelf-compassion, as mentioned, presents itself in this context as a powerful internal resource. Conceptualized by Kristin Neff as the ability to treat oneself with kindness in difficult situations, recognizing suffering as part of the human experience and maintaining a balanced perspective on emotions, self-compassion has been associated with improved mental health, strengthened resilience, and promoted subjective well-being. It is commonly measured using the Self-Compassion Scale (SCS), an instrument validated for Portuguese and composed of six domains: self-judgment, over-identification, isolation, common humanity, self-kindness and mindfulness. Although the literature on the effects of self-compassion is growing in the fields of psychology and health, there is still a scarcity of studies investigating this construct specifically in caregivers of children hospitalized with chronic diseases\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThus, understanding the levels of self-compassion among caregivers of children with complex chronic conditions who are hospitalized can provide important insights for the development of clinical interventions, public policies and institutional strategies that promote more humane, welcoming, and comprehensive care. Recognizing and valuing the suffering of these caregivers is the first step toward building practices that not only treat the disease but also \u0026ldquo;care for the caregivers.\u0026rdquo; This study aims to assess the levels of self-compassion among caregivers of children with complex chronic conditions who are hospitalized, analyzing contextual factors that may influence this construct.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003e\u003cstrong\u003eStudy design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis is a cross-sectional observational study with a quantitative approach.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLocation and period\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research was conducted in the Pediatric Ward, and data collection took place between November 2023 and March 2024, after approval by the Research Ethics Committee.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePopulation and sample\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study included primary caregivers (mothers, fathers, grandparents) of children and adolescents hospitalized in the unit during the collection period, whose children had chronic diseases with at least 12 months of evolution. The sample was non-probabilistic, for convenience, composed of 24 participants who met the inclusion criteria and agreed to voluntarily participate in the study by signing the Free and Informed Consent Form.\u003c/p\u003e\n\u003cp\u003eExclusion criteria included difficulties in understanding the instrument for linguistic or cognitive reasons, as well as refusal to participate in the interview.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInstrument\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo assess levels of self-compassion, we used the translated and validated version of the Self-Compassion Scale (SCS), developed by Neff et al\u003csup\u003e6\u003c/sup\u003e. The scale consists of 26 items distributed across six domains:\u003c/p\u003e\n\u003cp\u003e• \u0026nbsp; \u0026nbsp; Severe self-criticism (self-judgment),\u003c/p\u003e\n\u003cp\u003e• \u0026nbsp; \u0026nbsp; Over-identification,\u003c/p\u003e\n\u003cp\u003e• \u0026nbsp; \u0026nbsp; Isolation,\u003c/p\u003e\n\u003cp\u003e• \u0026nbsp; \u0026nbsp; Common humanity,\u003c/p\u003e\n\u003cp\u003e• \u0026nbsp; \u0026nbsp; Self-kindness,\u003c/p\u003e\n\u003cp\u003e• \u0026nbsp; \u0026nbsp; Mindfulness.\u003c/p\u003e\n\u003cp\u003eEach item is answered on a 5-point Likert scale, ranging from 1 (“almost never”) to 5 (“almost always”). Domains with negative scores (self-criticism, over-identification, and isolation) were recoded according to the original author’s guidelines, enabling the calculation of the overall self-compassion score.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection procedures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe interviews were conducted in a private room to ensure the privacy and comfort of the participants. The questionnaires were administered in person, with the assistance of the researcher, after reading and signing the informed consent form. The average duration of the application was 30 minutes.\u003c/p\u003e\n\u003cp\u003eIn addition to the Self-Compassion Scale (SCS), a sociodemographic characterization form was administered, containing information such as age, gender, degree of kinship with the child, number of children, education level, presence of a support network, and religiosity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data were organized in a spreadsheet (Microsoft Excel®) and analyzed using descriptive statistics, using measures of central tendency (mean), dispersion (standard deviation), and absolute and relative frequencies. The overall mean of the self-compassion scale and the scores for each of its domains were presented in tabular and graphical formats.