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Ay A, Semerci R, Savaş EH, Sarıdağ KNK. Development and psychometric analysis of care needs scale for mothers of children with congenital heart disease. J Pediatr Nurs 2024; 78:51-59. [PMID: 38865825 DOI: 10.1016/j.pedn.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 05/31/2024] [Accepted: 06/05/2024] [Indexed: 06/14/2024]
Abstract
PURPOSE This cross-sectional study aimed to create and evaluate a care needs scale for mothers of children with congenital heart disease (CHD) to determine its psychometric properties. DESIGN AND METHODS This methodological research was conducted with 155 mothers whose children were diagnosed with CHD and were treated at a university hospital. The study's methodology included scale development, specialist opinions, and a pilot test. Data analysis involved descriptive statistics, exploratory and confirmatory factor analyses, and reliability assessments. RESULTS The 11-item scale was created using component analysis, expert comments, and pilot testing. It was divided into two categories: Information Needs Regarding Disease and Treatment and Needs Regarding Care. The Exploratory Factor Analysis revealed a 2-factor structure, explaining 41.5% of the variance. Reliability analysis showed reliable dimensions, and Tukey's scalability test indicated the scale requires separate dimension evaluation. The model fit indices were obtained as CMIN/DF (72.751/41) = 1.774, GFI = 0.925, IFI = 0.923, TLI = 0.893, CFI = 0.920, RMSEA = 0.071, SRMR = 0.063. The Cronbach's alpha coefficient for subdimension 1 was 0.758, and for subdimension 2 was 0.678, indicating reliable dimensions. CONCLUSION The developed scale provides a valuable tool for assessing the care needs of mothers of children with CHD, contributing to enhancing maternal support programs in pediatric cardiology clinics. PRACTICE IMPLICATIONS Assessment of the care needs of mothers who have children with CHD is promising for the development of educational programs on this subject and to ensure the competence of mothers for care.
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Affiliation(s)
- Ayşe Ay
- Nursing Department, Faculty of Health Sciences, Başkent University, Ankara, Turkey.
| | - Remziye Semerci
- Child and Disease Nursing Department, Nursing Faculty, Koç University, İstanbul, Turkey
| | - Eyşan Hanzade Savaş
- Child and Disease Nursing Department, Nursing Faculty, Koç University, İstanbul, Turkey
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Cassedy A, Wray J, Qadir AA, Ernst MM, Brown K, Franklin R, Wernovsky G, Marino BS. Behavioral and Emotional Outcomes in Children with Congenital Heart Disease: Effects of Disease Severity, Family Life Stress, Disease-Related Chronic Stress, and Psychosocial Adaptation. J Pediatr 2023; 259:113450. [PMID: 37164178 DOI: 10.1016/j.jpeds.2023.113450] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 04/03/2023] [Accepted: 04/21/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE To evaluate whether effects of congenital heart disease (CHD) severity and family life stress on behavioral and emotional functioning are mediated by disease-related chronic stress and psychosocial adaptation. STUDY DESIGN A cross-sectional analysis of the Pediatric Cardiac Quality of Life Inventory Testing Study was performed. Relationships between CHD severity (comprising 3 groups: mild heart disease, moderate biventricular disease, and single ventricle) and family life stress, on patient- and parent disease-related chronic stress, psychosocial adaptation, and behavioral-emotional outcomes were assessed using structural equation modeling. Patient and parent models were reported separately. RESULTS There were 981 patient-parent dyads: 22% had mild heart disease, 63% biventricular, and 15% single ventricle; 19% of families reported moderate to major family life stress. Path models revealed that CHD severity and family life stress were mediated by disease-related chronic stress and psychosocial adaptation factors (R2 = 0.18-0.24 for patient outcomes and R2 = 0.33-0.34 for parent outcomes, P < .001, respectively). CONCLUSIONS The effects of greater CHD severity and family life stress on behavioral-emotional outcomes were mediated by worse disease-related chronic stress and psychosocial adaptation factors. Both disease-related chronic stress and psychosocial adaptation factors may be targets for interventions to improve behavioral and emotional outcomes.
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Affiliation(s)
- Amy Cassedy
- Division of Biostatistics and Epidemiology at Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
| | - Jo Wray
- Heart and Lung Directorate, Department of Pediatric Cardiology, Great Ormond Street Hospital for Children NHS Foundation Trust and NIHR GOSH BRC, London, United Kingdom
| | - Asad A Qadir
- Division of Cardiology, Pediatric Heart Center, University of Texas Health Science Center San Antonio, San Antonio, TX
| | - Michelle M Ernst
- Department of Pediatrics, University of Cincinnati College of Medicine, Division of Behavioral Medicine at Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Katherine Brown
- Heart and Lung Directorate, Department of Pediatric Cardiology, Great Ormond Street Hospital for Children NHS Foundation Trust and NIHR GOSH BRC, London, United Kingdom
| | - Rodney Franklin
- Department of Pediatric Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Gil Wernovsky
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Divisions of Cardiac Critical Care and Pediatric Cardiology, Children's National Hospital, Washington, DC
| | - Bradley S Marino
- Department of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland, OH
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Davey BT, Lee JH, Manchester A, Gunnlaugsson S, Ohannessian CM, Rodrigues R, Popp J. Maternal Reaction and Psychological Coping After Diagnosis of Congenital Heart Disease. Matern Child Health J 2023; 27:671-679. [PMID: 36786936 DOI: 10.1007/s10995-023-03599-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2023] [Indexed: 02/15/2023]
Abstract
OBJECTIVES A diagnosis of congenital heart disease (CHD) during fetal life or infancy can be devastating for parents, resulting in significant psychological stressors. The goals of this study were to (1) assess maternal resolution and adaptation to a new diagnosis of CHD, (2) explore how maternal resolution and adaptation relates to psychological well-being and (3) evaluate whether specific illness parameters impact resolution status. METHODS This cross-sectional study evaluated resolution to diagnosis in the first 6 months of life for mothers of children with CHD. Mothers completed a Reaction to Diagnosis Interview (RDI) and psychological surveys assessing stress, depression, and coping skills. The RDI invites parents to discuss the diagnosis, changes in their thoughts and feelings since the diagnosis, and reflections on why they think they have a child with a medical condition. A chart review of the child recording illness parameters was also performed. RESULTS Thirty-six mothers participated in this study. Twelve of their children had a prenatal diagnosis of CHD (33.3%). Seventeen mothers (47.2%) were unresolved to the diagnosis of CHD in their child, regardless of the timing or severity of the diagnosis. Twenty-four participants (68.6%) had significant or highly significant life stress and 9 participants (25.7%) had clinical concerns or met criteria for Post-Traumatic Stress Disorder. Nineteen mothers (55.9%) were at risk for clinical depression. Mothers unresolved to the diagnosis had higher rates of post-traumatic stress than those resolved to the diagnosis (47.1% vs. 10.5%, p = 0.03). Mothers of infants with a prenatal diagnosis of CHD reported significantly lower rates of life stress despite higher severity of heart defects (p = 0.02). CONCLUSIONS FOR PRACTICE Mothers of infants with CHD have similar proportions of resolution to diagnosis compared to mothers of children with other chronic diseases. They experience a high rate of symptoms of life stress, post-traumatic stress and clinical depression. Symptoms of post-traumatic stress are higher in mothers unresolved to the diagnosis. Identification of those at highest risk for poor adaptation to the diagnosis may allow for targeted psychological support services for those most vulnerable.
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Affiliation(s)
- Brooke T Davey
- Division of Cardiology, Connecticut Children's, 282 Washington St, Hartford, CT, 06106, USA.
- Department of Research, Connecticut Children's, 282 Washington St, Hartford, CT, 06106, USA.
- Department of Pediatrics, University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT, 06030, USA.
| | - Ji Hyun Lee
- Department of Research, Connecticut Children's, 282 Washington St, Hartford, CT, 06106, USA
| | - Alison Manchester
- Department of Human Development and Family Studies, University of Connecticut, 348 Mansfield Road, U-1058, Storrs, CT, 06269-1058, USA
| | - Sigfus Gunnlaugsson
- Division of Pulmonary Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Christine M Ohannessian
- Family and Child Sciences, Florida State University, 207 Sandels Bldg, Tallahassee, FL, 32306, USA
| | - Rosa Rodrigues
- Department of Research, Connecticut Children's, 282 Washington St, Hartford, CT, 06106, USA
| | - Jill Popp
- The LEGO Foundation, Højmarksvej 8, 7190, Billund, Denmark
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The Relationship of Family Factors to Psychosocial Outcomes in Children with Hypoplastic Left Heart Syndrome at 6 Years of Age. J Pediatr 2022; 255:50-57.e2. [PMID: 36265572 DOI: 10.1016/j.jpeds.2022.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 10/08/2022] [Accepted: 10/12/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The objective of this study was to describe the relationships between family factors and outcomes for children with hypoplastic left heart syndrome (HLHS). STUDY DESIGN This cross-sectional study was ancillary to the Pediatric Heart Network Single Ventricle Reconstruction Extension Study to examine family factors including parental mental health, quality of life (QOL), family resources, function and management, and their relationships to child psychosocial outcomes (adaptive behavior, internalizing and externalizing behaviors and health-related quality of life [HRQOL]) at 6 years of age. RESULTS Participants were parents (115 mothers, 71 fathers) of children with HLHS. Parents reported anxiety, QOL and family resources that were worse than the general population; 33% reported family dysfunction. There were no meaningful differences between reports from mothers and fathers. Parental perception of better child health was associated with better family management of the condition (P < .05). Several family management factors explained a moderate amount of variance in adaptive behavior (ΔR2 = 0.08-0.14), adaptive skills (ΔR2 = 0.19-0.21), and HRQOL scores (ΔR2 = 0.04-0.18); little variance was explained in internalizing problems (ΔR2 = 0.02-0.03) (all P < .05) above and beyond demographic and clinical variables. CONCLUSIONS HLHS has a significant impact on both children and families. Relationships between child and family characteristics may impose risk or protection. Improved understanding of these associations should guide counseling and tailored interventions.
