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Shoaib AB. Islamic perspectives on preconception, prenatal, and perinatal counseling. Front Pediatr 2024; 12:1373918. [PMID: 38450297 PMCID: PMC10914958 DOI: 10.3389/fped.2024.1373918] [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: 01/20/2024] [Accepted: 02/08/2024] [Indexed: 03/08/2024] Open
Abstract
With advances in prenatal imaging, genetic testing, and medical treatment of premature neonates, new bioethical challenges have arisen. Many Muslims turn to their faith and religious leaders to help navigate these novel challenges. This article briefly discusses the factors that are involved in religious leaders issuing a fatwa, or religious opinion. Using clinical scenarios, this article reviews the current discourse amongst Islamic scholars and laws in Muslim-majority countries regarding challenging bioethical topics surrounding preconception counseling, antenatal testing and termination of pregnancy, as well as Islamic scholars' attempts to determine a minimum gestational age of viability using primary religious texts, the Quran and hadith. Challenges and shortcomings in the Islamic perspective on these issues are also addressed to highlight areas in which further research should be pursued. A deeper understanding of Islamic religious perspectives on these topics can help clinicians in providing care that is informed by patients' cultural and religious values.
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Affiliation(s)
- Abdullah Bin Shoaib
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, United States
- Division of Neurology, Children’s Medical Center, Dallas, TX, United States
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Finkelstein A, Bachner YG, Stein E, Benisti L, Tenenbaum A. Challenging and Facilitating Factors When Coping with the News of a Newborn's Down Syndrome Diagnosis: Perceptions of Activist Israeli Mothers. HEALTH COMMUNICATION 2023; 38:1349-1358. [PMID: 34894913 DOI: 10.1080/10410236.2021.2010326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Studies have shown that healthcare professionals (HP) play a significant role in parents' experience when informed of the birth of a child with Down Syndrome (DS). Past studies have focused on faith dilemmas of religious mothers that were informed that their child was born with DS and on understanding how faith was a source of emotional support for them. Studies that focus on religious activist mothers are scarce. We utilized a qualitative methodology to explore the experiences of Jewish mothers who are religious and activists. Semistructured interviews and focus groups were conducted with 17 religious Jewish mothers of children with DS, who participated in an activist, self-support group. The data were analyzed using interpretative phenomenological analysis (IPA). Most mothers felt unsupported by the HP although a few mentioned being congratulated on the birth and empowered by a physician who focused on their child's potential to develop. The mothers appreciated when HPs considered their opinions and values. They shared the common goal of changing the existing pathological, statistics-based discourse concerning children with DS. The study reinforces the important role of HP and policymakers' in collaborating with parents and their support groups early in the diagnostic stage.
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Affiliation(s)
- Adi Finkelstein
- Department of Nursing, Faculty of Life and Health Sciences, Jerusalem College of Technology
| | | | - Elkie Stein
- Department of Pediatrics, Hadassah Medical Center and the Faculty of Medicine, Hebrew University of Jerusalem
| | | | - Ariel Tenenbaum
- Department of Pediatrics, Hadassah Medical Center and the Faculty of Medicine, Hebrew University of Jerusalem
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The Special Features of Prenatal and Preimplantation Genetic Counseling in Arab Countries. Genes (Basel) 2022; 13:genes13020167. [PMID: 35205212 PMCID: PMC8872395 DOI: 10.3390/genes13020167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 01/02/2022] [Accepted: 01/12/2022] [Indexed: 12/04/2022] Open
Abstract
Genetic counseling services have only recently been introduced in most Arab countries, and their utilization is increasing. Prenatal genetic counseling is essential, particularly in the Arab context, which is characterized by high rates of consanguinity. Nevertheless, little is known about the decisions faced by parents and the factors underlying the complex decision making that must occur when accessing these services in Arab countries. Herein, we performed a narrative review to discuss the reported experiences of parents accessing genetic counseling in the prenatal setting in the 22 Arab countries. We also highlight the different types of decisions encountered and the factors influencing them. We report that: (i) utilization of genetic counseling services varies across different Arab countries; (ii) many factors affect decision making and service utilization, especially religion; and (iii) parents are faced with an array of decisions in the prenatal setting, partly driven by increased utilization of prenatal diagnosis and preimplantation genetic testing in some countries. Our work is the first to highlight the different factors and decisions influencing genetic counseling in Arab countries. Understanding these factors is essential for improving genetic counseling services in the region and helping counselors facilitate informed decision making.
