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McKechnie AC, Elgersma KM, Ambrose MB, Sanchez Mejia AA, Shah KM, Iwaszko Wagner T, Trebilcock A, Hallock C. Nurse-guided Mobile Health Care Program to Reduce Emotional Distress Experienced by Parents of Infants Prenatally Diagnosed with Critical Congenital Heart Disease: A Pilot Study. PROGRESS IN PEDIATRIC CARDIOLOGY 2024; 72:101687. [PMID: 38130374 PMCID: PMC10732467 DOI: 10.1016/j.ppedcard.2023.101687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Background Following prenatal diagnosis of critical congenital heart disease (CCHD), parents encounter emotional distress while facing caregiving challenges. Supportive psycho-educational interventions using mobile health (mHealth) can make care more accessible. Objectives We tested a novel nurse-guided mHealth care program, Preparing Heart and Mind™ (PHM™), with the objectives of examining feasibility and estimating the effect of the intervention on parents' emotional distress. Methods This pilot study design randomized participants using a 2:1 intervention to control ratio. Analysis involved description of retention, and intervention attendance and engagement, and adjusted linear mixed models to estimate group differences in depressive (CES-D), anxiety (STAI-S), and traumatic stress (IES-r) symptoms. Results The sample included 55 parents (n=38 PHM™ group, n=17 control). Complete retention of 37 (67%) parents included 29 (76%) in the PHM™ group and 8 (47%) control. Most attrition was due to infant death (7 parents), transplant referral (2 parents), or postnatal diagnostic ineligibility (4 parents). For the PHM™ group, ≥96% of parents attended pre- and postnatal sessions and most (65%) messaged with the nurse. mHealth engagement was highest prenatally, with handling uncertainty the most viewed topic (average 94% pages viewed). In linear mixed models analyses, the PHM™ group had on average 4.84 points lower depression (95% CI: -10.68-1.04), 6.56 points lower anxiety (-14.04-0.92), and 6.28 points lower trauma (-14.44-1.88) scores by study end. Conclusion Findings suggest that a nurse-guided mHealth approach is feasible and may contribute to a clinically important reduction in parents' emotional distress.
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Affiliation(s)
- Anne Chevalier McKechnie
- University of Minnesota School of Nursing, Child and Family Health Cooperative, 6-138D Weaver-Densford Hall, 308 Harvard Street SE, Minneapolis, MN 55455, USA
| | - Kristin M Elgersma
- University of Minnesota School of Nursing, Child and Family Health Cooperative, 6-138D Weaver-Densford Hall, 308 Harvard Street SE, Minneapolis, MN 55455, USA
| | - Matthew B Ambrose
- University of Minnesota Medical School, Department of Pediatrics, 420 Delaware Street SE, Minneapolis, MN 55455
- M Health Fairview Maternal and Fetal Medicine Center, 606 24th Avenue South, Minneapolis, MN 55454
| | - Aura A Sanchez Mejia
- Baylor College of Medicine, Department of Pediatrics, 1 Baylor Plaza, Houston, TX 77030
- Texas Children's Hospital Maternal-Fetal Medicine, 6651 Main Street, Houston, TX 77030
| | - Kavisha M Shah
- University of Minnesota Medical School, Department of Pediatrics, 420 Delaware Street SE, Minneapolis, MN 55455
- M Health Fairview Maternal and Fetal Medicine Center, 606 24th Avenue South, Minneapolis, MN 55454
| | - Taylor Iwaszko Wagner
- University of Minnesota School of Nursing, Child and Family Health Cooperative, 6-138D Weaver-Densford Hall, 308 Harvard Street SE, Minneapolis, MN 55455, USA
| | - Anna Trebilcock
- University of Minnesota School of Nursing, Child and Family Health Cooperative, 6-138D Weaver-Densford Hall, 308 Harvard Street SE, Minneapolis, MN 55455, USA
| | - Carrie Hallock
- GetWell, 7700 Old Georgetown Rd., 4th Floor, Bethesda, MD 20814
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Lee B, Sheth S, Gandhi R. Impact of the Fetal Echocardiogram on Maternal Depression and Well-Being. Pediatr Cardiol 2024:10.1007/s00246-024-03435-7. [PMID: 38424310 DOI: 10.1007/s00246-024-03435-7] [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: 11/30/2023] [Accepted: 01/27/2024] [Indexed: 03/02/2024]
Abstract
Fetal echocardiography allows for prenatal diagnosis of congenital heart disease (CHD). The objective of this study is to assess for the impact of fetal echocardiogram on levels of well-being and depression in pregnant women. Adult pregnant women carrying a fetus < 31-week gestational age were enrolled in the prospective observational study from February 2022 to June 2022. These subjects were split into two cohorts: those with CHD and those without CHD. Surveys were distributed prior to the fetal echocardiogram, six weeks later and six weeks after delivery. These surveys consisted of the Edinburgh Postpartum Depression Scale (EPDS) and questions about topics, such as anxiety and social support. Of the 152 subjects enrolled, 14 women had a fetus with CHD and 138 women had a fetus without CHD. Initial EPDS scores were elevated for the study population compared to the general population. Six weeks later, EPDS scores remained elevated. For the post-partum surveys, the EPDS scores were decreased below the rate of the general population for the group without CHD and similar to the general population rate for the CHD group. Anxiety, worry, and guilt remained low for both groups after the initial survey. Counseling from the pediatric cardiologist may help decrease anxiety and worry. Social support, like support groups, may be helpful for women carrying a fetus with CHD.
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Affiliation(s)
- Brian Lee
- Division of Pediatric Cardiology, Advocate Children's Hospital, Oak Lawn, IL, USA.