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Holt RF, Kronenberger WG, Pisoni DB. Family Environmental Dynamics Differentially Influence Spoken Language Development in Children With and Without Hearing Loss. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:361-377. [PMID: 34818506 PMCID: PMC9150738 DOI: 10.1044/2021_jslhr-21-00220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/16/2021] [Accepted: 09/07/2021] [Indexed: 05/19/2023]
Abstract
PURPOSE The aim of this study was to evaluate whether families of children with sensorineural hearing loss (SNHL) are organized similarly to those of typically developing, typically hearing (TH) children and whether the dimensions of family dynamics and environment are related to spoken language development similarly in children with and without SNHL. METHOD Primary caregivers of children with SNHL (n = 63) or TH (n = 65) completed the Family Environment Scale-Fourth Edition (FES-4) to assess multiple dimensions of family environment. Children's receptive vocabulary was assessed with the Peabody Picture Vocabulary Test-Fourth Edition, and their receptive language was assessed by an age-appropriate version of the Concepts and Following Directions subtest of the Clinical Evaluation of Language Fundamentals and the Sentence Comprehension subscale of the Comprehensive Assessment of Spoken Language-Second Edition. Principal component analysis was used to examine the dimensional structure of the family environment. RESULTS Three higher order components were derived from FES-4 subscales for both families of children with SNHL and with TH: Supportive, Controlling, and Conflicted. However, the composition of the factors themselves differed between the two groups. For the TH group, most family environment measures on the FES-4 were not associated with language outcomes. In contrast, for children with SNHL, families who were more supportive, less controlling, and less conflicted had children with better language skills. CONCLUSIONS Three well-accepted dimensions of family dynamics and functioning apply to families of children with SNHL, but their composition differs from those of families with TH children. Family environmental dynamics were much more strongly associated with language outcomes in children with SNHL than in their TH peers. The spoken language development of children with SNHL, in particular, is better in families that provide high levels of support for each other and, in particular, low levels of control, disorganization, and conflict, reflecting the fragile nature of their spoken language development.
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Affiliation(s)
- Rachael Frush Holt
- Department of Speech and Hearing Science, The Ohio State University, Columbus
| | - William G. Kronenberger
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis
- DeVault Otologic Research Laboratory, Department of Otolaryngology, Indiana University School of Medicine, Indianapolis
| | - David B. Pisoni
- DeVault Otologic Research Laboratory, Department of Otolaryngology, Indiana University School of Medicine, Indianapolis
- Department of Psychological and Brain Sciences, Indiana University, Bloomington
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Caring for a Child with Hypoplastic Left Heart Syndrome: Parent and Medical Perspective. Cardiol Ther 2021; 11:9-12. [PMID: 34826115 PMCID: PMC8617359 DOI: 10.1007/s40119-021-00246-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Indexed: 11/30/2022] Open
Abstract
This article, co-authored by parents of a child with hypoplastic left heart syndrome (HLHS) and his pediatric cardiology care team, discusses the parents’ experience of having a child with HLHS from diagnosis through living day-to-day with the heart condition as well as future directions.
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Mussatto KA, Van Rompay MI, Trachtenberg FL, Pemberton V, Young-Borkowski L, Uzark K, Hollenbeck-Pringle D, Dunbar-Masterson C, Infinger P, Walter P, Sawin K. Family Function, Quality of Life, and Well-Being in Parents of Infants With Hypoplastic Left Heart Syndrome. JOURNAL OF FAMILY NURSING 2021; 27:222-234. [PMID: 33535863 PMCID: PMC8594631 DOI: 10.1177/1074840720987309] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Survival for hypoplastic left heart syndrome (HLHS) has improved dramatically. Little is known about early family function, quality of life (QOL), or well-being/adjustment for parents of infants with HLHS. Parent/family outcomes over time, predictors, and differences in 143 mothers and 72 fathers were examined. Parents reported better family function compared with published norms, but 26% experienced family dysfunction. QOL and well-being were significantly lower than adult norms. QOL scores generally declined over time, whereas self-reported well-being improved. Responses from mothers and fathers showed different trends, with mothers having worse scores on most measures and at most time points. Being a single parent was a risk factor for poorer family function, but not for lower individual QOL or well-being. Family characteristics, stress, and coping skills were predictive of outcomes. Parents' psychosocial responses to the challenges of life with infants with HLHS change over time. Individually tailored psychosocial support is needed.
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Affiliation(s)
| | | | | | | | | | - Karen Uzark
- C.S. Mott Children's Hospital, Ann Arbor, MI, USA
| | | | | | | | | | - Kathleen Sawin
- Milwaukee School of Engineering, WI, USA
- Children's Hospital of Wisconsin, Milwaukee, USA
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Sood E, Lisanti AJ, Woolf-King SE, Wray J, Kasparian N, Jackson E, Gregory MR, Lopez KN, Marino BS, Neely T, Randall A, Zyblewski SC, Brosig CL. Parent mental health and family functioning following diagnosis of CHD: a research agenda and recommendations from the Cardiac Neurodevelopmental Outcome Collaborative. Cardiol Young 2021; 31:900-914. [PMID: 34082841 PMCID: PMC8759239 DOI: 10.1017/s1047951121002134] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Diagnosis of CHD substantially affects parent mental health and family functioning, thereby influencing child neurodevelopmental and psychosocial outcomes. Recognition of the need to proactively support parent mental health and family functioning following cardiac diagnosis to promote psychosocial adaptation has increased substantially over recent years. However, significant gaps in knowledge remain and families continue to report critical unmet psychosocial needs. The Parent Mental Health and Family Functioning Working Group of the Cardiac Neurodevelopmental Outcome Collaborative was formed in 2018 through support from an R13 grant from the National Heart, Lung, and Blood Institute to identify significant knowledge gaps related to parent mental health and family functioning, as well as critical questions that must be answered to further knowledge, policy, care, and outcomes. Conceptually driven investigations are needed to identify parent mental health and family functioning factors with the strongest influence on child outcomes, to obtain a deeper understanding of the biomarkers associated with these factors, and to better understand how parent mental health and family functioning influence child outcomes over time. Investigations are also needed to develop, test, and implement sustainable models of mental health screening and assessment, as well as effective interventions to optimise parent mental health and family functioning to promote psychosocial adaptation. The critical questions and investigations outlined in this paper provide a roadmap for future research to close gaps in knowledge, improve care, and promote positive outcomes for families of children with CHD.
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Affiliation(s)
- Erica Sood
- Nemours Cardiac Center & Nemours Center for Healthcare Delivery Science, Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA; Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Amy Jo Lisanti
- Department of Nursing and Clinical Care Services, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | | | - Jo Wray
- Centre for Outcomes and Experience Research in Children’s Health, Illness and Disability and NIHR GOSH Biomedical Research Centre, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Nadine Kasparian
- Cincinnati Children’s Center for Heart Disease and Mental Health, Heart Institute and the Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children’s Hospital; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Heart Centre for Children, The Sydney Children’s Hospitals Network, Sydney, Australia
| | - Emily Jackson
- Department of Patient and Family Services, Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA
| | - Mary R. Gregory
- Department of Nursing, School of Nursing and Health Professions, Missouri Western State University, Saint Joseph, Missouri, USA
- Department of Developmental Medicine/Behavior Sciences, Children’s Mercy Hospital, Kansas City, Missouri, USA
| | - Keila N. Lopez
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Bradley S. Marino
- Department of Pediatric Cardiology, Cleveland Clinic Children’s Hospital, Cleveland, Ohio, USA
| | - Trent Neely
- Sisters by Heart/Brothers by Heart, El Segundo, California, USA
| | - Amy Randall
- Mended Little Hearts of Wisconsin, Mended Hearts/Mended Little Hearts, Albany, Georgia, USA
| | - Sinai C. Zyblewski
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Cheryl L. Brosig
- Herma Heart Institute, Children’s Wisconsin, Milwaukee, Wisconsin, USA; Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Roberts SD, Kazazian V, Ford MK, Marini D, Miller SP, Chau V, Seed M, Ly LG, Williams TS, Sananes R. The association between parent stress, coping and mental health, and neurodevelopmental outcomes of infants with congenital heart disease. Clin Neuropsychol 2021; 35:948-972. [PMID: 33706666 DOI: 10.1080/13854046.2021.1896037] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Caring for the complex needs of a child with congenital heart disease (CHD) can place significant burden on the family. Parent mental health and coping have important influences on resilience and neurodevelopmental outcomes in children with CHD. Objectives: To describe the uptake of a cardiac neurodevelopmental program (CNP), examine parent mental health and coping specific to parenting a child with CHD, and explore the relationship between parent mental health and child neurodevelopmental outcomes. Method: Implementation and uptake of the CNP was examined, and forty-four parents of children with CHD completed the DASS and RSQ-CHD. Results: The CNP showed significant uptake in follow-up and interventions offered including 100% completed brain MRIs of eligible patients, 35% increase in neonatal neurology consults, and 100% of families counselled on neurodevelopmental outcomes. A significant proportion of parents endorsed moderate/severe levels of anxiety (25%), depression (20%), and CHD-specific stress. Parents predominantly engaged in secondary control engagement coping (F(2,64)=75.04, p<.001, ηp2=.70). Secondary control engagement coping was associated with lower parent total stress (r=-.48, p=.006) and anxiety (r=-.47, p=.009). Higher parent stress was associated with higher anxiety (r=.45, p=.016), depression (r=.37, p=.05), more severe types of CHD (r=.35, p=.048), older child age (t(30)= -2.33, p=.03), and lower child cognitive scores (r=-.37, p=.045). More severe types of CHD were associated with lower language scores (F(3,35)=3.50, p=.03). Conclusions: This study highlights the relationship between parent mental health and early child cognitive outcomes in CHD and helps inform models of psychological care to reduce family burden and improve child outcomes.
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Affiliation(s)
- Samantha D Roberts
- Division of Neurology, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada.,York University, Toronto, Ontario, Canada
| | - Vanna Kazazian
- Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Meghan K Ford
- Division of Neurology, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Davide Marini
- Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Steven P Miller
- Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada
| | - Vann Chau
- Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michael Seed
- Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada
| | - Linh G Ly
- Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tricia S Williams
- Division of Neurology, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada
| | - Renee Sananes
- Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada.,Division of Cardiology, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
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Neurodevelopmental evaluation for school-age children with congenital heart disease: recommendations from the cardiac neurodevelopmental outcome collaborative. Cardiol Young 2020; 30:1623-1636. [PMID: 33143766 DOI: 10.1017/s1047951120003546] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
In 2012, the American Heart Association and the American Academy of Paediatrics released a scientific statement with guidelines for the evaluation and management of the neurodevelopmental needs of children with CHD. Decades of outcome research now highlight a range of cognitive, learning, motor, and psychosocial vulnerabilities affecting individuals with CHD across the lifespan. The number of institutions with Cardiac Neurodevelopmental Follow-Up Programmes and services for CHD is growing worldwide. This manuscript provides an expanded set of neurodevelopmental evaluation strategies and considerations for professionals working with school-age children with CHD. Recommendations begin with the referral process and access to the evaluation, the importance of considering medical risk factors (e.g., genetic disorders, neuroimaging), and the initial clinical interview with the family. The neurodevelopmental evaluation should take into account both family and patient factors, including the child/family's primary language, country of origin, and other cultural factors, as well as critical stages in development that place the child at higher risk. Domains of assessment are reviewed with emphasis on target areas in need of evaluation based on current outcome research with CHD. Finally, current recommendations are made for assessment batteries using a brief core battery and an extended comprehensive clinical battery. Consistent use of a recommended assessment battery will increase opportunities for research collaborations, and ultimately help improve the quality of care for families and children with CHD.