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Josephi-Taylor S, Barlow-Stewart K, Selvanathan A, Roscioli T, Bittles A, Meiser B, Worgan L, Rajagopalan S, Colley A, Kirk EP. User Acceptability of Whole Exome Reproductive Carrier Testing for Consanguineous Couples in Australia. J Genet Couns 2018; 28:240-250. [DOI: 10.1007/s10897-018-0298-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 08/27/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Sarah Josephi-Taylor
- Centre for Clinical Genetics; Sydney Children’s Hospital; High St; Randwick, Sydney NSW 2031 Australia
- School of Women’s and Children’s Health; UNSW Medicine; Sydney NSW 2052 Australia
| | - Kristine Barlow-Stewart
- Northern Clinical School; Faculty of Medicine and Health; Kolling Institute Level 7; Sydney Medical School Northern; University of Sydney Royal North Shore Hospital; University of Sydney; St. Leonards; Sydney NSW 2065 Australia
| | - Arthavan Selvanathan
- Clinical Genetics Services SWSLHD; Liverpool Hospital; Liverpool NSW 2170 Australia
| | - Tony Roscioli
- Centre for Clinical Genetics; Sydney Children’s Hospital; High St; Randwick, Sydney NSW 2031 Australia
| | - Alan Bittles
- School of Medical and Health Sciences; Edith Cowan University; Joondalup WA 6027 Australia
| | - Bettina Meiser
- Prince of Wales Clinical School; Faculty of Medicine; UNSW; Sydney NSW 2052 Australia
| | - Lisa Worgan
- Clinical Genetics Services SWSLHD; Liverpool Hospital; Liverpool NSW 2170 Australia
| | - Sulekha Rajagopalan
- Clinical Genetics Services SWSLHD; Liverpool Hospital; Liverpool NSW 2170 Australia
| | - Alison Colley
- Clinical Genetics Services SWSLHD; Liverpool Hospital; Liverpool NSW 2170 Australia
| | - Edwin P. Kirk
- Centre for Clinical Genetics; Sydney Children’s Hospital; High St; Randwick, Sydney NSW 2031 Australia
- School of Women’s and Children’s Health; UNSW Medicine; Sydney NSW 2052 Australia
- Genetics Laboratory; NSW Health Pathology East; Randwick, Sydney NSW 2031 Australia
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Bakst S, Romano-Zelekha O, Ostrovsky J, Shohat T. Determinants associated with making prenatal screening decisions in a national study. J OBSTET GYNAECOL 2018; 39:41-48. [PMID: 30244627 DOI: 10.1080/01443615.2018.1463977] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study sought to evaluate the associations between background exposures and psychological determinants, among postpartum Jewish and Arab women, relative to actual prenatal test endorsement. The independent and aggregative effects of contextual features and the subjective opinions and attitudes relative to a prenatal testing were evaluated, using logistic regressions. After accounting for contextual features, Jews with positive vs. negative opinions on screening were significantly more likely to undergo a prenatal screening. Specifically, having more favourable ideas on pregnancy termination, among Jews, was associated with a greater likelihood of triple test, nuchal translucency and ultrasound uptake as compared with those that refused. Similarly, Arabs who were more inclined to abort the pregnancy had a greater chance of using nuchal translucency and ultrasound vs. those that declined testing. As the preferences for prenatal test outcomes are multifaceted and vary according to population group, a better understanding of the factors involved in making testing choices could help ease the decision-making process. Impact Statement What is already known on this subject? The choice to undergo prenatal screening tests is influenced by various determinants, which include: social, demographic and emotional factors that vary by cultural preferences. Indeed, women integrate (subjective) beliefs and values that extend beyond rational (objective) reasoning when estimating whether or not to undergo testing. It may then be that, prenatal test choices might be, influenced less by actual risk status and more so by emotional factors. And while, the latter are more likely to be amendable, and thus influence changes in perception, the effect of psychological exposures on the decision making process in the genetic testing context, especially among Israeli Jews and Arabs, has been understudied. What the results of this study add? The current study extends the focus by addressing the role of evaluative beliefs and emotional factors involved with formulating prenatal screening judgments relative to actual testing among individuals with diverse profiles (Israeli Jews and Arabs). What was clarified was that background factors and psychological perceptions, such as having supportive attitudes on screening and a willingness to undergo abortion were, for the most part, related to prenatal test uptake. Concomitantly, these involve dense decision-making practices that can be difficult to approximate, as cultural settings and individual preferences often have an impact on intention-to-test. What the implications are of these findings for clinical practice and/or further research? Culturally appropriate counselling that would account for personal preferences alongside actual risk appraisals could enable pregnant women to make informed and autonomous prenatal testing choices. The integration of socio-demographics, psychological correlates and other contextual factors into a theoretical framework, studied uniquely by sub-populations, could enrich future research. Such research can, in turn, provide a clearer picture of the social need for genetic counselling, help customise local interventions, and on a broader scale inform national policy.