- Division of Pediatric Cardiology, Valley Children's Hospital, Madera, CA, USA.
| | - Saloni Sheth
- Division of Pediatric Cardiology, Advocate Children's Hospital, Oak Lawn, IL, USA
| | - Rupali Gandhi
- Division of Pediatric Cardiology, Advocate Children's Hospital, Oak Lawn, IL, USA
- Division of Pediatric Cardiology, University of Chicago, Chicago, IL, USA
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Mutti G, Ait Ali L, Marotta M, Nunno S, Consigli V, Baratta S, Orsi ML, Mastorci F, Vecoli C, Pingitore A, Festa P, Costa S, Foffa I. Psychological Impact of a Prenatal Diagnosis of Congenital Heart Disease on Parents: Is It Time for Tailored Psychological Support? J Cardiovasc Dev Dis 2024; 11:31. [PMID: 38276657 PMCID: PMC10816578 DOI: 10.3390/jcdd11010031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/12/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
The prenatal diagnosis of congenital heart disease (CHD) represents, for both parents, a particularly stressful and traumatic life event from a psychological point of view. The present review sought to summarize the findings of the most relevant literature on the psychological impact of prenatal diagnosis of CHD on parents, describing the most common mechanisms employed in order to face this unexpected finding. We also highlight the importance of counseling and the current gaps in the effects of psychological support on this population.
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Affiliation(s)
- Giulia Mutti
- Fondazione Toscana, G. Monasterio, Via Aurelia Sud, 54100 Massa, Italy (M.M.); (V.C.); (C.V.); (P.F.); (S.C.); (I.F.)
| | - Lamia Ait Ali
- Fondazione Toscana, G. Monasterio, Via Aurelia Sud, 54100 Massa, Italy (M.M.); (V.C.); (C.V.); (P.F.); (S.C.); (I.F.)
- Istituto di Fisiologia Clinica CNR, Via Aurelia Sud, 54100 Massa, Italy
| | - Marco Marotta
- Fondazione Toscana, G. Monasterio, Via Aurelia Sud, 54100 Massa, Italy (M.M.); (V.C.); (C.V.); (P.F.); (S.C.); (I.F.)
| | - Silvia Nunno
- Fondazione Toscana, G. Monasterio, Via Aurelia Sud, 54100 Massa, Italy (M.M.); (V.C.); (C.V.); (P.F.); (S.C.); (I.F.)
| | - Veronica Consigli
- Fondazione Toscana, G. Monasterio, Via Aurelia Sud, 54100 Massa, Italy (M.M.); (V.C.); (C.V.); (P.F.); (S.C.); (I.F.)
| | - Stefania Baratta
- Fondazione Toscana, G. Monasterio, Via Aurelia Sud, 54100 Massa, Italy (M.M.); (V.C.); (C.V.); (P.F.); (S.C.); (I.F.)
| | - Maria Letizia Orsi
- Fondazione Toscana, G. Monasterio, Via Aurelia Sud, 54100 Massa, Italy (M.M.); (V.C.); (C.V.); (P.F.); (S.C.); (I.F.)
| | - Francesca Mastorci
- Istituto di Fisiologia Clinica CNR, Via Moruzzi 1, 56124 Pisa, Italy; (F.M.); (A.P.)
| | - Cecilia Vecoli
- Fondazione Toscana, G. Monasterio, Via Aurelia Sud, 54100 Massa, Italy (M.M.); (V.C.); (C.V.); (P.F.); (S.C.); (I.F.)
- Istituto di Fisiologia Clinica CNR, Via Aurelia Sud, 54100 Massa, Italy
| | - Alessandro Pingitore
- Istituto di Fisiologia Clinica CNR, Via Moruzzi 1, 56124 Pisa, Italy; (F.M.); (A.P.)
| | - Pierluigi Festa
- Fondazione Toscana, G. Monasterio, Via Aurelia Sud, 54100 Massa, Italy (M.M.); (V.C.); (C.V.); (P.F.); (S.C.); (I.F.)
| | - Sabrina Costa
- Fondazione Toscana, G. Monasterio, Via Aurelia Sud, 54100 Massa, Italy (M.M.); (V.C.); (C.V.); (P.F.); (S.C.); (I.F.)
| | - Ilenia Foffa
- Fondazione Toscana, G. Monasterio, Via Aurelia Sud, 54100 Massa, Italy (M.M.); (V.C.); (C.V.); (P.F.); (S.C.); (I.F.)
- Istituto di Fisiologia Clinica CNR, Via Aurelia Sud, 54100 Massa, Italy
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Ehrler M, Wettach C, Beck I, Valsangiacomo Buechel ER, Latal B, Landolt MA. Mental health-related quality of life in mothers of children with surgically repaired congenital heart disease: a 13-year longitudinal study. Qual Life Res 2023; 32:2975-2986. [PMID: 37248407 PMCID: PMC10474212 DOI: 10.1007/s11136-023-03440-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 05/31/2023]
Abstract
AIMS Having a child with congenital heart disease (CHD) can affect parental health-related quality of life (HR-QoL). We investigated the long-term trajectories of mental HRQoL (m-HRQoL) in mothers of children with CHD and examined risk factors for persistent low m-HRQoL. METHODS One hundred twenty-five mothers of children with CHD completed a standardized questionnaire on m-HRQoL (mental subscale SF-12) after the children's first open-heart surgery and subsequently when the children were 1, 4, 6, 10, and 13 years old. A z-score for m-HRQoL was calculated with national norms. Latent class growth analysis (LCGA) was used to identify subgroups of mothers with regards to their m-HRQoL trajectories over time. Regression analysis investigated predictors for chronically low m-HRQoL. RESULTS Compared to norms, mothers of children with CHD had significantly lower m-HRQoL immediately after open-heart surgery (β = -0.30 (CI-95: -0.44, -0.15)). Subsequently, m-HRQoL increased to a normal level (m-HRQoL compared to the norm from 1 to 13 years: β ranges between 0.05 and 0.27). LCGA revealed two distinct groups of m-HRQoL trajectories: A group with normal m-HRQoL (75% of mothers, means z-scores range between - 0.76 and 0.62) and a group with chronically low m-HRQoL (25% of mothers, mean z-scores range between -1.32 and -0.10). Chronically, low m-HRQoL was associated with poorer social support (OR = 3.39 (CI-95: 1.40, 8.49), p = 0.008) but not with parental education, migration background, number of open-heart surgeries, diagnosis of a univentricular CHD, or low IQ. CONCLUSION A quarter of mothers of children with CHD have chronically low m-HRQoL throughout their child's development, especially those mothers with poor social support. Further studies of family-oriented approaches are needed to identify and support these mothers and reinforce parental well-being.