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Stapleton G, Dondorp W, Schröder-Bäck P, de Wert G. A Capabilities Approach to Prenatal Screening for Fetal Abnormalities. HEALTH CARE ANALYSIS 2020; 27:309-321. [PMID: 31309357 DOI: 10.1007/s10728-019-00379-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
International guidelines recommend that prenatal screening for fetal abnormalities should only be offered within a non-directive framework aimed at enabling women in making meaningful reproductive choices. Whilst this position is widely endorsed, developments in cell-free fetal DNA based Non-Invasive Prenatal Testing are now raising questions about its continued suitability for guiding screening policy and practice. This issue is most apparent within debates on the scope of the screening offer. Implied by the aim of enabling meaningful reproductive choices is the idea that screening services should support women in accessing prenatal tests that best enable them to realize the types of reproductive choice that they find important. However, beyond whatever options meet the quality standards required for facilitating an informed decision, the remaining criteria of facilitating autonomous choice is strictly non-directive. As a result, policy makers receive little indication prior to consultation with each individual woman, about what conditions should be prioritized during the offer of screening. In this paper we try to address this issue by using the capabilities approach to further specify the non-directive aim of enabling meaningful reproductive choice. The resulting framework is then used to assess the relative importance of offering prenatal screening where concerning different types of genetic condition. We conclude that greater priority may be ascribed to offering prenatal screening for conditions that more significantly diminish a woman's central capabilities. It follows that serious congenital and earlier-onset conditions are more likely to fulfill these criteria.
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Affiliation(s)
- Greg Stapleton
- Department of Health, Ethics and Society, GROW School for Oncology and Developmental Biology, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 MD, Maastricht, The Netherlands.
| | - Wybo Dondorp
- Department of Health, Ethics and Society, GROW School for Oncology and Developmental Biology, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 MD, Maastricht, The Netherlands
| | - Peter Schröder-Bäck
- Department of International Health, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Guido de Wert
- Department of Health, Ethics and Society, GROW School for Oncology and Developmental Biology, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 MD, Maastricht, The Netherlands
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Huang JS, Huang ST, Sun KP, Hong ZN, Chen LW, Kuo YR, Chen Q. Health-related quality of life in children and adolescents undergoing intraoperative device closure of isolated perimembranous ventricular septal defects in southeastern China. J Cardiothorac Surg 2019; 14:218. [PMID: 31842949 PMCID: PMC6916053 DOI: 10.1186/s13019-019-1040-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 12/05/2019] [Indexed: 12/20/2022] Open
Abstract
Objectives To investigate the health-related quality of life (HRQOL) in children and adolescents who underwent intraoperative device closure of perimembranous ventricular septal defects (pmVSDs). Methods From October 2017 to January 2018, a total of 126 children and adolescents with isolated pmVSDs who underwent intraoperative device closure were enrolled in this study. We used the Pediatric Quality of Life Inventory Measurement Models 4.0 generic core scales to measure HRQOL 24 h before the operation and three months and one year after surgery. Results A total of 126 patients were successfully occluded. No severe complications occurred during the operative time, and 1 case of Mobitz type I atrioventricular block (AVB) and 1 case of complete cAVB occurred during the postoperative period. Compared with the data before the operation, the total score and five domain scores, including physical, psychosocial, emotional, social and psychological functioning, were significantly higher at three months after the operation. In addition, the total score, physical functioning score, and the psychosocial functioning score at the 1-year follow-up were even higher than those at 3 months after the operation. Conclusions The present study suggests that intraoperative device closure of pmVSD could improve health-related quality of life in children/adolescents and that the improvement may progress as the time after the operation increases. Further studies should concentrate on comparisons with other medical methods, larger samples, and longer follow-up periods.
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Affiliation(s)
- Jiang-Shan Huang
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China.,Department of Cardiac Surgery, Fujian Provincial Maternity and Children's Hospital, affiliated hospital of Fujian Medical University, Fuzhou, 350001, People's Republic of China
| | - Shu-Ting Huang
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China.,Department of Cardiac Surgery, Fujian Provincial Maternity and Children's Hospital, affiliated hospital of Fujian Medical University, Fuzhou, 350001, People's Republic of China
| | - Kai-Peng Sun
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China.,Department of Cardiac Surgery, Fujian Provincial Maternity and Children's Hospital, affiliated hospital of Fujian Medical University, Fuzhou, 350001, People's Republic of China
| | - Zhi-Nuan Hong
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China.,Department of Cardiac Surgery, Fujian Provincial Maternity and Children's Hospital, affiliated hospital of Fujian Medical University, Fuzhou, 350001, People's Republic of China
| | - Liang-Wan Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China
| | - Yur-Ren Kuo
- Department of Surgery, Division of Plastic Surgery, Kaohsiung Medical University Hospital, 100 TzYou 1st Rd, Kaohsiung City, 80756, Taiwan
| | - Qiang Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China.
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13
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Ryan KR, Jones MB, Allen KY, Marino BS, Casey F, Wernovsky G, Lisanti AJ. Neurodevelopmental Outcomes Among Children With Congenital Heart Disease: At-Risk Populations and Modifiable Risk Factors. World J Pediatr Congenit Heart Surg 2019; 10:750-758. [PMID: 31658880 DOI: 10.1177/2150135119878702] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
As survivable outcomes among patients with complex congenital heart disease (cCHD) have continued to improve over the last several decades, more attention is being dedicated to interventions that impact not just survival but quality of life among patients with cCHD. In particular, patients with cCHD are at risk for impaired neurodevelopmental outcomes. In this review summarizing select presentations given at the 14th Annual Pediatric Cardiac Intensive Care Society's Annual Meeting in 2019, we discuss the neurodevelopmental phenotype of patients with cCHD, patients at greatest risk of impaired development, and three specific modifiable risk factors impacting development.
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Affiliation(s)
- Kathleen R Ryan
- Division of Cardiology, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
| | - Melissa B Jones
- Division of Cardiac Critical Care, Children's National Health System, Washington, DC, USA.,Division of Pediatric Cardiology, Children's National Health System, Washington, DC, USA
| | - Kiona Y Allen
- Division of Cardiology, Ann and Robert H. Lurie Children's Hospital of Chicago, IL, USA.,Division of Critical Care Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, IL, USA
| | - Bradley S Marino
- Division of Cardiology, Ann and Robert H. Lurie Children's Hospital of Chicago, IL, USA.,Division of Critical Care Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, IL, USA
| | - Frank Casey
- Department of Cardiology, Belfast Health and Social Care Trust, Belfast, Ireland
| | - Gil Wernovsky
- Division of Cardiac Critical Care, Children's National Health System, Washington, DC, USA.,Division of Pediatric Cardiology, Children's National Health System, Washington, DC, USA
| | - Amy Jo Lisanti
- Department of Cardiac Nursing and the Center for Pediatric Nursing Research and Evidence-based Practice, Children's Hospital of Philadelphia, PA, USA
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14
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Jackson AC, Frydenberg E, Koey XM, Fernandez A, Higgins RO, Stanley T, Liang RPT, Le Grande MR, Murphy BM. Enhancing Parental Coping with a Child's Heart Condition: A Co-production Pilot Study. Compr Child Adolesc Nurs 2019; 43:314-333. [PMID: 31584303 DOI: 10.1080/24694193.2019.1671915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Families of children with congenital heart disease (CHD) can have difficulties coping with the stress of their child's condition and would benefit from assistance to cope better. To address the needs of these parents, the Australian Center for Heart Health/HeartKids Australia/Melbourne Graduate School of Education co-produced Family Coping Project was initiated. This project involved two systematic literature reviews, interviews with parents of children with CHD, and the development and piloting of a manualised parental coping program. The primary aims of the pilot study were to determine whether the program would: attract high needs families; enhance the coping self-efficacy of parents; and be acceptable to parents in terms of content and mode of delivery. The secondary aims were to investigate whether the program would impact on parental coping, parental stress and general stress. Parents completed pre-, post-program and 6-month follow up assessment measures, with parent stress scores being compared to stress scores reported for other chronic condition parent carer groups. Twenty-one parents participated and provided baseline data. They were found to be significantly more stressed than other parent carer groups. Eleven parents completed post-program data and 13 completed 6-month follow-up data. There was a significant increase in parents' coping self-efficacy from pre- to post-program, and from pre- to 6-months. Parents' use of productive coping styles increased significantly from pre- to post-program. The program was rated as highly acceptable in terms of content and delivery mode. The pilot provides strong evidence for upscaling the program in conjunction with individualized psychological support for parents to extend knowledge acquisition and attitude change into enhanced coping skills and demonstrated the benefits of a co-production process.
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Affiliation(s)
- Alun C Jackson
- Australian Centre for Heart Health , Melbourne, Australia.,Faculty of Health, Deakin University , Geelong, Australia.,Melbourne Graduate School of Education, University of Melbourne , Melbourne, Australia.,Centre on Behavioural Health, Hong Kong University , Hong Kong, People's Republic of China
| | - Erica Frydenberg
- Melbourne Graduate School of Education, University of Melbourne , Melbourne, Australia
| | - Xui Min Koey
- Melbourne Graduate School of Education, University of Melbourne , Melbourne, Australia
| | - Amanda Fernandez
- Melbourne Graduate School of Education, University of Melbourne , Melbourne, Australia
| | - Rosemary O Higgins
- Australian Centre for Heart Health , Melbourne, Australia.,Faculty of Health, Deakin University , Geelong, Australia.,Department of Physiotherapy, University of Melbourne , Melbourne, Australia
| | - Tracy Stanley
- HeartKids Australia Family Support Program, Royal Children's Hospital , Melbourne, Australia
| | - Rachel Pui-Tak Liang
- Melbourne Graduate School of Education, University of Melbourne , Melbourne, Australia
| | - Michael R Le Grande
- Australian Centre for Heart Health , Melbourne, Australia.,Faculty of Health, Deakin University , Geelong, Australia
| | - Barbara M Murphy
- Australian Centre for Heart Health , Melbourne, Australia.,Faculty of Health, Deakin University , Geelong, Australia.,Department of Psychology, University of Melbourne , Melbourne, Australia
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15
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Bishop MN, Gise JE, Donati MR, Shneider CE, Aylward BS, Cohen LL. Parenting Stress, Sleep, and Psychological Adjustment in Parents of Infants and Toddlers With Congenital Heart Disease. J Pediatr Psychol 2019; 44:980-987. [DOI: 10.1093/jpepsy/jsz026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 03/29/2019] [Accepted: 04/02/2019] [Indexed: 02/06/2023] Open
Abstract
Abstract
Objective
Parents of children with chronic medical needs report increased parenting challenges, poor sleep, and maladjustment. The impact of parenting stress on both sleep and adjustment has yet to be evaluated for parents of infants and young children with congenital heart disease (CHD). We studied the relations among parenting stress, sleep, and adjustment in parents of infants and toddlers with CHD. We expected that sleep quality would mediate the relationship between parenting stress and adjustment.