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical aspects\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe project was approved by the institution's Research Ethics Committee under CAAE No. 66131322.1.0000.5505. All participants signed the TCLE, ensuring the principles of autonomy, confidentiality, and voluntary participation, in accordance with Resolution No. 466/2012 of the National Health Council.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eTwenty-four primary caregivers of children and adolescents hospitalized with chronic health conditions participated in the study. The mean age of participants was 35.2 years (SD\u0026thinsp;\u0026plusmn;\u0026thinsp;9.87), with a predominance of females (95.8%). Most caregivers were mothers (91.3%), followed by grandparents (8.7%). The average number of children per caregiver was 2.67 (SD\u0026thinsp;\u0026plusmn;\u0026thinsp;1.43). Regarding religiosity, 87.5% reported having a religion, with 52.3% being Catholic, 42.8% Evangelical and 4.7% belonging to other denominations. Regarding the support network, 62.5% reported receiving support, mainly from parents, grandparents and aunts, as described in Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u0026nbsp;\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDemographic data of caregivers.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eAge group (years)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003ePercentage (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eSupport network\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003ePercentage (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e25\u0026ndash;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e41.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e62.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e31\u0026ndash;41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e41.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e37.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e16.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eDegree of kinship\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e\u003cstrong\u003eReligion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eMother\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e87.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eCatholic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e45.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eGrandmother\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e8.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eEvangelical\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e37.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eFather\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eProtestant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e12.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eDemographic issues related to the hospitalized children themselves were also analyzed, as shown in Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and Fig. \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e below.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDemographic data of hospitalized children and adolescents.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eAge group (years)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\n \u003cp\u003ePercentage (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\n \u003cp\u003e33.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e5\u0026ndash;10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\n \u003cp\u003e45.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\n \u003cp\u003e20.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration of illness leading to hospitalization (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e1\u0026ndash;4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\n \u003cp\u003e70.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e5\u0026ndash;10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\n \u003cp\u003e20.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\n \u003cp\u003e8.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eIllness leading to hospitalization (medical specialty)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eHematology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e25.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eUrology/Nephrology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e20.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eGastroenterology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e16.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003ePulmonology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e12.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eNeurology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e12.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eOthers (genetics, rheumatology, otorhinolaryngology)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e12.