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Affiliation(s)
- Melanie Ehrler
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
- URPP Adaptive Brain Circuits in Development and Learning, University of Zurich, Zurich, Switzerland
| | - Corina Wettach
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Ingrid Beck
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland
- Department of Pediatrics, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Emanuela R Valsangiacomo Buechel
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
- Division of Cardiology, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Beatrice Latal
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Markus A Landolt
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.
- Department of Psychosomatics and Psychiatry, University Children's Hospital Zurich, Zurich, Switzerland.
- Division of Child and Adolescent Psychology, Department of Psychology, University of Zurich, Zurich, Switzerland.
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Thorpe A, Delaney RK, Pinto NM, Ozanne EM, Pershing ML, Hansen LM, Lambert LM, Fagerlin A. Parents' Psychological and Decision-Making Outcomes following Prenatal Diagnosis with Complex Congenital Heart Defect: An Exploratory Study. MDM Policy Pract 2023; 8:23814683231204551. [PMID: 37920604 PMCID: PMC10619352 DOI: 10.1177/23814683231204551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 08/24/2023] [Indexed: 11/04/2023] Open
Abstract
Background. Parents with a fetus diagnosed with a complex congenital heart defect (CHD) are at high risk of negative psychological outcomes. Purpose. To explore whether parents' psychological and decision-making outcomes differed based on their treatment decision and fetus/neonate survival status. Methods. We prospectively enrolled parents with a fetus diagnosed with a complex, life-threatening CHD from September 2018 to December 2020. We tested whether parents' psychological and decision-making outcomes 3 months posttreatment differed by treatment choice and survival status. Results. Our sample included 23 parents (average Age[years]: 27 ± 4, range = 21-37). Most were women (n = 18), non-Hispanic White (n = 20), and married (n = 21). Most parents chose surgery (n = 16), with 11 children surviving to the time of the survey; remaining parents (n = 7) chose comfort-directed care. Parents who chose comfort-directed care reported higher distress (x ¯ = 1.51, s = 0.75 v. x ¯ = 0.74, s = 0.55; Mdifference = 0.77, 95% confidence interval [CI], 0.05-1.48) and perinatal grief (x ¯ = 91.86, s = 22.96 v. x ¯ = 63.38, s = 20.15; Mdifference = 27.18, 95% CI, 6.20-48.16) than parents who chose surgery, regardless of survival status. Parents who chose comfort-directed care reported higher depression (x ¯ = 1.64, s = 0.95 v. x ¯ = 0.65, s = 0.49; Mdifference = 0.99, 95% CI, 0.10-1.88) than parents whose child survived following surgery. Parents choosing comfort-directed care reported higher regret (x ¯ = 26.43, s = 8.02 v. x ¯ = 5.00, s = 7.07; Mdifference = 21.43, 95% CI, 11.59-31.27) and decisional conflict (x ¯ = 20.98, s = 10.00 v. x ¯ = 3.44, s = 4.74; Mdifference = 17.54, 95% CI; 7.75-27.34) than parents whose child had not survived following surgery. Parents whose child survived following surgery reported lower grief (Mdifference = -19.71; 95% CI, -39.41 to -0.01) than parents whose child had not. Conclusions. The results highlight the potential for interventions and care tailored to parents' treatment decisions and outcomes to support parental coping and well-being. Highlights Question: Do the psychological and decision-making outcomes of parents differ based on their treatment decision and survival outcome following prenatal diagnosis with complex CHD?Findings: In this exploratory study, parents who decided to pursue comfort-directed care after a prenatal diagnosis reported higher levels of psychological distress and grief as well as higher decisional conflict and regret than parents who decided to pursue surgery.Meaning: The findings from this exploratory study highlight potential differences in parents' psychological and decision-making outcomes following a diagnosis of complex CHD for their fetus, which appear to relate to the treatment approach and the treatment outcome and may require tailoring of psychological and decision support.
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Affiliation(s)
- Alistair Thorpe
- University of Utah Intermountain Healthcare Department of Population Health Sciences, Salt Lake City, UT, USA
- Department of Applied Health Research, University College London, London, UK
| | - Rebecca K. Delaney
- University of Utah Intermountain Healthcare Department of Population Health Sciences, Salt Lake City, UT, USA
| | - Nelangi M. Pinto
- Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
- Division of Pediatric Cardiology at Seattle Children’s Hospital, Seattle, WA, USA
| | - Elissa M. Ozanne
- University of Utah Intermountain Healthcare Department of Population Health Sciences, Salt Lake City, UT, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mandy L. Pershing
- University of Utah Intermountain Healthcare Department of Population Health Sciences, Salt Lake City, UT, USA
| | - Lisa M. Hansen
- Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Linda M. Lambert
- Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Angela Fagerlin
- University of Utah Intermountain Healthcare Department of Population Health Sciences, Salt Lake City, UT, USA
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation
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Lee BK, Loomba RS. Rates of depression, anxiety, and stress in parents of children with congenital heart disease using the Depression Anxiety Stress Scale. Ann Pediatr Cardiol 2022; 15:374-379. [PMID: 36935826 PMCID: PMC10015400 DOI: 10.4103/apc.apc_27_22] [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: 02/14/2022] [Revised: 04/20/2022] [Accepted: 07/10/2022] [Indexed: 01/07/2023] Open
Abstract
Context and Background The Cardiac Neurodevelopmental Outcome Collaborative has recommended using the Depression Anxiety Stress Scale (DASS) to evaluate for depression, anxiety, and stress in parents of children with congenital heart disease (CHD). There has not been a longitudinal study investigating its utility in these parents. Aims The aim of this study was to determine the trend of depression, anxiety, and stress in parents of patients with CHD. Methods Our center uses this self-reported survey at every visit between 6 and 36 months of age. This was a single-centered, retrospective study from January 1, 2018, to June 1, 2020. Statistical Analysis Cox regression analysis was conducted using a composite end point of having an abnormal score in any of the three domains. Results Two hundred and seventy-three mothers and 139 fathers were included in the study. For mothers, scores in each domain were elevated at 12 and 24 months. For fathers, scores in each domain were elevated at 6 months, followed by a decrease before peaking again, with depression increasing at 36 months and anxiety and stress increasing at 30 months. Increased length of stay for the index surgery was associated with an abnormal score for mothers (B = 0.02, P < 0.01) and fathers (B = 0.01, P = 0.04). Being in a relationship with the father (B = -0.8, P < 0.01) was associated with freedom of an abnormal score for mothers. Conclusions Scores concerning for depression, anxiety, and stress peak at different points for parents. Length of stay for the index surgery and being in a relationship are important factors in the mental health of parents.