Methods
Sixty-nine parents of infants and toddlers with CHD were evaluated on self-report measures of illness-related parenting stress (Pediatric Inventory for Parents), sleep (Pittsburgh Sleep Quality Index), and psychological adjustment (Brief Symptom Index-18).
Results
The parents of infants and toddlers with CHD reported elevated levels of parenting stress, sleep problems, and maladjustment. The positive relationship between parenting stress and parent maladjustment was mediated by sleep quality.
Conclusions
Findings suggest that parents of infants and toddlers with CHD report high parenting stress, poor sleep, and maladjustment. Analyses indicate the stress-adjustment relationship is mediated by quality of sleep. Given the multiple demands on parents of infants and children with CHD, it is important to attend to parents’ overall functioning and mental health. Our findings highlight targets for intervention to improve the well-being of parents of young children with CHD.
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Affiliation(s)
| | - Jensi E Gise
- Department of Psychology, Georgia State University
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16
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Wray J, Cassedy A, Ernst MM, Franklin RC, Brown K, Marino BS. Psychosocial functioning of parents of children with heart disease-describing the landscape. Eur J Pediatr 2018; 177:1811-1821. [PMID: 30232593 DOI: 10.1007/s00431-018-3250-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 08/31/2018] [Accepted: 09/10/2018] [Indexed: 01/23/2023]
Abstract
The aim was to describe the psychological functioning of parents of school-age children with heart disease (HD) in a large-scale, transnational evaluation of parent dyads across the spectrum of cardiac diagnoses and a range of psychosocial domains. Parents of children with HD attending routine out-patient cardiology follow-up visits completed questionnaires assessing their mental health, coping, and family functioning. Parents (1197 mothers and 1053 fathers) of 1214 children (mean age: 12.6 years; S.D. 3.0 years; median time since last surgery: 8.9 years) with congenital or acquired HD from three centers each in the UK and the USA participated (80% response rate). Parents of children with milder HD demonstrated few differences from healthy norms and had significantly lower scores on measures of illness-related stress and post-traumatic stress than parents of children with single ventricle conditions or cardiomyopathy. Parents in these latter two diagnostic sub-groups had significantly higher levels of anxiety and depression than healthy norms but did not differ on other measures of family functioning and coping skills. There were few differences between parents from the UK and the USA. Agreement between mothers and fathers within a dyad was highest for the measure of frequency of illness-related stressors (ICC = 0.67) and lowest for anxiety (ICC = 0.12).Conclusion: Our results suggest two different pathways for the long-term psychological well-being of parents of children with HD: on the one hand, more complex HD is associated with poorer long-term psychosocial outcomes; in contrast, there are also grounds for optimism, particularly for parents of children with less complex conditions, with better psychological outcomes noted for some groups of parents compared to previously reported early psychosocial outcomes. Future work needs to identify factors other than disease severity which might explain poorer (or better) functioning in some parents of children with more complex HD. What is Known: • Parents of children with congenital heart disease report elevated levels of anxiety, depression, and stress after cardiac surgery in infancy. • Maternal mental health problems can have an adverse impact on the psychological adjustment of the child with congenital heart disease. What is New: • Parents of children with milder forms of heart disease do not differ from healthy norms in the longer term and psychological outcomes are better than might be expected from early findings. • More complex diagnoses, particularly functional single ventricle conditions and cardiomyopathy, are associated with poorer long-term psychosocial outcomes for parents.
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Affiliation(s)
- Jo Wray
- Critical Care and Cardiorespiratory Department, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK.
| | - Amy Cassedy
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Michelle M Ernst
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Rodney C Franklin
- Department of Pediatric Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Katherine Brown
- Critical Care and Cardiorespiratory Department, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - Bradley S Marino
- Department of Pediatrics, Divisions of Pediatric Cardiology and Critical Care Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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17
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Abstract
Parental stress is a universal experience for parents who have children diagnosed with CHD and has been studied within the context of the child's illness, but not through a broader health disparity lens. This paper provides a thorough synthesis of the current literature on parental stress addressing disparities in parents of children with CHD. Several theories and models from within this literature are described and a new comprehensive framework, the Parental Stress and Resilience in CHD Model, is presented. Future research and clinical implications are discussed.
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19
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Parent's Perspectives on How They Cope With the Impact on Their Family of a Child With Heart Disease. J Pediatr Nurs 2018; 40:e9-e17. [PMID: 29396310 DOI: 10.1016/j.pedn.2018.01.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 01/24/2018] [Accepted: 01/24/2018] [Indexed: 11/22/2022]
Abstract
PURPOSE Studies of familial coping with a child's chronic condition have highlighted psychological distress; family functioning; and quality of life; as issues that demand coping strategies. There are conflicting findings on impact and coping and a paucity of information about the specific coping challenges for parents of a child with heart disease, with few qualitative studies in this area. The purpose of the study was to explore the way parents coped with their child's heart condition as it impacted on different domains of family functioning. DESIGN AND METHOD In this qualitative study, interviews were held with 17 parents attending a pediatric hospital-based family support program in 2015. Fifteen of the 17 children's conditions were classified as "major". Domains covered in the interviews included: coping challenges posed at different stages of the illness trajectory, parenting, condition management, transitions, psychological impact, social support and coping strategies. Interview transcripts were coded thematically. RESULTS Multiple points of stress and challenges to coping were identified: coping with the diagnosis, including consideration of termination; dealing with the challenges facing their child; coping with parenting including co-parenting issues; the role of social support in coping; and identification of adaptive and maladaptive coping behaviours. CONCLUSION A large range of positive coping strategies were identified, as was the need for coping-focused psychological support throughout the parents' and children's journey. PRACTICE IMPLICATIONS The strategies identified have formed the basis of a manualised intervention for these parents.
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Borghi L, Salvatici E, Banderali G, Riva E, Giovannini M, Vegni E. Psychological wellbeing in parents of children with phenylketonuria and association with treatment adherence. Minerva Pediatr (Torino) 2018; 73:330-339. [PMID: 29651832 DOI: 10.23736/s2724-5276.18.05126-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Phenylketonuria (PKU) is a rare metabolic disorder that leads to severe neurological abnormalities unless early treated with a strict phenylalanine (Phe)-restricted diet. The parents' involvement in PKU management is crucial and could lead to psychological distress; however, few studies have explored the parents' psychological wellbeing. The study aimed to: 1) evaluate the presence of psychological distress and impaired quality of life among parents of children with PKU, assessing the impact of the diagnosis and the impact of the treatment management; 2) explore the associations between parents' psychological outcomes and their children's blood-Phe levels. METHODS One hundred thirty-eight parents of patients with PKU (who need a Phe-restricted diet) and with a mild form (mild hyperphenylalaninemia-MHP, with no diet indication) filled-out self-report psychological questionnaires; Phe-levels of children with PKU were retrieved. RESULTS Parents of children with PKU did not report higher levels of psychological distress neither compared with the normative scores nor with parents of children with MHP. Optimal Phe-levels were associated with a higher number of parents' depressive complaints, with a lower tendency to express anger feelings, with a lower social functioning, and a higher mental health. CONCLUSIONS Parents of children with PKU showed a good psychological adaptation to their children's disease and treatment. Findings highlighted associations between parents' psychological wellbeing and their children's adherence to diet. Interestingly, an optimal adherence to the diet of their children was associated with parental low social functioning, a higher tendency to control the anger expression, and greater somatic depressive symptoms.
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Affiliation(s)
- Lidia Borghi
- Unit of Clinical Psychology, Department of Health Sciences, University of Milan, Milan, Italy -
| | | | | | - Enrica Riva
- Department of Pediatrics, University of Milan, Milan, Italy
| | | | - Elena Vegni
- Unit of Clinical Psychology, Department of Health Sciences, University of Milan, Milan, Italy
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21
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Abstract
BACKGROUND Parents may experience anxiety and stress when their children undergo cardiac catheterisation. The goal of this study was to assess the level of anxiety in parents of children undergoing cardiac catheterisation and to identify factors that were associated with level of anxiety. METHODS This was a cross-sectional survey of parents of children who underwent cardiac catheterisation. Anxiety levels were measured using a validated self-report questionnaire - State-Trait Anxiety Inventory, which generates state anxiety scores on the current state of anxiety and trait anxiety scores on the stable aspects of anxiety proneness. One sample t-test was used to compare the data with normative data. Multiple linear regression was used to assess the factors associated with the state score. RESULTS A total of 113 parents completed the survey. The mean age of parents was 34.0±7.7 years and the mean age of children undergoing catheterisation was 6.7±5.7 years. Compared with normative data, mean state score was significantly higher in our cohort (p<0.05) despite no difference in the trait score. Final multivariate model showed that the state score was significantly associated with child age group (<1 year [coefficient β 7.2] and 10-18 years [6.3], compared to 1 to <10 years of age [reference]) and history of previous catheterisation (-5.2) (p<0.05). CONCLUSIONS Concurrent state anxiety level was high among parents of children undergoing cardiac catheterisation, whereas trait anxiety level was not. Higher anxiety was experienced by parents of infants and adolescents without a history of previous catheterisation.