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eTable \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003c/p\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003eScores on the Self-Compassion Scale (SCS)\u003c/h2\u003e\n \u003cp\u003eThe overall mean score on the Self-Compassion Scale was 3.13 (SD\u0026thinsp;\u0026plusmn;\u0026thinsp;0.52), ranging from 1.8 to 4.1. Among the six domains assessed, greater impairment was observed in the domain of severe self-criticism (mean\u0026thinsp;=\u0026thinsp;2.94; SD\u0026thinsp;\u0026plusmn;\u0026thinsp;0.69). The other domains had the following means:\u003c/p\u003e\n \u003cp\u003e\u0026bull; \u0026nbsp; \u0026nbsp; Over-identification: 3.03 (SD \u0026plusmn; 0.82)\u003c/p\u003e\n \u003cp\u003e\u0026bull; \u0026nbsp; \u0026nbsp; Isolation: 3.43 (SD \u0026plusmn; 1.07)\u003c/p\u003e\n \u003cp\u003e\u0026bull; \u0026nbsp; \u0026nbsp; Common humanity: 3.34 (SD \u0026plusmn; 0.74)\u003c/p\u003e\n \u003cp\u003e\u0026bull; \u0026nbsp; \u0026nbsp; Self-kindness: 3.06 (SD \u0026plusmn; 0.70)\u003c/p\u003e\n \u003cp\u003e\u0026bull; \u0026nbsp; \u0026nbsp; Mindfulness: 3.00 (SD \u0026plusmn; 0.68\u003c/p\u003e\n \u003cp\u003eTable \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\" class=\"fr-table-selection-hover\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eMean scores obtained in the Self-Compassion Scale questionnaire. Items rated on a Likert scale ranging from 1 (almost never) to 5 (almost always).\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eItem\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eI disapprove of and judge myself for my mistakes and inadequacies.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e3.125\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eWhen I\u0026rsquo;m feeling down, I tend to obsess and fixate on everything that\u0026rsquo;s wrong.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e3.083\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eWhen things go wrong, I see difficulties as part of life that everyone goes through.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e3.125\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eWhen I think about my flaws and inadequacies, I feel more separate and disconnected from the rest of the world.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e3.541\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eI try to be caring toward myself when I\u0026rsquo;m experiencing emotional pain.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e3.125\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eWhen I fail at something important to me, I beat myself up with feelings of inadequacy.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e2.958\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eWhen I\u0026rsquo;m feeling down, I remind myself that many others feel the same way.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e3.500\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eWhen going through tough times, I tend to be very hard and demanding on myself.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e2.291\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eWhen something upsets or saddens me, I try to keep my emotional balance.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e3.041\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eWhen I feel inadequate in some way, I try to remind myself that most people feel that way at times.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e3.375\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eI am intolerant and impatient with aspects of my personality I don\u0026rsquo;t like.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e3.250\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eWhen I go through a truly difficult time, I give myself the tenderness and care I need.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e3.083\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eWhen I\u0026rsquo;m feeling down, I tend to think that most people are probably happier than I am.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e3.625\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eWhen something painful happens, I try to have a balanced view of the situation.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e3.083\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eI try to see my mistakes and flaws as part of the human condition.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e3.375\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eWhen I see aspects of myself I don\u0026rsquo;t like, I feel really down.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e3.166\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eWhen I fail at something important to me, I try to keep things in perspective (not dramatize).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e3.083\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eWhen I feel overwhelmed, I tend to think others have it easier than I do.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e3.500\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eI am tolerant and affectionate toward myself when I experience suffering.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e2.958\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eWhen something upsets or saddens me, I let myself get carried away by my feelings.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e3.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eI can be quite cold and harsh with myself when I\u0026rsquo;m suffering.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e2.875\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eWhen I\u0026rsquo;m feeling down, I try to look at my feelings with curiosity and openness.