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Affiliation(s)
- Brian K. Lee
- Pediatric Cardiology, Advocate Children's Heart Institute, Oak Lawn, IL, USA
| | - Rohit S. Loomba
- Pediatric Cardiology, Advocate Children's Heart Institute, Oak Lawn, IL, USA
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Role alteration predicts anxiety and depressive symptoms in parents of infants with congenital heart disease: a pilot study. Cardiol Young 2021; 31:1842-1849. [PMID: 33818351 PMCID: PMC8490483 DOI: 10.1017/s1047951121001037] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Parents of infants born with critical congenital heart disease are at risk for adverse mental health symptoms. The purpose of this study was to identify infant-, parent-, and environmental-based stressors for mothers and fathers after their infants' cardiac surgery, and to explore relationships between stressors and mental health symptoms of anxiety and depression. METHODS This study enrolled 28 biological mother-father dyads from families admitted to the paediatric cardiac intensive care unit for cardiac surgery at one free-standing children's hospital in the Northeast. Paired t-tests were used to examine group differences between mothers and fathers on perceived stressors and mental health symptoms, while linear mixed effects modelling was used to explore the predictive relationship between perceived stressors, personal factors, and mental health symptoms. RESULTS Mothers reported higher perceived stressor scores of parental role alteration (t = 4.03, p < 0.01) and infant appearance and behaviour (t = 2.61, p = 0.02), and total perceived stress (t = 2.29 p = 0.03), compared to fathers. Mothers also reported higher anxiety (t = 2.47, p = 0.02) and depressive symptoms (t = 3.25, p < 0.01) than fathers. In multivariable analysis, parental role alteration significantly predicted anxiety (t = 5.20, p < 0.01, d = 0.77) and depressive symptoms (t = 7.09, p < 0.01, d = 1.05) for mothers and fathers. The consensus subscale of the Dyadic Adjustment Scale also significantly predicted depressive symptoms (t = -2.42, p = 0.02, d = 0.04). CONCLUSION Parents were distressed during their infant's admission for surgical repair for critical congenital heart disease. Parental role alteration was significantly associated with parental anxiety and depressive symptoms, while poor relationship quality was associated with depressive symptoms, highlighting areas for potential nursing-led psychosocial led interventions.
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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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Lisanti AJ, Demianczyk AC, Vaughan K, Martino GF, Ohrenschall RS, Quinn R, Chittams JL, Medoff-Cooper B. Parental role alteration strongly influences depressive symptoms in mothers of preoperative infants with congenital heart disease. Heart Lung 2021; 50:235-241. [PMID: 33340826 PMCID: PMC7969439 DOI: 10.1016/j.hrtlng.2020.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Mothers of infants with congenital heart disease are at risk for depression. OBJECTIVES This study explored the influence on maternal depressive symptoms of several known factors for mothers in the pediatric cardiac intensive care unit, including perceived stressors, attachment, and anxiety. METHODS This study was a secondary analysis of 30 mothers of infants awaiting cardiac surgery. Linear regressions were calculated to determine the relationships between perceived stressors, maternal attachment, anxiety, and maternal depressive symptoms. RESULTS Nearly half of mothers reported depressive symptoms above the measure cut-off score, indicating they were at risk for likely clinical depression. Subscales of perceived stress explained 61.7% of the variance in depressive symptoms (F = 11.815, p<0.0001) with parental role alteration subscale as the strongest predictor (standardized beta=0.694, p = 0.03). CONCLUSIONS Findings underscore the importance of mental health screening and instituting nursing practices to enhance parental role for mothers of infants awaiting cardiac surgery.
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Affiliation(s)
- Amy J Lisanti
- Nursing and Clinical Care Services, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, United States of America; University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA 19104, United States of America.
| | - Abigail C Demianczyk
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, United States of America.
| | - Kayla Vaughan
- Nursing and Clinical Care Services, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, United States of America.
| | - Giordana Fraser Martino
- Nursing and Clinical Care Services, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, United States of America.
| | - Rachel Schaake Ohrenschall
- Nursing and Clinical Care Services, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, United States of America.
| | - Ryan Quinn
- University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA 19104, United States of America.
| | - Jesse L Chittams
- University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA 19104, United States of America.
| | - Barbara Medoff-Cooper
- University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA 19104, United States of America; Research Institute, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, United States of America.
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10
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Lisanti AJ, Demianczyk AC, Costarino A, Vogiatzi MG, Hoffman R, Quinn R, Chittams JL, Medoff-Cooper B. Skin-to-Skin Care is Associated with Reduced Stress, Anxiety, and Salivary Cortisol and Improved Attachment for Mothers of Infants With Critical Congenital Heart Disease. J Obstet Gynecol Neonatal Nurs 2020; 50:40-54. [PMID: 33181093 DOI: 10.1016/j.jogn.2020.09.154] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To estimate the effect of skin-to-skin care (SSC) on biobehavioral measures of stress (anxiety and salivary cortisol) and attachment (attachment scores and salivary oxytocin) of mothers before and after their infants' neonatal cardiac surgery. DESIGN A prospective interventional, baseline response-paired pilot study. SETTING Cardiac center of a large, metropolitan, freestanding children's hospital. PARTICIPANTS Thirty women whose infants were hospitalized for neonatal cardiac surgery. METHODS Participants acted as their own controls before, during, and after SSC at two time points: once before and once after surgery. We measured the stress response of mothers, as indicated by self-reported scores of anxiety and maternal salivary cortisol, and maternal-infant attachment, as indicated by self-reported scores and maternal salivary oxytocin. RESULTS Significant reductions in self-reported scores of anxiety and salivary cortisol were found as a result of SSC at each time point, as well as increased self-reported attachment. No significant differences were found in oxytocin. CONCLUSION Our findings provide initial evidence of the benefits of SSC as a nurse-led intervention to support maternal attachment and reduce physiologic and psychological stress responses in mothers of infants with critical congenital heart disease before and after neonatal cardiac surgery.
