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Pediatr Cardiol. 2018 Jan;39(1):79-88. doi: 10.1007/s00246-017-1730-6. Epub 2017 Oct 4.

Biopsychosocial Predictors of Quality of Life Outcomes in Pediatric Congenital Heart Disease.

Author information

1
Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA. Michelle.ernst@cchmc.org.
2
Division of Behavioral Medicine, Cincinnati Children's Hospital Medical Center, ML3015, 3333 Burnet Ave, Cincinnati, OH, 45229, USA. Michelle.ernst@cchmc.org.
3
Department of Pediatrics and Medical Social Sciences, Divisions of Pediatric Cardiology and Critical Care Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
4
Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
5
Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
6
Department of Pediatric Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK.
7
Cardiorespiratory Department, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.

Abstract

The purpose of this prospective multi-center cross-sectional study was to identify key biopsychosocial factors that impact quality of life (QOL) of youth with congenital heart disease (CHD). Patient-parent pairs were recruited at a regular hospital follow-up visit. Patient- and parent-proxy-reported QOL were assessed using the Pediatric Cardiac Quality of Life Inventory (PCQLI). Wallander's and Varni's disability-stress coping model guided factor selection, which included disease factors, educational impairment, psychosocial stress, child psychological and parent/family factors. Measures utilized for these factors included the Pediatric Inventory for Parents, Self-Perception Profile for Children/Adolescents, Child Behavior Checklist, Revised Children's Manifest Anxiety Scale, Child PTSD Symptom Scale, State-Trait Anxiety Inventory, and Posttraumatic Diagnostic Scale. Ordinary least squares regression was applied to test the theoretical model, with backwards stepwise elimination process. The models accounted for a substantial amount of variance in QOL (Patient-reported PCQLI R 2 = 0.58, p < 0.001; Parent-proxy-reported PCQLI R 2 = 0.60, p < 0.001). For patient-reported QOL, disease factors, educational impairment, poor self-esteem, anxiety, patient posttraumatic stress, and parent posttraumatic stress were associated with lower QOL. For parent-proxy-report QOL, disease factors, educational impairment, greater parental medical stress, poorer child self-esteem, more child internalizing problems, and parent posttraumatic stress were associated with lower QOL. The results highlight that biopsychosocial factors account for over half the variance in QOL in CHD survivors. Assessing and treating psychological issues in the child and the parent may have a significant positive impact on QOL.

KEYWORDS:

Pediatric congenital heart disease; Psychosocial outcomes; Quality of life

PMID:
28980091
DOI:
10.1007/s00246-017-1730-6
[Indexed for MEDLINE]

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