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22
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Ernst MM, Marino BS, Cassedy A, Piazza-Waggoner C, Franklin RC, Brown K, Wray J. Biopsychosocial Predictors of Quality of Life Outcomes in Pediatric Congenital Heart Disease. Pediatr Cardiol 2018; 39:79-88. [PMID: 28980091 DOI: 10.1007/s00246-017-1730-6] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 09/13/2017] [Indexed: 10/18/2022]
Abstract
The purpose of this prospective multi-center cross-sectional study was to identify key biopsychosocial factors that impact quality of life (QOL) of youth with congenital heart disease (CHD). Patient-parent pairs were recruited at a regular hospital follow-up visit. Patient- and parent-proxy-reported QOL were assessed using the Pediatric Cardiac Quality of Life Inventory (PCQLI). Wallander's and Varni's disability-stress coping model guided factor selection, which included disease factors, educational impairment, psychosocial stress, child psychological and parent/family factors. Measures utilized for these factors included the Pediatric Inventory for Parents, Self-Perception Profile for Children/Adolescents, Child Behavior Checklist, Revised Children's Manifest Anxiety Scale, Child PTSD Symptom Scale, State-Trait Anxiety Inventory, and Posttraumatic Diagnostic Scale. Ordinary least squares regression was applied to test the theoretical model, with backwards stepwise elimination process. The models accounted for a substantial amount of variance in QOL (Patient-reported PCQLI R 2 = 0.58, p < 0.001; Parent-proxy-reported PCQLI R 2 = 0.60, p < 0.001). For patient-reported QOL, disease factors, educational impairment, poor self-esteem, anxiety, patient posttraumatic stress, and parent posttraumatic stress were associated with lower QOL. For parent-proxy-report QOL, disease factors, educational impairment, greater parental medical stress, poorer child self-esteem, more child internalizing problems, and parent posttraumatic stress were associated with lower QOL. The results highlight that biopsychosocial factors account for over half the variance in QOL in CHD survivors. Assessing and treating psychological issues in the child and the parent may have a significant positive impact on QOL.
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Affiliation(s)
- Michelle M Ernst
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA. .,Division of Behavioral Medicine, Cincinnati Children's Hospital Medical Center, ML3015, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
| | - Bradley S Marino
- Department of Pediatrics and Medical Social Sciences, Divisions of Pediatric Cardiology and Critical Care Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Amy Cassedy
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Carrie Piazza-Waggoner
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Rodney C Franklin
- Department of Pediatric Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Katherine Brown
- Cardiorespiratory Department, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Jo Wray
- Cardiorespiratory Department, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
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23
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Responses of mothers of children with CHD: quality of life, anxiety and depression, parental attitudes, family functionality. Cardiol Young 2017; 27:1748-1754. [PMID: 28651675 DOI: 10.1017/s1047951117001184] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
UNLABELLED Introduction The aim of this study was to evaluate the anxiety and depression status, family functions, parenting attitudes, and quality of life in the mothers of children with CHD. METHOD The study enrolled 120 mothers: 40 of children with cyanotic CHD, 40 of children with non-cyanotic CHD, and 40 of healthy controls. Short Form-36 for quality of life, Hospital Anxiety-Depression Scale for anxiety and depression, Family Assessment Device for the detection of problems affecting family functions, and Parental Attitude Research Instrument for measuring child-rearing attitudes were used in the study. RESULTS Statistically significant decreases were found in the general health standards of mothers of non-cyanotic children (p=0.035) and in the emotional and physical role difficulty of mothers of cyanotic children (p=0.006, p=0.010). When anxiety and depression levels of the parents were examined, the anxiety level of the cyanotic group was found to be significantly higher than that of the other groups (p=0.031). When family behaviours were assessed, there was a statistically significant decrease in role status in the families having a child with cyanotic CHD (p=0.035). In the Parental Attitude Research Instrument test, the husband and wife incompatibility sub-scale was found to be statistically significantly lower in the cyanotic CHD group (p=0.030). CONCLUSION When there is a diseased person in the family, the focus should not be solely on the problems of the patient but also on preventive methods to be implemented in order to protect the mental health of all family members.
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Sjostrom-Strand A, Terp K. Parents' Experiences of Having a Baby With a Congenital Heart Defect and the Child's Heart Surgery. Compr Child Adolesc Nurs 2017; 42:10-23. [PMID: 28786702 DOI: 10.1080/24694193.2017.1342104] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The incidence of children born with congenital heart disease is 1%. Congenital heart disease is among the birth defects that lead to the longest hospital stays, and children with congenital heart disease often require frequent hospitalization and several heart operations, along with lifelong follow-up visits. This study aims to describe parents' experiences when their child has a heart defect and undergoes open heart surgery. A total of 10 parents were interviewed: 8 mothers and 2 fathers. The interviews took place 2 years after the heart surgery. The interviews were analyzed using a content analysis method, which resulted in 4 categories: maintaining belief, experiencing the surgery as a turning point, experiencing the pediatric intensive care unit with anxiety and fear, and perception of support. When parents face their child having a congenital heart defect and plan heart surgery, the whole family is living through a stressful time and has to handle many difficult situations. Parents need support from the health care team.
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Affiliation(s)
| | - Karina Terp
- a Department of Nursing , Lund University , Lund , Sweden
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25
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Borghi L, Salvatici E, Riva E, Giovannini M, Vegni EA. Psychological and psychosocial implications for parenting a child with phenylketonuria: a systematic review. Minerva Pediatr 2017; 71:181-195. [PMID: 28472877 DOI: 10.23736/s0026-4946.17.04950-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Since phenylketonuria (PKU) appears to have specificities that might challenge the parents' adaptation and well-being, the present review aimed to evaluate the impact of parenting a child with PKU on parents' psychological and psychosocial functioning. EVIDENCE ACQUISITION A systematic electronic search was conducted using PubMED, Scopus, Embase, PsychInfo, Google Scholar and Cochrane Database to identify studies exploring psychological and psychosocial issues of parents of PKU children. The search retrieved 427 articles to review against inclusion criteria; a total of 17 studies were included in the review. Results were summarized qualitatively. EVIDENCE SYNTHESIS Findings revealed a complex pattern of interrelated factors both on parental psychological wellbeing and psychosocial functioning. In particular, crucial for parents' adjustment to child PKU are the diagnosis resolution and the perceived social support; parents showed good coping strategies and quality of life; while, with regard to mental health, the studies reviewed showed inconsistent results, thus pointed out a moderate level of distress. The review examines patterns of results across studies and discusses methodological heterogeneities and problems related to different or inconsistent findings. CONCLUSIONS Parenting a child with PKU had direct implications on the diagnosis resolution, the parents mental health and the disease management. Findings could help healthcare professionals to identify situations at risk for psychological maladjustments both in parents and in children, as the unresolved diagnosis or a tendency toward the social isolation. Results highlighted the necessity of a multidisciplinary caring approach for the family, with a particular focus on critical moments such diagnosis or developmental transitions.
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Affiliation(s)
- Lidia Borghi
- Unit of Clinical Psychology, Department of Health Sciences, University of Milan, Milan, Italy -
| | | | - Enrica Riva
- Department of Pediatrics, University of Milan, Milan, Italy
| | | | - Elena A Vegni
- Unit of Clinical Psychology, Department of Health Sciences, University of Milan, Milan, Italy
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26
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O'Connor AM, Wray J, Tomlinson RS, Cassedy A, Jacobs JP, Jenkins KJ, Brown KL, Franklin RCG, Mahony L, Mussatto K, Newburger JW, Wernovsky G, Ittenbach RF, Drotar D, Marino BS. Impact of Surgical Complexity on Health-Related Quality of Life in Congenital Heart Disease Surgical Survivors. J Am Heart Assoc 2016; 5:e001234. [PMID: 27451455 PMCID: PMC5015349 DOI: 10.1161/jaha.114.001234] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 05/03/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Surgical complexity and related morbidities may affect long-term patient quality of life (QOL). Aristotle Basic Complexity (ABC) score and Risk Adjustment in Congenital Heart Surgery (RACHS-1) category stratify the complexity of pediatric cardiac operations. The purpose of this study was to examine the relationship between surgical complexity and QOL and to investigate other demographic and clinical variables that might explain variation in QOL in pediatric cardiac surgical survivors. METHODS AND RESULTS Pediatric Cardiac Quality of Life (PCQLI) study participants who had undergone cardiac surgery were included. The PCQLI database provided sample characteristics and QOL scores. Surgical complexity was defined by the highest ABC raw score or RACHS-1 category. Relationships among surgical complexity and demographic, clinical, and QOL variables were assessed using ordinary least squares regression. A total of 1416 patient-parent pairs were included. Although higher ABC scores and RACHS-1 categories were associated with lower QOL scores (P<0.005), correlation with QOL scores was poor to fair (r=-0.10 to -0.29) for all groups. Ordinary least squares regression showed weak association with R(2)=0.06 to R(2)=0.28. After accounting for single-ventricle anatomy, number of doctor visits, and time since last hospitalization, surgical complexity scores added no additional explanation to the variance in QOL scores. CONCLUSIONS ABC scores and RACHS-1 categories are useful tools for morbidity and mortality predictions prior to cardiac surgery and quality of care initiatives but are minimally helpful in predicting a child's or adolescent's long-term QOL scores. Further studies are warranted to determine other predictors of QOL variation.
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Affiliation(s)
- Amy M O'Connor
- Division of Cardiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Jo Wray
- Cardiorespiratory Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK Department of Pediatric Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Ryan S Tomlinson
- Division of Cardiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Amy Cassedy
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Jeffrey P Jacobs
- Division of Thoracic and Cardiovascular Surgery, The Congenital Heart Institute of Florida, All Children's Hospital and Children's Hospital of Tampa, University of South Florida College of Medicine, Cardiac Surgical Associates, St. Petersburg and Tampa, FL
| | - Kathy J Jenkins
- Department of Cardiology, Children's Hospital Boston, Harvard Medical School, Boston, MA Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Kate L Brown
- Cardiorespiratory Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Rodney C G Franklin
- Department of Pediatric Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Lynn Mahony
- Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
| | - Kathleen Mussatto
- Division of Cardiology, Department of Pediatrics, The Children's Hospital of Wisconsin, Milwaukee, WI
| | - Jane W Newburger
- Department of Cardiology, Children's Hospital Boston, Harvard Medical School, Boston, MA Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Gil Wernovsky
- Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, PA Division of Critical Care Medicine, Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, PA
| | - Richard F Ittenbach
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Dennis Drotar
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Bradley S Marino
- Division of Cardiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Berant E, Mikulincer M, Florian V. Attachment Style and Mental Health: A 1-Year Follow-Up Study of Mothers of Infants with Congenital Heart Disease. PERSONALITY AND SOCIAL PSYCHOLOGY BULLETIN 2016. [DOI: 10.1177/0146167201278004] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The longitudinal contribution of attachment style to mental health was examined among mothers of infants with Congenital Heart Disease (CHD). Eighty-five mothers of newborns with CHD completed self-report scales tapping attachment style, appraisal of motherhood, ways of coping with motherhood tasks, and mental health 2 weeks after the infant’s CHD diagnosis and 1 year later. Mothers’ attachment anxiety and avoidance at Time 1 were related to poor mental health at the same point of time. In addition, attachment avoidance at Time 1 predicted further deterioration of mental health from Time 1 to Time 2. Attachment style at Time 1 also predicted the ways mothers appraised and coped with motherhood tasks, which, in turn, were related to mental health changes. The theoretical implications of the data were discussed.