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11
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McKechnie AC, Johnson KA, Baker MJ, Docherty SL, Leuthner SR, Thoyre S. Adaptive Leadership in Parents Caring for their Children Born with Life-Threatening Conditions. J Pediatr Nurs 2020; 53:41-51. [PMID: 32438191 PMCID: PMC7362670 DOI: 10.1016/j.pedn.2020.03.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 03/31/2020] [Accepted: 03/31/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to chronicle the adaptive challenges and adaptive work, including emerging leadership behaviors, recounted over time by the parents of very young children diagnosed before birth with life threatening conditions. DESIGN AND METHODS A descriptive, follow-up study design was used for the current study. Following the original grounded dimensional analysis study completed in 2012, the corpus for this analysis was collected in 2014. In-depth, audio-recorded interviews were conducted with 15 families (8 couples, 7 mothers). The 15 children, born with cardiac, abdominal, and cerebrospinal anomalies, were 14 - 37 months or deceased at follow-up. A directed content analysis of transcribed verbatim interviews was structured by the Adaptive Leadership framework. RESULTS Parents described behaviors that indicated a non-linear development towards adaptive leadership as they accomplished the adaptive work within intra- and interpersonal domains that was necessary to address challenges over time. Not all parents described abilities and/or a willingness to mobilize others to do adaptive work, suggesting that adaptive leadership remained an unrealized potential. CONCLUSIONS Understood as a complex adaptive system, parents of medically at-risk children hold potential for development towards adaptive leadership and collaborative partnership within the family and with healthcare providers. PRACTICE IMPLICATIONS Due to improved survival rates, parents face ongoing challenges related to their children's unpredictable and often chronic health needs. Study findings illustrate parents' adaptive work and leadership behaviors, which can inform nursing assessments, as well as the type and timing for intervention.
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Affiliation(s)
- Anne C McKechnie
- Child and Family Health Cooperative, School of Nursing, University of Minnesota, Minneapolis, MN, United States of America.
| | - Kathy A Johnson
- College of Nursing, Chamberlain University, Downers Grove, IL, United States of America
| | - Maureen J Baker
- MSN Division, School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Sharron L Docherty
- School of Nursing, Duke University, Durham, NC, United States of America
| | - Steven R Leuthner
- Division of Neonatology, Department of Pediatrics and Bioethics, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Suzanne Thoyre
- PhD Division, School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
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12
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Riikonen A, Aho AL, Rantanen A. The relationship satisfaction of parents to children with congenital heart disease. INTERPERSONA: AN INTERNATIONAL JOURNAL ON PERSONAL RELATIONSHIPS 2019. [DOI: 10.5964/ijpr.v13i1.325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The purpose of the research is to describe the marital satisfaction of parents with a child with congenital heart disease, and the factors associated with it. The data were collected using an electronic questionnaire from applicable parents (n = 104) via the website of the Finnish Association for Heart Children and Adults and a closed Facebook forum where such parents are members. Marital satisfaction was measured using the ENRICH Marital Satisfaction (EMS) scale. The data were analysed using statistical methods. The variables were described by frequencies, percentages, and dispersion measures (Md = median, Q1= lower quartile, Q3 = upper quartile). Associations between the background variables and relationship satisfaction were examined using Mann-Whitney U test and Kruskall-Wallis test. Most of the surveyed parents were quite satisfied with their relationships. Parental factors associated with marital satisfaction were the gender of the parent, current health situation, support received from the spouse, problems with the spouse, and remarkable changes in economic situation during last year. The age of the child with a congenital heart disease was a factor associated with marital satisfaction. The interaction skills of the parents must continue to be supported and strengthened, because good interpersonal skills increase marital satisfaction and help resolve the conflicts that may arise in a relationship.
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13
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Barker PC, Tatum GH, Campbell MJ, Camitta MGW, Milazzo AS, Hornik CP, French A, Miller SG. Improving maternal-infant bonding after prenatal diagnosis of CHD. Cardiol Young 2018; 28:1306-1315. [PMID: 30079851 PMCID: PMC6197928 DOI: 10.1017/s104795111800121x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Infants with prenatally diagnosed CHD are at high risk for adverse outcomes owing to multiple physiologic and psychosocial factors. Lack of immediate physical postnatal contact because of rapid initiation of medical therapy impairs maternal-infant bonding. On the basis of expected physiology, maternal-infant bonding may be safe for select cardiac diagnoses. METHODS This is a single-centre study to assess safety of maternal-infant bonding in prenatal CHD. RESULTS In total, 157 fetuses with prenatally diagnosed CHD were reviewed. On the basis of cardiac diagnosis, 91 fetuses (58%) were prenatally approved for bonding and successfully bonded, 38 fetuses (24%) were prenatally approved but deemed not suitable for bonding at delivery, and 28 (18%) were not prenatally approved to bond. There were no complications attributable to bonding. Those who successfully bonded were larger in weight (3.26 versus 2.6 kg, p<0.001) and at later gestation (39 versus 38 weeks, p<0.001). Those unsuccessful at bonding were more likely to have been delivered via Caesarean section (74 versus 49%, p=0.011) and have additional non-cardiac diagnoses (53 versus 29%, p=0.014). There was no significant difference regarding the need for cardiac intervention before hospital discharge. Infants who bonded had shorter hospital (7 versus 26 days, p=0.02) and ICU lengths of stay (5 versus 23 days, p=0.002) and higher survival (98 versus 76%, p<0.001). CONCLUSION Fetal echocardiography combined with a structured bonding programme can permit mothers and infants with select types of CHD to successfully bond before ICU admission and intervention.