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e2.541\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eI am tolerant of my mistakes and inadequacies.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e3.083\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eWhen something painful happens, I tend to exaggerate its significance.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e3.083\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eWhen I fail at something important to me, I feel alone in my failure.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e3.083\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eI try to be understanding and patient with aspects of my personality I don\u0026rsquo;t like.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e3.250\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eThe domains related to self-deprecating feelings (self-criticism, over-identification, and isolation) had scores equal to or above 3, suggesting significant levels of emotional distress among participants. In contrast, domains related to emotional self-regulation and self-empathy had moderate averages, with no predominance of high scores, which may indicate less internalization of positive self-compassion strategies.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study sought to assess levels of self-compassion among caregivers of children with chronic conditions admitted to pediatric wards. The results show that, although the overall mean score on the Self-Compassion Scale was moderate (3.13), the severe self-criticism domain had the lowest scores, indicating greater emotional fragility in this dimension.\u003c/p\u003e \u003cp\u003eThese findings are consistent with the literature that points to the presence of feelings of inadequacy, guilt and self-punishment among family caregivers of children with chronic diseases, especially in prolonged hospital settings\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. The predominance of women (mothers) in the role of caregivers, as observed in this study, has also been described as a factor associated with greater emotional overload and lower levels of self-care\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eInternational studies show that self-compassion, understood as the ability to offer oneself understanding and acceptance in the face of suffering, is strongly associated with a reduction in anxiety and depressive symptoms in populations exposed to chronic stress situations, such as family members of hospitalized patients\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e,\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. In the present study, the domains related to self-kindness and mindfulness had scores close to the overall average, suggesting that, although emotional suffering is present, caregivers maintain, to some extent, internal resources for affective regulation\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe dimension of \u0026ldquo;common humanity,\u0026rdquo; which represents the perception that pain is part of the shared experience among human beings, showed preserved scores, which may be related to the presence of religiosity (87.5% of participants) and the perception of community belonging, often associated with spirituality. The literature points out that faith can be an important coping strategy and promote resilience among family members of children with complex illnesses\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eOn the other hand, high scores in the domains of isolation and over-identification reflect the impact of the hospital experience on caregivers, who, in assuming the role of emotional and practical reference for the sick child, may neglect their own emotional needs and experience feelings of loneliness, even when inserted in family contexts. This split between the care offered and the care received is one of the main gaps observed in family-centered pediatric care\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe data obtained reinforce the importance of institutional actions that promote compassionate care also directed at caregivers, recognizing their suffering as an integral part of the care process. Strategies such as support groups, psychological support and training of health professionals in empathic communication can contribute to mitigating subjective suffering and favoring the preservation of caregivers' mental health in the hospital environment.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eCaregivers of children with chronic conditions who are hospitalized showed moderate levels of self-compassion, with lower scores in the domains of self-criticism and isolation. These data indicate significant emotional vulnerability, which is often overlooked in the hospital setting but can affect both the caregiver's well-being and the quality of care provided to the child.\u003c/p\u003e \u003cp\u003eRecognizing these emotional patterns is essential for implementing more humane and family-centered interventions. Understanding the limitations and internal resources of these caregivers enables the development of more sensitive emotional support strategies, promoting mental health and strengthening the bond between caregiver and child.