Vulnerability beyond infection: Effects of peer victimization on quality of life and psychosocial well-being in inborn errors of immunity.
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BACKGROUND: Inborn errors of immunity (IEIs) comprise a heterogeneous group of over 500 genetic disorders characterized by increased susceptibility to infections, autoimmunity, and malignancy. Beyond their biological burden, IEIs may impose substantial psychosocial challenges due to frequent hospitalizations, prolonged treatments, and perceived social differences. Although bullying is a recognized determinant of anxiety, depression, and impaired quality of life (QoL), its impact in children with IEIs remains poorly understood. This study investigated the relationship between peer victimization (PV), psychological symptoms, and QoL among children with IEI. METHODS: A case-control study was conducted at the Department of Pediatric Immunology and Allergy, ***University, including children aged 8-18 years with confirmed IEI and healthy controls (HCs) with similar age and sex distribution. Questionnaires were used to evaluate the PV, psychological status, and QOL of children and adolescents with and without IEI. RESULTS: Fifty-nine patients and sixty-five HCs (median age 13 years) were enrolled. Predominantly antibody deficiencies represented the most common IEI category (39%). No significant difference was found between the study and HCs for PV, depression state and trait anxiety. Patients demonstrated significantly lower PedsQL school, psychosocial, and total scores compared with HCs (p = .004, p = .021, p = .018, respectively). Peer victimization correlated negatively with psychosocial health and positively with anxiety and depression scores. Regression analysis identified peers' awareness of the illness, RCADS total score and property-related victimization as independent predictors of poorer psychosocial outcomes. CONCLUSION: Children with IEI constitute a psychosocially vulnerable population. Routine psychosocial screening and integrated mental health support are essential for comprehensive care and improved quality of life.