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Affiliation(s)
- Piers C.A. Barker
- Division of Pediatric Cardiology, Department of Pediatrics, Duke University Medical Center, Durham, USA
| | - Gregory H. Tatum
- Division of Pediatric Cardiology, Department of Pediatrics, Duke University Medical Center, Durham, USA
| | - Michael J. Campbell
- Division of Pediatric Cardiology, Department of Pediatrics, Duke University Medical Center, Durham, USA
| | - Michael GW Camitta
- Division of Pediatric Cardiology, Department of Pediatrics, Duke University Medical Center, Durham, USA
| | - Angelo S. Milazzo
- Division of Pediatric Cardiology, Department of Pediatrics, Duke University Medical Center, Durham, USA
| | | | - Amanda French
- Advanced Practice Nursing, Duke University Medical Center, Durham, USA
| | - Stephen G. Miller
- Division of Pediatric Cardiology, Department of Pediatrics, Duke University Medical Center, Durham, USA
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14
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Re JM, Dean S, Mullaert J, Guedeney A, Menahem S. Maternal Distress and Infant Social Withdrawal (ADBB) Following Infant Cardiac Surgery for Congenital Heart Disease. World J Pediatr Congenit Heart Surg 2018; 9:624-637. [DOI: 10.1177/2150135118788788] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Mothers and infants are exposed to multiple stresses when cardiac surgery is required for the infant. This study reviewed infant responsiveness using a standardized objective observational measure of social withdrawal and explored its association with measures of maternal distress. Methods: Mother–infant pairs involving infants surviving early cardiac surgery were assessed when the infant was aged two months. Infant social withdrawal was measured using the Alarm Distress Baby Scale. Maternal distress was assessed using self-report measures for maternal depression (Edinburgh Postnatal Depression Scale), anxiety (Spielberger State-Trait Anxiety Scale), and parenting stress (Parenting Stress Index–Short Form). Potential associations between infant social withdrawal and maternal distress were evaluated. Results: High levels of maternal distress and infant social withdrawal were identified relative to community norms with a positive association. Such an association was not found between infant social withdrawal and the cardiac abnormality and surgery performed. Conclusion: The vulnerability of infants requiring cardiac surgery may be better understood when factors beyond their medical condition are considered. The findings suggested an association between maternal distress and infant social withdrawal, which may be consistent with mothers’ distress placing infants subjected to cardiac surgery at substantially increased risk of social withdrawal. However, it is unclear to what extent infant withdrawal may trigger maternal distress and what the interactive effects are. Further research is warranted. Trialing a mother–infant support program may be helpful in alleviating distress and improving the well-being and outcomes for these families.
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Affiliation(s)
- Jennifer M. Re
- Psychiatry Department, Monash University, Melbourne, Victoria, Australia
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Suzanne Dean
- Psychiatry Department, Monash University, Melbourne, Victoria, Australia
| | - Jimmy Mullaert
- Denis Diderot University, Paris, France
- Biostatistics, Epidemiology and Clinical Research Department, APHP, Paris, France
| | - Antoine Guedeney
- Denis Diderot University, Paris, France
- Department of Child and Adolescent Psychiatry, APHP, Paris, France
| | - Samuel Menahem
- Psychiatry Department, Monash University, Melbourne, Victoria, Australia
- Paediatric Cardiology Unit, Monash Medical Centre, Melbourne, Victoria, Australia
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15
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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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16
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17
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Boyd RC, Scharko AM, Cole JCM, Patterson CA, Benton TD, Power TJ. Training Pediatric Psychologists for Perinatal Behavioral Health Services in a Pediatric Hospital. J Clin Psychol Med Settings 2018; 23:99-111. [PMID: 26531132 DOI: 10.1007/s10880-015-9439-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Although pediatric hospitals specialize in providing care to children and adolescents, at The Children's Hospital of Philadelphia (CHOP), our team has been providing behavioral health services for two unique parent populations-parents with a child in the Newborn Infant Intensive Care Unit and pregnant women carrying fetuses with specific birth defects and receiving prenatal care in the Center for Fetal Diagnosis and Treatment. A new training program was developed to expand the scope of pediatric psychologists' practice to include perinatal behavioral health services, specifically for these two unique parent populations served at CHOP. The program includes direct service provision for adult mental health concerns, as well as education and support to help families cope with the existing medical conditions. This article describes the training program and its implementation as a model of training for other pediatric hospitals. The roles of psychologists embedded in these units and hospital privileges are discussed.
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Affiliation(s)
- Rhonda C Boyd
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. .,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Alexander M Scharko
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Joanna C M Cole
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Chavis A Patterson
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Tami D Benton
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Thomas J Power
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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18
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McGauran M, Jordan B, Beijers R, Janssen I, Franich-Ray C, de Weerth C, Cheung M. Long-term alteration of the hypothalamic-pituitary-adrenal axis in children undergoing cardiac surgery in the first 6 months of life. Stress 2017; 20:505-512. [PMID: 28720027 DOI: 10.1080/10253890.2017.1349748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Children with congenital heart disease (CHD) have poorer neurodevelopmental and psychological outcomes. The mechanisms underlying this remain unclear. One mechanism could be that the stressful experience of cardiac surgery early in life influences long-term hypothalamic-pituitary-adrenal (HPA) axis regulation. Dysregulation of the HPA axis has been linked to poorer neurocognitive and psychological outcomes in other study populations. This case-control study aims to compare HPA-axis regulation (circadian rhythm and reactivity) using salivary cortisol in 3- to 5-year-olds with CHD who did and did not have cardiac surgery prior to 6 months of age. Saliva samples for cortisol analysis were collected from preschoolers with CHD (N = 28, Males = 18, Females = 10) over two weekend days, and before and after an echocardiogram. Caregiver education, child age, sex, and cardiac disease severity score were included as confounders. Multilevel analysis (hierarchical linear modeling) was used to analyze the data. The analysis for the cortisol circadian rhythm shows that the early surgery group has a flatter diurnal slope secondary to lower mean weekend morning waking cortisol levels than controls but similar mean bed time values. Multilevel analysis of the stress response to an echocardiogram indicates that the early surgery group has an increased response when compared to the control group. This is the first study to show that cardiac surgery prior to 6 months of age is associated with a different pattern of HPA-axis regulation at 3-5 years of age.