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Marino BS, Cassedy A, Drotar D, Wray J. The Impact of Neurodevelopmental and Psychosocial Outcomes on Health-Related Quality of Life in Survivors of Congenital Heart Disease. J Pediatr 2016; 174:11-22.e2. [PMID: 27189685 DOI: 10.1016/j.jpeds.2016.03.071] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 03/04/2016] [Accepted: 03/28/2016] [Indexed: 01/30/2023]
Affiliation(s)
- Bradley S Marino
- Divisions of Cardiology and Critical Care Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
| | - Amy Cassedy
- Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Dennis Drotar
- Division of Behavioral Medicine and Clinical Psychology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Jo Wray
- Critical Care and Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
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Jackson AC, Frydenberg E, Liang RPT, Higgins RO, Murphy BM. Familial impact and coping with child heart disease: a systematic review. Pediatr Cardiol 2015; 36:695-712. [PMID: 25618163 DOI: 10.1007/s00246-015-1121-9] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Accepted: 01/16/2015] [Indexed: 10/24/2022]
Abstract
Families of children with congenital heart disease (CHD) cope differently depending on individual and familial factors beyond the severity of the child's condition. Recent research has shifted from an emphasis on the psychopathology of family functioning to a focus on the resilience of families in coping with the challenges presented by a young child's condition. The increasing number of studies on the relationship between psychological adaptation, parental coping and parenting practices and quality of life in families of children with CHD necessitates an in-depth re-exploration. The present study reviews published literature in this area over the past 25 years to generate evidence to inform clinical practice, particularly to better target parent and family interventions designed to enhance family coping. Twenty-five studies were selected for inclusion, using the PRISMA guidelines. Thematic analysis identified a number of themes including psychological distress and well-being, gender differences in parental coping, and variable parenting practices and a number of subthemes. There is general agreement in the literature that families who have fewer psychosocial resources and lower levels of support may be at risk of higher psychological distress and lower well-being over time, for both parent and the child. Moreover, familial factors such as cohesiveness and adaptive parental coping strategies are necessary for successful parental adaptation to CHD in their child. The experiences, needs and ways of coping in families of children with CHD are diverse and multi-faceted. A holistic approach to early psychosocial intervention should target improved adaptive coping and enhanced productive parenting practices in this population. This should lay a strong foundation for these families to successfully cope with future uncertainties and challenges at various phases in the trajectory of the child's condition.
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Affiliation(s)
- Alun C Jackson
- Heart Research Centre, 14-20 Blackwood Street, North Melbourne, VIC, 3051, Australia,
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Harvey KA, Kovalesky A, Woods RK, Loan LA. Experiences of mothers of infants with congenital heart disease before, during, and after complex cardiac surgery. Heart Lung 2013; 42:399-406. [DOI: 10.1016/j.hrtlng.2013.08.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 08/14/2013] [Accepted: 08/15/2013] [Indexed: 11/30/2022]
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Perricone G, Guerra MP, Cruz O, Polizzi C, Lima L, Morales MR, de Lemos MS, Fontana V. Maternal Coping Strategies in Response to a Child's Chronic and Oncological Disease: a Cross-Cultural Study in Italy and Portugal. Pediatr Rep 2013; 5:43-7. [PMID: 23904966 PMCID: PMC3718229 DOI: 10.4081/pr.2013.e11] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 04/03/2013] [Accepted: 04/30/2013] [Indexed: 11/23/2022] Open
Abstract
A child's oncological or chronic disease is a stressful situation for parents. This stress may make it difficult for appropriate management strategies aimed at promoting the child's wellbeing and helping him or her cope with a disease to be adopted. In particular, this study focuses on the possible connections between the variable national cultural influences and the parental strategies used to cope with a child's severe disease by comparing the experiences of Italian and Portuguese mothers. The study investigates differences and cross-cultural elements among the coping strategies used by Italian and Portuguese mothers of children with oncological or chronic disease. Two groups of mothers took part: 59 Italian mothers (average age 37.7 years; SD=4.5) and 36 Portuguese mothers (average age 39.3 years; SD=4.6). The tool used was the Italian and the Portuguese versions of the COPE inventory that measures five coping strategies: Social Support, Avoidance Coping, Positive Aptitude, Religious Faith and Humor, Active Coping. There were statistically significant differences between Portuguese and Italian mothers regarding Social Support (F(3, 94)=6.32, P=0.014, ɳ(2)=0.065), Religious Faith and Humor (F(3, 94)=20.06, P=0.001, ɳ(2)=0.18, higher values for Portuguese mothers) and Avoidance Coping (F(3, 94)=3.30, P=0.06, ɳ(2)=0.035, higher values for Italian mothers). Regarding child's disease, the only statistically significant difference was in Religious Faith and Humor (F(3, 94)=7.49, P=0.007, ɳ(2)=0.076, higher values for mothers of children with chronic disease). The findings of specific cultural transversalities provide the basis for reflection on important factors emerging on the relationship between physicians and parents. In fact, mothers' coping abilities may allow health workers involved in a child's care not only to understand how parents face a distressful event, but also to provide them with professional support.
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Affiliation(s)
| | - Marina Prista Guerra
- Faculty of Psychology and Educational Sciences, University of Porto, Porto, Portugal
| | - Orlanda Cruz
- Faculty of Psychology and Educational Sciences, University of Porto, Porto, Portugal
| | | | - Lígia Lima
- Escola Superior Enfermagem do Porto, Portugal
| | | | - Marina Serra de Lemos
- Faculty of Psychology and Educational Sciences, University of Porto, Porto, Portugal
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Franich-Ray C, Bright MA, Anderson V, Northam E, Cochrane A, Menahem S, Jordan B. Trauma reactions in mothers and fathers after their infant's cardiac surgery. J Pediatr Psychol 2013; 38:494-505. [PMID: 23603253 DOI: 10.1093/jpepsy/jst015] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To investigate the prevalence and nature of trauma symptoms in mothers and fathers of infants who had cardiac surgery. METHOD Parents of infants who underwent cardiac surgery before 3 months of age were recruited at the time of surgery. 77 mothers and 55 fathers completed the Acute Stress Disorder Scale 1 month after their infant was discharged from hospital. RESULTS 26 of 77 (33.8%) mothers and 10 of 55 (18.2%) fathers satisfied criteria for acute stress disorder. For all symptom clusters, except dissociation, mothers had significantly higher mean scores (and therefore higher levels of symptoms) than did fathers, ps = .01, -.02. 83 percent of parents endorsed at least 1 trauma symptom and 11.4% endorsed only 1 symptom at a clinical level. Symptoms of dissociation were the most commonly endorsed by both parents, with each symptom in that cluster being endorsed at a clinical level by at least 26% of parents. CONCLUSIONS Consistent with our hypotheses, approximately one-third of parents overall, as well as one-third of mothers and close to one-fifth of fathers, experienced trauma symptoms consistent with a diagnosis of acute stress disorder. Most parents experienced at least one symptom at a clinical level, with symptoms of dissociation being the most commonly endorsed symptom cluster. These findings highlight the need for clinical supports for parents.
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33
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Perricone G, Polizzi C, De Luca F. Self-representation of children suffering from congenital heart disease and maternal competence. Pediatr Rep 2013; 5:e1. [PMID: 23667730 PMCID: PMC3649740 DOI: 10.4081/pr.2013.e1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 10/29/2012] [Accepted: 12/12/2012] [Indexed: 12/04/2022] Open
Abstract
Child development may be subject to forms of motor, physical, cognitive and self-representation impairments when complex congenital heart disease (CHD) occurs. In some cases, inadequacy of both self-representation as well as the family system are displayed. It seems to be important to search the likely internal and external resources of the CHD child, and the possible connections among such resources, which may help him/her to manage his/her own risk condition. The research project inquires the possible resources related to the self-representation and self-esteem levels of the CHD child, and those related to maternal self-perception as competent mothers. A group of 25 children (mean age = 10.2; SD=1.8) suffering from specific forms of CHD, and a group made up of their relative mothers (mean age = 38.2; SD=5) were studied. The tools used were the Human Figure Drawing, to investigate child body-related self-representation; the TMA scale (Self-esteem Multidimensional Test), to investigate the child's self-esteem; and the Q-sort questionnaire, to assess how mothers perceived their maternal competence. Data concerning the likely correlations between the child's self-representation and the maternal role competence show [that] positive correlations between some indicators of maternal competence, specific aspects of CHD children's self-representation (mothers' emotional coping and children's self-image adequacy) and self-esteem (mothers' emotional scaffolding and children's self-esteem at an emotional level). By detecting the occurrence of specific correlations among resources of both child and mother, the study provides cardiologists with information that is useful for building a relationship with the families concerned, which would seem to enhance the quality of the process of the cure itself.
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Affiliation(s)
- Giovanna Perricone
- Department of Psychology, Unit of research Pediatric Psychology, University of Palermo, Palermo
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Fleary SA, Heffer RW. Impact of growing up with a chronically ill sibling on well siblings' late adolescent functioning. ISRN FAMILY MEDICINE 2013; 2013:737356. [PMID: 24959574 PMCID: PMC4041246 DOI: 10.5402/2013/737356] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Accepted: 01/14/2013] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to explore the continuing impact of growing up with an ill sibling on well siblings' late adolescent functioning. Forty late adolescents (M age = 18.78, SD = 0.83), who identified themselves as growing up with an ill sibling, completed a semistructured interview, demographic questionnaire, Personality Assessment Screener, and My Feelings and Concerns Sibling Questionnaire. Participants reported clinically significant problems on some PAS scales, and gender differences were found for acting out and alienation. Significant relationships were reported for communication and social withdrawal and alienation. Both positive and negative themes about the experience were elicited from the responses in the semistructured interview. This study provides evidence for some lingering negative effects of growing up with an ill sibling on well siblings' late adolescent functioning. Additionally, evidence for siblings' development of positive characteristics that may act as protective variables as they face the stressors of late adolescence was also highlighted.