\u003c/p\u003e \u003cp\u003eIn view of this, it is recommended that health services also extend their attention to family members through psychological support, qualified listening, and compassionate care. Incorporating these actions into the hospital routine is essential for truly comprehensive and humanized pediatric care.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding Statement:\u0026nbsp;\u003c/strong\u003eOne of the authors (CPD) receives scientific initiation scholarship to carry out this work. The funding sources had no influence on the study design, data collection, analysis and interpretation or the writing of the manuscript. \u0026nbsp;We believe that this declaration covers all relevant interests related to the research presented in our manuscript. We assure you that we have taken utmost care to maintain the objectivity and scientific integrity of our study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003eThis study was conducted in accordance with the Declaration of Helsinki. Ethical approval was obtained from the Research Ethics Committee of the Federal University of São Paulo (UNIFESP) (CAAE No. 66131322.1.0000.5505). All participants were informed about the objectives and procedures of the study and provided written informed consent prior to data collection, in accordance with Resolution No. 466/2012 of the Brazilian National Health Council.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u003c/strong\u003e Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest:\u0026nbsp;\u003c/strong\u003eThe authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eCamila Padula Domingues. Contribution: Conceptualization, Study Design, Data Collection, Data Analysis, Manuscript Writing.-Aline Maria de Oliveira Rocha. Contribution: Data analysis, Manuscript writing, Study supervision.-Rafaela Moura de Souza. Contribution: Conceptualization, Study design, Data collection, Data analysis, Manuscript review, Study supervision.-Simone Brasil de Oliveira Iglesias. Contribution: Conceptualization, Study design, Data analysis, Manuscript review, Study supervision.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe would like to thank the team at the Pediatric Ward of UNIFESP, Hospital S\u0026atilde;o Paulo and the study participants.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eFeudtner, C.; Hays, R.M.; Haynes, G.; Geyer, J.R.; Neff, J.M.; Koepsell, T.D. Deaths attributed to pediatrics complex chronic conditions: national trends and implications for supportive cara services. Pedriatr 2001; 107 (6): E99.\u003c/li\u003e\n\u003cli\u003eCohen, E.; Kuo, D.Z.; Agrawal, R.; Berry, J.G.; Bhagat, S.K.M.; Simon, T.D. et al. Children With Medical Complexity: An Emerging Population for Clinical and Research Initiatives. Pediatr. 2011; 127(3):529-538.\u003c/li\u003e\n\u003cli\u003ePassone CGB, Grisi SJ, Farhat SC, et al. Complexity of Pediatric Chronic Disease: Cross‑Sectional Study with 16 237 Patients Followed by Multiple Medical Specialties. Rev Paul Pediatr. 2020;38:e2018101. doi:10.1590/1984‑0462/2020/38/2018101.\u003c/li\u003e\n\u003cli\u003ePereira IC. Cuidadores familiares de crian\u0026ccedil;as com doen\u0026ccedil;as cr\u0026oacute;nicas: o impacto da doen\u0026ccedil;a [disserta\u0026ccedil;\u0026atilde;o de mestrado]. Lisboa: ISPA \u0026ndash; Instituto Universit\u0026aacute;rio; 2021.\u003c/li\u003e\n\u003cli\u003eJones BL, Contro N, Koch KD. The duty of the physician to care for the family in pediatric palliative care: context, communication, and caring. Pediatrics. 2014 Feb;133 Suppl 1:S8-15. doi: 10.1542/peds.2013-3608C. PMID: 24488541.\u003c/li\u003e\n\u003cli\u003eNeff KD. Self-compassion: An alternative conceptualization of a healthy attitude toward oneself. \u003cem\u003eSelf Identity.\u003c/em\u003e 2003;2(2):85\u0026ndash;101.\u003c/li\u003e\n\u003cli\u003eJunior, Helv\u0026eacute;cio Miranda Magalh\u0026atilde;es. \u0026quot;Redes de Aten\u0026ccedil;\u0026atilde;o \u0026agrave; Sa\u0026uacute;de: rumo \u0026agrave; integralidade.\u0026quot; Divulga\u0026ccedil;\u0026atilde;o em sa\u0026uacute;de para debate [on-line] 52 (2014): 15-37.\u003c/li\u003e\n\u003cli\u003eAra\u0026uacute;jo YB, Collet N, Gomes IP, N\u0026oacute;brega RD. Enfrentamento do adolescente em condi\u0026ccedil;\u0026atilde;o cr\u0026ocirc;nica: import\u0026acirc;ncia da rede social. Rev Bras Enferm. 2011 Mar-Abr; 64(2):281-6. 6. Pizzignacco TMP, Mello\u003c/li\u003e\n\u003cli\u003ePeterson-Carmichael SL, Cheifetz IM. The chronically critically ill patient: pediatric considerations. Respiratory Care. 2012 Jun; 57(6):993-1002.\u003c/li\u003e\n\u003cli\u003eSouza LE, Rocha RG, Santos MJ. Espiritualidade como estrat\u0026eacute;gia de enfrentamento em contextos de doen\u0026ccedil;a pedi\u0026aacute;trica cr\u0026ocirc;nica. \u003cem\u003ePsicol Sa\u0026uacute;de Doen\u0026ccedil;as.\u003c/em\u003e 2022;23(2):453\u0026ndash;66.\u003c/li\u003e\n\u003cli\u003eHill DL, Nye RT, Boyden JY, Johnston EE, Hinds P, Friebert S, et al. Relationship between parental distress and proxy symptom reports in pediatric palliative care. \u003cem\u003eJ Pain Symptom Manage.\u003c/em\u003e 2025;69(6):654\u0026ndash;62. doi:10.1016/j.jpainsymman.2025.03.007.