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Affiliation(s)
- Monica McGauran
- a Social & Mental Health Research Group, Murdoch Children's Research Institute , Royal Children's Hospital , Parkville , VIC , Australia
- b Department of Paediatrics , University of Melbourne , Melbourne , Australia
| | - Brigid Jordan
- a Social & Mental Health Research Group, Murdoch Children's Research Institute , Royal Children's Hospital , Parkville , VIC , Australia
- b Department of Paediatrics , University of Melbourne , Melbourne , Australia
- c Department of Social Work , Royal Children's Hospital , Melbourne , Australia
| | - Roseriet Beijers
- d Department of Developmental Psychology, Behavioural Science Institute , Radboud University , Nijmegen , The Netherlands
| | - Irma Janssen
- d Department of Developmental Psychology, Behavioural Science Institute , Radboud University , Nijmegen , The Netherlands
| | - Candice Franich-Ray
- a Social & Mental Health Research Group, Murdoch Children's Research Institute , Royal Children's Hospital , Parkville , VIC , Australia
- b Department of Paediatrics , University of Melbourne , Melbourne , Australia
| | - Carolina de Weerth
- d Department of Developmental Psychology, Behavioural Science Institute , Radboud University , Nijmegen , The Netherlands
| | - Michael Cheung
- b Department of Paediatrics , University of Melbourne , Melbourne , Australia
- e Cardiac Research Group, Murdoch Children's Research Institute , Parkville , VIC , Australia
- f Department of Cardiology , Royal Children's Hospital , Melbourne , Australia
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19
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Woolf-King SE, Anger A, Arnold EA, Weiss SJ, Teitel D. Mental Health Among Parents of Children With Critical Congenital Heart Defects: A Systematic Review. J Am Heart Assoc 2017; 6:JAHA.116.004862. [PMID: 28151402 PMCID: PMC5523775 DOI: 10.1161/jaha.116.004862] [Citation(s) in RCA: 152] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background Parents of children with critical congenital heart defects (PCCHDs) may be at high risk for mental health morbidity; however, the literature is not well characterized. Given that compromised parental mental health can lead to long‐term cognitive, health‐related, and behavioral problems in children, a systematic review of this literature could provide informed recommendations for continued research and enhance the care of families of children living with critical congenital heart defects. Methods and Results We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines that resulted in 30 studies on the mental health of PCCHDs. The literature revealed that PCCHDs are at an elevated risk for psychological problems, particularly in the immediate weeks and months following cardiac surgery. Up to 30% of PCCHDs have symptoms consistent with a diagnosis of posttraumatic stress disorder, with over 80% presenting with clinically significant symptoms of trauma; 25% to 50% of PCCHDs reported clinically elevated symptoms of depression and/or anxiety, and 30% to 80% reported experiencing severe psychological distress. There was high variability in measurements used to assess study outcomes, methodological quality, and sociocultural composition of the parents included in the studies. Conclusions There is an urgent need for additional research on the severity, course, persistence, and moderators of these mental health problems over time, and for the development and testing of screening approaches and interventions that can be feasibly delivered in the context of ongoing pediatric cardiac care.
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Affiliation(s)
- Sarah E Woolf-King
- Department of Psychology, Syracuse University, Syracuse, NY .,Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Alexandra Anger
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, San Francisco, CA.,Department of Pediatrics, Pediatric Heart Center, University of California, San Francisco, San Francisco, CA
| | - Emily A Arnold
- Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Sandra J Weiss
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, San Francisco, CA
| | - David Teitel
- Department of Pediatrics, Pediatric Heart Center, University of California, San Francisco, San Francisco, CA
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20
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Kolaitis GA, Meentken MG, Utens EMWJ. Mental Health Problems in Parents of Children with Congenital Heart Disease. Front Pediatr 2017; 5:102. [PMID: 28534022 PMCID: PMC5421144 DOI: 10.3389/fped.2017.00102] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 04/20/2017] [Indexed: 11/30/2022] Open
Abstract
This review will provide a concise description of mental health problems in parents of children with a (non-syndromic) congenital heart disease (CHD) during different stressful periods. Predictors of these problems and also implications for clinical practice will be mentioned. Having a child with CHD can be very stressful for parents, who have to face overwhelming emotions and also extra physical, financial, and other practical challenges. Parental distress has been reported in 30-80% of parents and appears not to be related to severity of CHD. Parental mental health, parenting, the parent-child relationship, and parental quality of life can all be affected. Parents, and especially mothers, are at risk of psychological distress, anxiety, depression, somatization, hopelessness, and posttraumatic stress symptoms, which in turn may influence mother's responsiveness. In the long term, the majority of parents adapt successfully to living with a child with CHD, but approximately 40% report a need for psychosocial care. These families may be helped by early psychosocial interventions to alleviate stress and reduce children's emotional and behavioral problems. A holistic approach to early psychosocial interventions should aim at improving coping and enhance parenting. During routine medical checkups, medical professionals should ask about parental stress, family functioning, and psychosocial functioning of the child and, when needed, adequate psychosocial care should be provided.
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Affiliation(s)
- Gerasimos A Kolaitis
- Department of Child Psychiatry, Medical School, "Aghia Sophia" Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece.,Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children's Hospital, Rotterdam, Netherlands
| | - Maya G Meentken
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children's Hospital, Rotterdam, Netherlands
| | - Elisabeth M W J Utens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children's Hospital, Rotterdam, Netherlands.,Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, Netherlands.,Academic Center for Child Psychiatry the Bascule/Department Child and Adolescent Psychiatry, Academic Medical Center, Amsterdam, Netherlands
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21
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Chaves C, Hervas G, Vazquez C. Granting wishes of seriously ill children: Effects on parents’ well-being. J Health Psychol 2016; 21:2314-27. [DOI: 10.1177/1359105315576348] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We investigated whether a positive intervention (i.e. granting a wish) in children with a chronic illness could promote positive psychological responses in their parents. Hospitalized children were randomly assigned to either the wish group or to a waiting-list control group. Mothers and fathers’ responses ( N = 86 and 38, respectively) were studied. Parents from the wish group showed higher levels of positive emotions and beliefs in a benevolent world than the control group. Mothers from the wish group reported higher benefit finding, gratitude, and love than those in the control group. Given that the child’s illness inevitably affects their parents, it is important to promote studies that include parents’ well-being dimensions.
