Behavioral and Emotional Outcomes in Children with Congenital Heart Disease: Effects of Disease Severity, Family Life Stress, Disease-related Chronic Stress, and Psychosocial Adaptation
The Journal of pediatrics
Behavior Problems; Congenital Heart Disease; Parent Coping; Psychosocial Adaptation
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.
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.