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Affiliation(s)
- Shelly Bakst
- a Ministry of Health , Israel Center for Disease Control (ICDC) , Ramat Gan , Israel
| | - Orly Romano-Zelekha
- a Ministry of Health , Israel Center for Disease Control (ICDC) , Ramat Gan , Israel
| | - Jenny Ostrovsky
- b Department of Community Genetics , Public Health Services, Tel Aviv University , Tel Aviv , Israel
| | - Tamy Shohat
- a Ministry of Health , Israel Center for Disease Control (ICDC) , Ramat Gan , Israel.,c Department of Epidemiology, Sackler School of Medicine , Tel Aviv University , Tel Aviv , Israel
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Verdonk P, Metselaar S, Storms O, Bartels E. Reproductive choices: a qualitative study of Dutch Moroccan and Turkish consanguineously married women's perspectives on preconception carrier screening. BMC WOMENS HEALTH 2018; 18:79. [PMID: 29855391 PMCID: PMC5984385 DOI: 10.1186/s12905-018-0574-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 05/21/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Cousin marriages, in the Netherlands most frequently between Turkish or Moroccan couples, are at higher risk of having offspring with recessive disorders. Often, these couples not perceive or accept this risk, and it is hardly considered a reason to refrain from family marriages. Preconception carrier screening (PCS) is offered to Jewish groups, and more recently in the Netherlands, to genetically isolated communities. In this study, Dutch Moroccan and Turkish women's perspectives on preconception carrier screening (PCS) and reproductive choices were explored. METHODS Individual interviews were held with Dutch Turkish and Moroccan consanguineously married women (n = 10) and seven group discussions with Turkish and Moroccan women (n = 86). Transcripts and notes were analyzed thematically. RESULTS All women welcomed PCS particularly for premarital genetic screening; regardless of possible reproductive choices, they prefer information about their future child's health. Their perspectives on reproductive choices on the basis of screening results are diverse: refraining from having children is not an option, in vitro fertilization (IVF) combined with pre-implantation genetic diagnosis (PGD) was welcomed, while prenatal genetic diagnosis (PND), termination of pregnancy (TOP), in vitro fertilization with a donor egg cell, artificial insemination with donor sperm (AID), and adoption, were generally found to be unacceptable. Besides, not taking any special measures and preparing for the possibility of having a disabled child are also becoming optional now rather than being the default option. CONCLUSIONS The women's preference for PCS for premarital screening as well as their outspokenness about not marrying or even divorcing when both partners appear to be carriers is striking. Raising awareness (of consanguinity, PCS and the choice for reproductive options), and providing information, screening and counseling sensitive to this target group and their preferences are essential in the provision of effective health care.
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Affiliation(s)
- Petra Verdonk
- Department of Medical Humanities, Amsterdam Public Health research institute, School of Medical Sciences, Boelelaan 1089a, 1081, HV, Amsterdam, The Netherlands.