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Affiliation(s)
- Sasha A. Fleary
- Department of Psychology, Texas A&M University, MS 4235, College Station, TX 77843, USA
| | - Robert W. Heffer
- Department of Psychology, Texas A&M University, MS 4235, College Station, TX 77843, USA
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Rowland E, Metcalfe A. Communicating inherited genetic risk between parent and child: a meta-thematic synthesis. Int J Nurs Stud 2012; 50:870-80. [PMID: 23026156 DOI: 10.1016/j.ijnurstu.2012.09.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 08/17/2012] [Accepted: 09/03/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Communicating genetic risk is a distressing process for families affected by inherited genetic conditions. This systematic review identifies and explores the challenges faced by parents and their (non)affected or at risk children caused by the (non)disclosure of genetic risk information. DESIGN Qualitative meta-synthesis and thematic analysis. DATA SOURCES Ovid databases; Ovid 'in progress', British Nursing Index, Embase, Medline and Psychinfo were combined with searches of EBSCOhost databases; CINAHL and ERIC and Web of science and ZETOC databases using truncations of communication, chronic illness and disease and words relating to family with specific genetic conditions; Cystic Fibrosis, Duchenne Muscular Dystrophy, Familial Adenomatous Polyposis, Hereditary Non-polyposis Colorectal Cancer, Huntington's Disease, Neurofibromatosis and Sickle Cell Anaemia. This was augmented with free Internet and hand searches and an exploration of the bibliographies of all included papers. REVIEW METHOD All papers were quality assessed to ascertain their research quality and methodological rigour. RESULTS A total of 2033 citations were retrieved. Following the removal of duplicates, irrelevant articles and the application of an inclusion criterion, 12 articles remained. A further three papers were omitted due to poor quality leaving nine papers which focussed on the disclosure of genetic information between parent and child (<18 years). Eight papers were qualitative in design and one used a mixed method approach. Thematic synthesis produced four themes that inform the structure of the paper; disclosure, emotions involved in disclosure, desired disclosure and recommendations. CONCLUSION Disclosure of genetic risk information within families is a highly complex and affective process often resulting in delayed disclosure. This can lead to increased family tensions generated by misunderstanding, blame and secrecy. Early, age appropriate disclosure can better prepare children for future considerations such as care planning and reproductive decision-making. It also contributes to effective coping strategies that promote enhanced adaptation and emotional well being. Early disclosure also reduces parental anxieties concerning disclosure from an unwitting source. Research shows that children and young people want their parents to engage in open and honest discussions about the genetic condition. Therefore to help facilitate effective family communication health professionals should provide family centred care and better emotional and informational support.
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Affiliation(s)
- Emma Rowland
- Florence Nightingale School of Nursing and Midwifery, Kings College London, United Kingdom.
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Marino BS, Lipkin PH, Newburger JW, Peacock G, Gerdes M, Gaynor JW, Mussatto KA, Uzark K, Goldberg CS, Johnson WH, Li J, Smith SE, Bellinger DC, Mahle WT. Neurodevelopmental outcomes in children with congenital heart disease: evaluation and management: a scientific statement from the American Heart Association. Circulation 2012; 126:1143-72. [PMID: 22851541 DOI: 10.1161/cir.0b013e318265ee8a] [Citation(s) in RCA: 1012] [Impact Index Per Article: 84.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The goal of this statement was to review the available literature on surveillance, screening, evaluation, and management strategies and put forward a scientific statement that would comprehensively review the literature and create recommendations to optimize neurodevelopmental outcome in the pediatric congenital heart disease (CHD) population. METHODS AND RESULTS A writing group appointed by the American Heart Association and American Academy of Pediatrics reviewed the available literature addressing developmental disorder and disability and developmental delay in the CHD population, with specific attention given to surveillance, screening, evaluation, and management strategies. MEDLINE and Google Scholar database searches from 1966 to 2011 were performed for English-language articles cross-referencing CHD with pertinent search terms. The reference lists of identified articles were also searched. The American College of Cardiology/American Heart Association classification of recommendations and levels of evidence for practice guidelines were used. A management algorithm was devised that stratified children with CHD on the basis of established risk factors. For those deemed to be at high risk for developmental disorder or disabilities or for developmental delay, formal, periodic developmental and medical evaluations are recommended. A CHD algorithm for surveillance, screening, evaluation, reevaluation, and management of developmental disorder or disability has been constructed to serve as a supplement to the 2006 American Academy of Pediatrics statement on developmental surveillance and screening. The proposed algorithm is designed to be carried out within the context of the medical home. This scientific statement is meant for medical providers within the medical home who care for patients with CHD. CONCLUSIONS Children with CHD are at increased risk of developmental disorder or disabilities or developmental delay. Periodic developmental surveillance, screening, evaluation, and reevaluation throughout childhood may enhance identification of significant deficits, allowing for appropriate therapies and education to enhance later academic, behavioral, psychosocial, and adaptive functioning.
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Mörelius E, Broström EB, Westrup B, Sarman I, Örtenstrand A. The Stockholm Neonatal Family-Centered Care Study: effects on salivary cortisol in infants and their mothers. Early Hum Dev 2012; 88:575-81. [PMID: 22284983 DOI: 10.1016/j.earlhumdev.2011.12.033] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Revised: 11/05/2011] [Accepted: 12/19/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND Parental involvement in the care of preterm infants in neonatal intensive care units (NICUs) is common, but little is known about the effect on stress responses in mothers and infants. AIMS The aim of this study is to evaluate the effect of family-centered care on salivary cortisol reactivity in mothers and preterm infants and the correlation between the mothers' and the preterm infants' salivary cortisol levels. METHODS This study is part of a randomized controlled trial conducted at two level-II NICUs, including Family Care (FC), where parents were able to stay 24h/day from admission to discharge, and Standard Care (SC). To investigate the cortisol response, saliva was collected from 289 preterm infants and their mothers before and after a diaper change at the time of discharge. RESULTS No significant differences were found between the two groups in salivary cortisol reactivity, either in mothers or in infants. The results revealed a correlation between preterm infants' and their mothers' baseline and response cortisol in the FC group: r=0.31 (p=0.001) and r=0.24 (p=0.01), respectively. Such correlation was not observed in the SC group: r=0.14 (p=0.14) and r=0.18 (p=0.07), respectively. CONCLUSIONS Family-centered care had no effect on salivary cortisol reactivity during diaper change. However, sharing the same environment may increase the concordance between preterm infants' and their mothers' salivary cortisol levels.
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Affiliation(s)
- Evalotte Mörelius
- Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Sweden.
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Solberg Ø, Grønning Dale MT, Holmstrøm H, Eskedal LT, Landolt MA, Vollrath ME. Trajectories of maternal mental health: a prospective study of mothers of infants with congenital heart defects from pregnancy to 36 months postpartum. J Pediatr Psychol 2012; 37:687-96. [PMID: 22408057 DOI: 10.1093/jpepsy/jss044] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To chart mothers' trajectories of mental health from pregnancy to 36 months postpartum in order to investigate the association between infants' congenital heart defects (CHD) and compromised maternal mental health. METHODS Mothers of infants with mild, moderate, or severe CHD (n = 141) and mothers (n = 36,437) enrolled in the Norwegian Mother and Child Cohort Study were assessed at regular intervals from pregnancy up to 36 months postpartum, including measurements at 6 and 18 months, using an 8-item version of the Hopkins Symptom Checklist-25. RESULTS Mean score trajectories of SCL-8 for mothers of infants with severe CHD deviated significantly from cohort controls 6, 18, and 36 months postpartum, indicating heightened symptoms of depression and anxiety. CONCLUSIONS Mothers of infants with severe CHD are at risk of compromised mental health from delivery to 36 months postpartum. Strain due to CHD-related interventions is identified as a possible partial mediator of the distress.
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Affiliation(s)
- Øivind Solberg
- Department of Psychosomatics and Health Behaviour, Norwegian Institute of Public Health, Box 4404 Nydalen, 0403 Oslo, Norway.
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Sarajuuri A, Lönnqvist T, Schmitt F, Almqvist F, Jokinen E. Patients with univentricular heart in early childhood: parenting stress and child behaviour. Acta Paediatr 2012; 101:252-7. [PMID: 22040350 DOI: 10.1111/j.1651-2227.2011.02509.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS To assess perceptions of child behaviour and parenting stress among the parents of young children with hypoplastic left heart syndrome (HLHS) and other forms of functionally univentricular heart defects (UVH). METHODS As part of our prospective nation-wide neurodevelopmental follow-up study, the parents of 23 patients with HLHS, 14 with UVH and 46 healthy controls at the mean age of 18 months received the questionnaires Child Behavior Checklist and Parenting Stress Index. RESULTS The reported level of total parenting stress was significantly higher among the mothers (mean score 241 vs 205, p < 0.001) and fathers (235 vs 202, p = 0.003) of patients with HLHS compared with those of controls. The parents of patients with HLHS reported significantly more total (mean T score 52 vs 45, p = 0.005) and internalizing (51 vs 41, p < 0.001) behaviour problems than the controls, but among the syndrome scales, a significant difference was only found in somatic complaints. The parents of patients with UVH did not report more parenting stress or emotional problems than the controls. CONCLUSION Hypoplastic left heart syndrome, a severe congenital heart defect, increases parenting stress. The reported emotional maladjustment in affected children might in part be owing to somatic complaints.
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Affiliation(s)
- A Sarajuuri
- Children's Hospital, University of Helsinki, Finland.
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Wray J, Lee K, Dearmun N, Franck L. Parental anxiety and stress during children's hospitalisation: the StayClose study. J Child Health Care 2011; 15:163-74. [PMID: 21917594 DOI: 10.1177/1367493511408632] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aims of this pilot study were to assess anxiety and stress in parents of children admitted to hospital and identify influencing factors, and assess the feasibility and acceptability of the methodology to parents and hospital staff. Parents of 28 children hospitalised for at least 3 days completed questionnaires assessing psychological functioning after admission, 16 and 13 of whom completed questionnaires at discharge and 3 months after discharge, respectively. Almost two-thirds of parents scored in the borderline/clinical range for anxiety at baseline and discharge. Higher anxiety scores were associated with the use of self-blame, lower optimism scores, higher levels of illness-related uncertainty and a greater number of previous hospital stays. Three months after discharge, 38% had borderline/clinical levels of anxiety, with scores significantly correlated with those at baseline and discharge. Although parents were willing to participate, and the questionnaires were acceptable, this pilot study identified some practical and logistical difficulties that will be addressed in the next phase of the study. Parents experience substantial stress and anxiety when their child is hospitalised. Screening for those at high risk for anxiety and implementing interventions to reduce uncertainty and maladaptive coping strategies may be beneficial.
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Affiliation(s)
- Jo Wray
- UCL Institute of Child Health, UK.