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22
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Brenner M, Côté SM, Boivin M, Tremblay RE. Severe congenital malformations, family functioning and parents' separation/divorce: a longitudinal study. Child Care Health Dev 2016; 42:16-24. [PMID: 26174996 DOI: 10.1111/cch.12269] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/27/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND We aim to explore the association of a severe congenital malformation (SCM) with postnatal family functioning and parents' separation/divorce and to examine if this association might be moderated by birth order of the child and parental level of education. SCM refers to malformations that, without medical intervention, cause handicap or death. METHODS Using the Quebec Longitudinal Study of Child Development, an ongoing population-based birth cohort study initiated in 1998, we compared 1675 families of children with and without a SCM to identify if having a child with a SCM was associated with maternal perception of family functioning. We examined if an SCM was associated with parents' separation and examined parents' education level and birth order of the children to evaluate whether these factors had any moderating effect on the results. RESULTS There were no significant differences in family functioning between families with and without a SCM child at 5 and 17 months. At 5 months, family functioning was significantly better (P = 0.03) for families with a SCM firstborn child than for families with a SCM child that is not firstborn. For parental separation, no significant differences were observed at 5 and 29 months and 4 years. No significant moderating effects were observed for birth order and parental education on parental separation. CONCLUSIONS Families of children with a SCM do not appear to be at higher risk of family dysfunction within the first 17 months after birth nor of parental separation within the first 4 years after birth. Family functioning tends to be worst in families where the child with SCM is the second or subsequent child born.
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Affiliation(s)
- M Brenner
- School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - S M Côté
- School of Public Health, University of Montreal, Montreal, Canada.,Institute of Genetic, Neurobiological and Social Foundations of Child Development, Tomsk State University, Tomsk, Russian Federation
| | - M Boivin
- School of Psychology, Laval University, Québec, Canada.,Institute of Genetic, Neurobiological and Social Foundations of Child Development, Tomsk State University, Tomsk, Russian Federation
| | - R E Tremblay
- Institute of Genetic, Neurobiological and Social Foundations of Child Development, Tomsk State University, Tomsk, Russian Federation.,School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland.,Departments of Pediatrics and Psychology, University of Montreal, Montreal, Canada
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Landolt MA, Ystrom E, Stene-Larsen K, Holmstrøm H, Vollrath ME. Exploring causal pathways of child behavior and maternal mental health in families with a child with congenital heart disease: a longitudinal study. Psychol Med 2014; 44:3421-3433. [PMID: 24286537 DOI: 10.1017/s0033291713002894] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND A congenital heart defect (CHD) can increase the risk of mental health problems in affected children and their parents. The extent to which risk factors for these problems are shared in families or are specific to the individual family member is unclear. METHOD Prospective data from the Norwegian Mother and Child Cohort Study (MoBa; n = 93,009) were linked with a nationwide CHD registry, and 408 children with CHD were identified. Mothers' reports on child internalizing problems and their own distress were assessed by questionnaires at child ages 6, 18 and 36 months. A structural model was applied to distinguish between familial (shared) factors and individual-specific factors for mental health problems. RESULTS CHD was a substantial risk factor for problems in children and their mothers at all time points. CHD contributed on average 31% and 39% to the variance in children's and mothers' problems respectively. Both shared familial and individual-specific factors unique to CHD families contributed to risk for mental health problems. Whereas individual-specific risk factors contributed to the stability of problems in mothers, the effect of these factors lasted only a short time in children. Mutual influences over time were found between the mother's and the child's mental health at 18 and 36 months. CONCLUSIONS The burden of CHD in a child is shared between family members but is also specific to the individual. This study points to a need for both an individual and a family-based approach to provide psychological support to children with CHD and their parents.
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Affiliation(s)
- M A Landolt
- Department of Psychosomatics and Psychiatry,University Children's Hospital,Zurich,Switzerland
| | - E Ystrom
- Division of Mental Health,Norwegian Institute of Public Health,Oslo,Norway
| | - K Stene-Larsen
- Division of Mental Health,Norwegian Institute of Public Health,Oslo,Norway
| | - H Holmstrøm
- Department of Pediatrics,Oslo University Hospital,Norway
| | - M E Vollrath
- Division of Mental Health,Norwegian Institute of Public Health,Oslo,Norway
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24
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Affiliation(s)
- David Isaacs
- Clinical Ethics, Children's Hospital at Westmead, Sydney, New South Wales, Australia
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25
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Dale MTG, Solberg O, Holmstrøm H, Landolt MA, Eskedal LT, Vollrath ME. Relationship satisfaction among mothers of children with congenital heart defects: a prospective case-cohort study. J Pediatr Psychol 2013; 38:915-26. [PMID: 23792348 DOI: 10.1093/jpepsy/jst038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To assess the level of partner relationship satisfaction among mothers of children with different severity of congenital heart defects (CHD) compared with mothers in the cohort. METHODS Mothers of children with mild, moderate, or severe CHD (n = 182) and a cohort of mothers of children without CHD (n = 46,782) from the Norwegian Mother and Child Cohort Study were assessed at 5 time points from pregnancy to 36 months postpartum. A 5-item version of the Relationship Satisfaction scale was used, and relevant covariates were explored. RESULTS The trajectories of relationship satisfaction among mothers of children with varying CHD severity did not differ from the trajectories in the cohort. All women in the cohort experienced decreasing relationship satisfaction from 18 months after delivery up to 36 months after delivery. CONCLUSIONS Having a child with CHD, regardless of severity, does not appear to exacerbate the decline in relationship satisfaction.
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Affiliation(s)
- Maria T G Dale
- Department of Psychosomatics and Health Behavior, Norwegian Institute of Public Health, Oslo, Norway.
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Effectiveness of psychological intervention for treating symptoms of anxiety and depression among pregnant women diagnosed with fetal malformation. Int J Gynaecol Obstet 2013; 121:123-6. [DOI: 10.1016/j.ijgo.2012.12.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 12/10/2012] [Accepted: 01/25/2013] [Indexed: 01/25/2023]
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