Behavioral and Emotional Outcomes in Children with Congenital Heart Disease: Effects of Disease Severity, Family Life Stress, Disease-related Chronic Stress, and Psychosocial Adaptation

Authors

Amy Cassedy, Division of Biostatistics and Epidemiology at Cincinnati Children's Hospital Medical Center, Cincinnati, OH. Electronic address: Amy.cassedy@cchmc.org.
Jo Wray, Heart and Lung Directorate, Great Ormond Street Hospital for Children NHS Foundation Trust and NIHR GOSH BRC, London, UK.
Asad A. Qadir, Division of Cardiology, Pediatric Heart Center, University of Texas Health Science Center San Antonio, San Antonio, TX.
Michelle M. Ernst, Department of Pediatrics, University of Cincinnati College of Medicine, Division of Behavioral Medicine at Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Katherine Brown, Heart and Lung Directorate, Great Ormond Street Hospital for Children NHS Foundation Trust and NIHR GOSH BRC, London, UK.
Rodney Franklin, Department of Pediatric Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK.
Gil Wernovsky, Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Divisions of Cardiac Critical Care and Pediatric Cardiology, Children's National Hospital, Washington, DC.
Bradley S. Marino, Department of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland, OH.

Document Type

Journal Article

Publication Date

5-8-2023

Journal

The Journal of pediatrics

DOI

10.1016/j.jpeds.2023.113450

Keywords

Behavior Problems; Congenital Heart Disease; Parent Coping; Psychosocial Adaptation

Abstract

OBJECTIVE: To evaluate whether effects of congenital heart disease (CHD) severity and family life stress on behavioral and emotional functioning are mediated by disease-related chronic stress and psychosocial adaptation. STUDY DESIGN: A cross-sectional analysis of the Pediatric Cardiac Quality of Life Inventory Testing Study was performed. Relationships between CHD severity (comprised of three groups: mild heart disease, moderate biventricular [BV] disease, and single ventricle (SV)] and family life stress, on patient- and parent-disease-related chronic stress, psychosocial adaptation, and behavioral-emotional outcomes were assessed using structural equation modeling. Patient and parent models were reported separately. RESULTS: There were 981 patient-parent dyads: 22% had mild heart disease, 63% BV, and 15% SV; 19% of families reported moderate to major family life stress. Path models revealed that CHD severity and family life stress were mediated by disease-related chronic stress and psychosocial adaptation factors (R=0.18 to 0.24 for patient outcomes and R=0.33 to 0.34 for parent outcomes, p<0.001, respectively). CONCLUSION: The effects of greater CHD severity and family life stress on behavioral-emotional outcomes were mediated by worse disease-related chronic stress and psychosocial adaptation factors. Both disease-related chronic stress and psychosocial adaptation factors may be targets for interventions to improve behavioral and emotional outcomes.

APA Citation

Cassedy, Amy; Wray, Jo; Qadir, Asad A.; Ernst, Michelle M.; Brown, Katherine; Franklin, Rodney; Wernovsky, Gil; and Marino, Bradley S., "Behavioral and Emotional Outcomes in Children with Congenital Heart Disease: Effects of Disease Severity, Family Life Stress, Disease-related Chronic Stress, and Psychosocial Adaptation" (2023). GW Authored Works. Paper 2930.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/2930

Department

Pediatrics