| | - Suzanne Metselaar
- Department of Medical Humanities, Amsterdam Public Health research institute, Boelelaan 1089a, 1081, HV, Amsterdam, The Netherlands
| | - Oka Storms
- Department of Social and Cultural Anthropology, VU University, De Boelelaan 1105, 1081, HV, Amsterdam, The Netherlands.,MOVISIE Netherlands Centre for Social Development, Catharijnesingel 47, 3511, GC, Utrecht, The Netherlands
| | - Edien Bartels
- Department of Social and Cultural Anthropology, VU University, De Boelelaan 1105, 1081, HV, Amsterdam, The Netherlands
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Gitsels-van der Wal JT, Martin L, Manniën J, Verhoeven P, Hutton EK, Reinders HS. A qualitative study on how Muslim women of Moroccan descent approach antenatal anomaly screening. Midwifery 2015; 31:e43-9. [DOI: 10.1016/j.midw.2014.12.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 10/20/2014] [Accepted: 12/22/2014] [Indexed: 11/17/2022]
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Antenatal counselling for congenital anomaly tests: Pregnant Muslim Moroccan women׳s preferences. Midwifery 2015; 31:e50-7. [DOI: 10.1016/j.midw.2015.01.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 12/23/2014] [Accepted: 01/06/2015] [Indexed: 11/18/2022]
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Gitsels–van der Wal JT, Manniën J, Gitsels LA, Reinders HS, Verhoeven PS, Ghaly MM, Klomp T, Hutton EK. Prenatal screening for congenital anomalies: exploring midwives' perceptions of counseling clients with religious backgrounds. BMC Pregnancy Childbirth 2014; 14:237. [PMID: 25037919 PMCID: PMC4223558 DOI: 10.1186/1471-2393-14-237] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 07/16/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the Netherlands, prenatal screening follows an opting in system and comprises two non-invasive tests: the combined test to screen for trisomy 21 at 12 weeks of gestation and the fetal anomaly scan to detect structural anomalies at 20 weeks. Midwives counsel about prenatal screening tests for congenital anomalies and they are increasingly having to counsel women from religious backgrounds beyond their experience. This study assessed midwives' perceptions and practices regarding taking client's religious backgrounds into account during counseling. As Islam is the commonest non-western religion, we were particularly interested in midwives' knowledge of whether pregnancy termination is allowed in Islam. METHODS This exploratory study is part of the DELIVER study, which evaluated primary care midwifery in The Netherlands between September 2009 and January 2011. A questionnaire was sent to all 108 midwives of the twenty practices participating in the study. RESULTS Of 98 respondents (response rate 92%), 68 (69%) said they took account of the client's religion. The two main reasons for not doing so were that religion was considered irrelevant in the decision-making process and that it should be up to clients to initiate such discussions. Midwives' own religious backgrounds were independent of whether they paid attention to the clients' religious backgrounds. Eighty midwives (82%) said they did not counsel Muslim women differently from other women. Although midwives with relatively many Muslim clients had more knowledge of Islamic attitudes to terminating pregnancy in general than midwives with relatively fewer Muslim clients, the specific knowledge of termination regarding trisomy 21 and other congenital anomalies was limited in both groups. CONCLUSION While many midwives took client's religion into account, few knew much about Islamic beliefs on prenatal screening for congenital anomalies. Midwives identified a need for additional education. To meet the needs of the changing client population, counselors need more knowledge of religious opinions about the termination of pregnancy and the skills to approach religious issues with clients.
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Affiliation(s)
- Janneke T Gitsels–van der Wal
- Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 HV Amsterdam, Netherlands
- Faculty of Theology, VU University Amsterdam, De Boelelaan 1105, 1081 HV Amsterdam, Netherlands
| | - Judith Manniën
- Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 HV Amsterdam, Netherlands
| | - Lisanne A Gitsels
- University College Roosevelt, Lange Noordstraat 1, 4331 CB Middelburg, Netherlands
| | - Hans S Reinders
- Faculty of Theology, VU University Amsterdam, De Boelelaan 1105, 1081 HV Amsterdam, Netherlands
| | | | - Mohammed M Ghaly
- Center for Islamic Legislation & Ethics (CILE) Hamad Bin Khalifa University Qatar Foundation, P.O. Box 34110, Doha, Qatar
| | - Trudy Klomp
- Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 HV Amsterdam, Netherlands
| | - Eileen K Hutton
- Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 HV Amsterdam, Netherlands
- Department of Midwifery Education Program, McMaster University, 50 Main Street East, Hamilton, Canada