\u003c/li\u003e\n\u003cli\u003eMikelyte R, Harrison Dening K, Oliveira D, Vanelli JM, Neves AF, Dekker NL, et al. \u0026ldquo;It\u0026rsquo;s my life, it\u0026rsquo;s my choice and I want to say when\u0026rdquo; vs \u0026ldquo;A good death is to be on good terms with God\u0026rdquo;: Comparing the views of people with dementia in the UK and Brazil about a good death\u0026mdash;a cross-cultural qualitative study. \u003cem\u003eBMC Palliat Care.\u003c/em\u003e 2025;24:138. doi:10.1186/s12904-025-01771-w.\u003c/li\u003e\n\u003cli\u003eNeff KD, Germer CK. A pilot study and randomized controlled trial of the mindful self‐compassion program. \u003cem\u003eJ Clin Psychol.\u003c/em\u003e 2013;69(1):28\u0026ndash;44.\u003c/li\u003e\n\u003cli\u003eFontes CM, Polidoro M, Martins MC. A sobrecarga do cuidador de crian\u0026ccedil;as com condi\u0026ccedil;\u0026otilde;es cr\u0026ocirc;nicas complexas. \u003cem\u003eRev Paul Pediatr.\u003c/em\u003e 2019;37(4):458\u0026ndash;64.\u003c/li\u003e\n\u003cli\u003eMinist\u0026eacute;rio da Sa\u0026uacute;de (BR). Diretrizes para o cuidado das pessoas com doen\u0026ccedil;as cr\u0026ocirc;nicas nas redes de aten\u0026ccedil;\u0026atilde;o \u0026agrave; sa\u0026uacute;de e nas linhas de cuidado priorit\u0026aacute;rias. Bras\u0026iacute;lia (DF): MS; 2013.\u003c/li\u003e\n\u003cli\u003eAmerican Academy of Pediatrics. Patient-and family-centered care and the pediatrician\u0026rsquo;s role. Pediatrics. 2012;129(2):394-404.\u003c/li\u003e\n\u003cli\u003eContim D, Chaud MN, Fonseca AS. The children and teenagers with chronic disease and family questions: a literature review. Revista Nursing. 2005 Jun; 85: 267-71\u003c/li\u003e\n\u003cli\u003eKissane DW. The challenge of family-centered care in palliative medicine. Ann Palliat Med 2016;5(4):319-321. doi: 10.21037/apm.2016.08.04.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Self-compassion, Chronic Diseases, Palliative Care, Caregivers, Pediatrics, Mental Health","lastPublishedDoi":"10.21203/rs.3.rs-9125155/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9125155/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eTo assess levels of self-compassion among caregivers of children with chronic conditions admitted to a pediatric ward, exploring associated sociodemographic and contextual factors.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eAn observational, cross-sectional study with a quantitative approach was conducted between November 2023 and March 2024, involving 24 caregivers of children admitted to the Clinical Pediatrics Ward of a tertiary hospital. Participants completed the Self-Compassion Scale (SCS) and sociodemographic data were collected through structured questionnaires. Descriptive statistics were used to analyze the domain sof self-compassion and caregivers\u0026rsquo; characteristics.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe overall mean score on the SCS was 3.13 (SD\u0026thinsp;\u0026plusmn;\u0026thinsp;0.52), ranging from 1.8 to 4.1. The domain with the greatest impairment was excessive self-criticism (mean\u0026thinsp;=\u0026thinsp;2.94; SD\u0026thinsp;\u0026plusmn;\u0026thinsp;0.69), followed by feelings of isolation. Most caregivers were mothers (91.3%), with a mean age of 35.2 years (SD\u0026thinsp;\u0026plusmn;\u0026thinsp;9.87). A support network was reported by 62.5%, and 87.5% declared religiosity. Additionally, the majority had low to medium socioeconomic status, with prolonged involvement in daily care of their children.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eCaregivers of hospitalized children with chronic conditions showed moderate levels of self-compassion, with a predominance of self-criticism and isolation. These findings highlight the importance of institutional strategies that foster emotional support and resilience among family members, contributing to more comprehensive and compassionate pediatric care.\u003c/p\u003e","manuscriptTitle":"Self-Compassion Among Caregivers of Children with Complex Chronic Conditions: A Cross-Sectional Study in a Pediatric Ward","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-14 09:50:09","doi":"10.21203/rs.3.rs-9125155/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-28T17:46:40+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-16T20:13:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"149533410560255001857476845769071772326","date":"2026-04-10T19:34:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"48510636454005748249349031091881313943","date":"2026-04-09T14:31:05+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-07T09:08:40+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-19T06:56:59+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-19T01:34:59+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-19T01:34:37+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pediatrics","date":"2026-03-14T21:46:03+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"36e3c254-7d4b-482b-aeb9-43fbe286bfd8","owner":[],"postedDate":"April 14th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-14T09:50:09+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-14 09:50:09","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9125155","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9125155","identity":"rs-9125155","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}