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Moola F, McCrindle BW, Longmuir PE. Physical activity participation in youth with surgically corrected congenital heart disease: Devising guidelines so Johnny can participate. Paediatr Child Health 2011; 14:167-70. [PMID: 20190897 DOI: 10.1093/pch/14.3.167] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2009] [Indexed: 11/13/2022] Open
Abstract
While most youth with congenital heart disease have simple structural lesions and near-normal activity tolerance and functioning, youth with complex structural defects may be affected by significant morbidity. Efforts are being made to consider the impact of exercise and physical activity on quality of life. The benefits of physical activity are well documented; however, the levels of participation and self-efficacy for activity remain low, thus increasing the risk of obesity and cardiovascular morbidity. Rehabilitation is a novel and emerging area, and decisions regarding advocacy versus restriction of physical activity may pose a challenge for both cardiologists and nonspecialists. The present article outlines the rationale for physical activity recommendations in youth with surgically corrected congenital heart disease and the psychosocial determinants of participation. Clinical recommendations and future directions are proposed.
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Affiliation(s)
- Fiona Moola
- Graduate Department of Exercise Sciences, The Hospital for Sick Children, University of Toronto, Toronto, Ontario
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Sable C, Foster E, Uzark K, Bjornsen K, Canobbio MM, Connolly HM, Graham TP, Gurvitz MZ, Kovacs A, Meadows AK, Reid GJ, Reiss JG, Rosenbaum KN, Sagerman PJ, Saidi A, Schonberg R, Shah S, Tong E, Williams RG. Best Practices in Managing Transition to Adulthood for Adolescents With Congenital Heart Disease: The Transition Process and Medical and Psychosocial Issues. Circulation 2011; 123:1454-85. [DOI: 10.1161/cir.0b013e3182107c56] [Citation(s) in RCA: 317] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Marino BS, Drotar D, Cassedy A, Davis R, Tomlinson RS, Mellion K, Mussatto K, Mahony L, Newburger JW, Tong E, Cohen MI, Helfaer MA, Kazak AE, Wray J, Wernovsky G, Shea JA, Ittenbach R. External validity of the pediatric cardiac quality of life inventory. Qual Life Res 2011; 20:205-14. [PMID: 21188538 PMCID: PMC3418540 DOI: 10.1007/s11136-010-9731-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE The Pediatric Cardiac Quality of Life Inventory (PCQLI) is a disease-specific, health-related quality of life (HRQOL) measure for pediatric heart disease (HD). The purpose of this study was to demonstrate the external validity of PCQLI scores. METHODS The PCQLI development site (Development sample) and six geographically diverse centers in the United States (Composite sample) recruited pediatric patients with acquired or congenital HD. Item response option variability, scores [Total (TS); Disease Impact (DI) and Psychosocial Impact (PI) subscales], patterns of correlation, and internal consistency were compared between samples. RESULTS A total of 3,128 patients and parent participants (1,113 Development; 2,015 Composite) were analyzed. Response option variability patterns of all items in both samples were acceptable. Inter-sample score comparisons revealed no differences. Median item-total (Development, 0.57; Composite, 0.59) and item-subscale (Development, DI 0.58, PI 0.59; Composite, DI 0.58, PI 0.56) correlations were moderate. Subscale-subscale (0.79 for both samples) and subscale-total (Development, DI 0.95, PI 0.95; Composite, DI 0.95, PI 0.94) correlations and internal consistency (Development, TS 0.93, DI 0.90, PI 0.84; Composite, TS 0.93, DI 0.89, PI 0.85) were high in both samples. CONCLUSION PCQLI scores are externally valid across the US pediatric HD population and may be used for multi-center HRQOL studies.
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Affiliation(s)
- Bradley S Marino
- Department of Pediatrics, Division of Cardiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 2003, Cincinnati, OH 45229, USA.
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Spijkerboer AW, De Koning WB, Duivenvoorden HJ, Bogers AJJC, Verhulst FC, Helbing WA, Utens EMWJ. Medical predictors for long-term behavioral and emotional outcomes in children and adolescents after invasive treatment of congenital heart disease. J Pediatr Surg 2010; 45:2146-53. [PMID: 21034936 DOI: 10.1016/j.jpedsurg.2010.07.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2010] [Revised: 05/31/2010] [Accepted: 07/16/2010] [Indexed: 11/17/2022]
Abstract
BACKGROUND The aim of the study was to test the following: (1) the predictive value of medical variables for long-term parent-reported behavioral and emotional problems in children and adolescents who underwent invasive treatment of congenital heart disease in infancy and (2) the relationship between parental psychological distress and parental reports on problems in children. METHODS The Child Behavior Checklist was used to investigate to what extent behavioral and emotional problems in 7- to 17-year-old children with congenital heart disease can be predicted by the following: (1) medical history, (2) therapeutic intervention and direct postinterventional course, (3) long-term medical course, (4) present contact with physicians, and (5) present medical status. The General Health Questionnaire was used to assess parental distress (especially anxiety). RESULTS Higher Child Behavior Checklist total problems scores were predicted by cardiac medication before therapeutic intervention. Palliative intervention (Rashkind procedure) before therapeutic intervention was associated with more favorable scores on total problems and externalizing. Long-term maternal distress was significantly related to parent-reported problems in children. CONCLUSION Long-term behavioral and emotional outcomes are only marginally predicted by medical variables. In counseling of children with congenital heart disease and their parents, attention should be paid to long-term maternal distress that has an influence on parent-reported problems in children.
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Affiliation(s)
- Alinda W Spijkerboer
- Department of Child and Adolescent Psychiatry, Erasmus Medical Centre-Sophia Children's Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
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Franck LS, McQuillan A, Wray J, Grocott MPW, Goldman A. Parent stress levels during children's hospital recovery after congenital heart surgery. Pediatr Cardiol 2010; 31:961-8. [PMID: 20495910 DOI: 10.1007/s00246-010-9726-5] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2010] [Accepted: 05/05/2010] [Indexed: 11/30/2022]
Abstract
The hospitalization of a child for cardiac surgery is known to be a stressful experience for parents. However, little is known about the time course or the relationships between parental stress and the child's actual or perceived recovery. This research aimed to investigate pre- and postoperative parental stress and to examine some of the influencing factors during the postoperative period for children undergoing elective cardiac surgery. Parents of 211 children completed questionnaires and structured interviews preoperatively and on postoperative days 3, 5, 8, and 15. The stress of the parents remained moderate to high throughout their children's hospitalization regardless of the severity of illness. Parents' perceptions of their children's level of illness correlated with an objective measure of postoperative morbidity. There were few differences between mothers' and fathers' stress or their perceptions of their children's illness. Parents in more deprived communities and mothers born outside the UK had higher stress levels. These findings indicate the negative impact of children's surgery and intensive care hospitalization on parents. Better identification of parents at risk for high stress and specific interventions to improve parental support and coping are needed.
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Tifferet S, Elizur Y, Constantini S, Friedman O, Manor O. Maternal adaptation to pediatric neurosurgical diagnosis: a growth curve analysis. Psychol Health 2010; 25:213-29. [PMID: 20391216 DOI: 10.1080/08870440802245298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To describe trajectories of change in maternal adaptation to chronic pediatric neurosurgical diagnosis and to identify variables predicting the level and rate of adaptation. METHODS One hundred and thirty seven mothers of children diagnosed with neurosurgical illness participated. Mothers reported socio-demographic variables, neuroticism, optimism, spouse support, mental health, and personal growth. The coordinating nurse assessed illness variables. Data were collected from diagnosis to 32+months post-diagnosis. RESULTS Results showed poor maternal mental health at diagnosis, followed by a gradual improvement over the next 18 months, and then a slight regression. Optimism, spouse support and religiosity were identified as resistance factors, while neuroticism, treatment needs, maternal age, and maternal education were identified as risk factors. The rate of change in mental health was moderated by neuroticism. CONCLUSIONS Maternal adaptation to pediatric illness changes over time. The trajectories of adaptation vary in relation to personal, social and medical variables.
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Affiliation(s)
- Sigal Tifferet
- Department of Social Sciences and Management, Ruppin Academic Center, Emek Hefer, Israel.
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Solberg Ø, Dale MTG, Holmstrøm H, Eskedal LT, Landolt MA, Vollrath ME. Long-term symptoms of depression and anxiety in mothers of infants with congenital heart defects. J Pediatr Psychol 2010; 36:179-87. [PMID: 20558484 DOI: 10.1093/jpepsy/jsq054] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To examine the relationship between the severity of infants' congenital heart defects (CHD) and their mothers' symptoms of depression and anxiety from pregnancy to 18 months postpartum. METHODS Mothers of infants with mild, moderate, or severe CHD (n=162) and mothers (n=44,400) within the Norwegian Mother and Child Cohort Study were assessed with an eight-item short version (SCL-8) of the Hopkins Symptom Checklist-25 at the 30th week of gestation and at 6 and 18 months postpartum. RESULTS Only the postpartum mental health trajectory of mothers of infants with severe CHD deviated from the mental health trajectory of the cohort at 6 and 18 months postpartum, showing significantly elevated levels of depression and anxiety symptoms. CONCLUSIONS The results elucidate the relationship between infants' CHD severity and maternal symptoms of depression and anxiety, possibly identifying a specifically vulnerable patient dyad in need of postoperative interventions.
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Affiliation(s)
- Øivind Solberg
- Department of Psychosomatics and Health Behaviour, Norwegian Institute of Public Health, Box 4404 Nydalen, 0403 Oslo, Norway.
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Tifferet S, Manor O, Elizur Y, Friedman O, Constantini S. Maternal Adaptation to Pediatric Illness: A Personal Vulnerability Model. CHILDRENS HEALTH CARE 2010. [DOI: 10.1080/02739611003679840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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McCusker CG, Doherty NN, Molloy B, Rooney N, Mulholland C, Sands A, Craig B, Stewart M, Casey F. A controlled trial of early interventions to promote maternal adjustment and development in infants born with severe congenital heart disease. Child Care Health Dev 2010; 36:110-7. [PMID: 19961494 DOI: 10.1111/j.1365-2214.2009.01026.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Abstract Background Congenital heart disease can have a negative impact on both infant development and maternal adjustment. This study considered the impact of a new programme of early psychosocial interventions on such outcomes, following the birth of a child with severe congenital heart disease. Methods Seventy infants and their mothers were assigned to an intervention or control group based on order of presentation to the unit. Interventions aimed at bolstering mother-infant transactions, through psychoeducation, parent skills training and narrative therapy techniques were implemented. Results Clinically and statistically significant gains were observed at 6-month follow-up on the mental (but not the psychomotor) scale of the Bayleys-II. Positive gains were also manifested on feeding practices, maternal anxiety, worry and appraisal of their situation. Conclusions A programme of generalizable psychosocial interventions is shown to have a positive impact on the infant with severe congenital heart disease and the mother.
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Affiliation(s)
- C G McCusker
- Department of Clinical Psychology, 4th Floor Bostock House, The Royal Hospitals, Grosvenor Road, Belfast, Northern Ireland, UK.
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