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Gitsels-van der Wal JT, Manniën J, Ghaly MM, Verhoeven PS, Hutton EK, Reinders HS. The role of religion in decision-making on antenatal screening of congenital anomalies: a qualitative study amongst Muslim Turkish origin immigrants. Midwifery 2013; 30:297-302. [PMID: 23726134 DOI: 10.1016/j.midw.2013.04.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 04/03/2013] [Accepted: 04/08/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE to explore what role religious beliefs of pregnant Muslim women play in their decision-making on antenatal screening, particularly regarding congenital abnormalities and termination, and whether their interpretations of the religious doctrines correspond to the main sources of Islam. DESIGN qualitative pilot study using in-depth interviews with pregnant Muslim women. SETTING one midwifery practice in a medium-sized city near Amsterdam participated in the study. PARTICIPANTS 10 pregnant Muslim women of Turkish origin who live in a high density immigrant area and who attended primary midwives for antenatal care were included in the study. DATA COLLECTION AND DATA ANALYSIS to explore the role of religion in decision-making on antenatal screening tests, a topic list was constructed, including four subjects: being a (practising) Muslim, the view on unborn life, the view on disabled life and the view on termination. To analyse the interviews, open and axial coding based on the Grounded Theory was used and descriptive and analytical themes were identified and interpreted. FINDINGS all 10 interviewees stated that their faith played a role in their decision-making on antenatal screening, specific to the combined test. They did not consider congenital anomalies as a problem and did not consider termination to be an option in case of a disabled fetus. However, the Islamic jurisprudence considers that termination is allowed if the fetus has serious abnormalities, but only before 19 weeks plus one day of gestation. KEY CONCLUSIONS religious convictions play a role regarding antenatal screening in pregnant Muslim women of Turkish origin. The interviewees did not consider a termination in case of an affected child. Women were unaware that within Islamic tradition there is the possibility of termination if a fetus has serious anomalies. Incomplete knowledge of religious doctrines may be influencing both decisions of antenatal screening and diagnostic tests uptake and of terminating a pregnancy for fetuses with serious anomalies. IMPLICATIONS FOR PRACTISE counsellors should be aware of the role of religious beliefs in the decision-making process on antenatal screening tests.
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Affiliation(s)
- Janneke T Gitsels-van der Wal
- Faculty of Theology, VU University Amsterdam, the Netherlands; Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands.
| | - Judith Manniën
- Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands.
| | - Mohammed M Ghaly
- Islamic Studies, Faculty of Humanities, Leiden University, the Netherlands.
| | | | - Eileen K Hutton
- Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands; McMaster University, Department Midwifery Education Program, Hamilton, Canada.
| | - Hans S Reinders
- Faculty of Theology, VU University Amsterdam, the Netherlands.
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Dery AM, Carmi R, Vardi IS. Attitudes toward the acceptability of reasons for pregnancy termination due to fetal abnormalities among prenatal care providers and consumers in Israel. Prenat Diagn 2008; 28:518-24. [DOI: 10.1002/pd.2017] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Cohen M, Mansoor D, Langut H, Lorber A. Quality of life, depressed mood, and self-esteem in adolescents with heart disease. Psychosom Med 2007; 69:313-8. [PMID: 17510294 DOI: 10.1097/psy.0b013e318051542c] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess health-related quality of life (HRQoL), depressed mood, and self-esteem in adolescents with heart disease and compare them with age-matched healthy adolescents (control group). METHODS Ninety adolescents (aged 12 to 18 years with congenital or acquired heart disease) and 87 controls completed the HRQoL (TAAQOL-CHD), Center for Epidemiologic Studies Depression scale, and Rosenberg self-esteem questionnaires. Relevant medical details were collected. The patients and their parents were asked to rate their perceived severity of heart disease. RESULTS Adolescents with severe heart disease reported higher levels of depressed mood and lower self-esteem than did adolescents with moderate and mild heart disease and age-matched healthy controls. Adolescents with severe heart disease also reported worse HRQoL than those with moderate and mild disease. According to the multiple regression analysis, 44% of variance of HRQoL was explained by the study variables. Disease severity alone explained 11% of the variance, but when entered with the other study variables, depressed mood, self-esteem, and adolescents' perceived severity of disease were the only significant contributors to the explained variance of HRQoL. An exploratory mediation analysis, using the Sobel test, was therefore applied, and it showed that depressed mood and perceived disease severity, but not self-esteem, mediated the relationship between disease severity and HRQoL. CONCLUSIONS Lower HRQoL was found in adolescents with severe heart disease. Psychosocial factors have a significant effect on the psychological state of adolescents, and they should be addressed and treated.
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Affiliation(s)
- Miri Cohen
- Social Work Department, Rambam-Health Care Campus, Haifa, Israel
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