Psychosocial adjustment, psychiatric morbidity and quality of life in adolescents and young adults with congenital heart disease

Abstract

ResumoObjetivos: Caracterizar a população de adolescentes e jovens adultos com cardiopatias congénitas (CC) ao nível do seu ajustamento psicossocial e morbilidade psiquiátrica, bem como avaliar a qualidade de vida (QV), para perceber quais são as variáveis com impacto na vida e na adaptação à doença. População e métodos: Participaram 74 pacientes com CC, sendo 41 do sexo masculino e 33 do sexo feminino, com idades entre 12-26 (média = 18,76 ± 3,86). Foram recolhidos os dados demográficos e clínicos mais relevantes dos pacientes e foi aplicado um conjunto de instrumentos, incluindo uma entrevista semiestruturada sobre tópicos de suporte social, estilo de educação na família, autoimagem e limitações físicas, uma entrevista psiquiátrica estandardizada e questionários para avaliar o ajustamento psicossocial na forma de autorrelato (YSR e ASR) e relato dos cuidadores (CBCL e ABCL), bem como um questionário de avaliação da qualidade de vida (WHOQOL-BREF). Resultados: O sexo feminino relatou mais ansiedade/depressão (u = 952,500; p = 0,003), alterações do pensamento (u = 929,500; p = 0,005) e comportamento agressivo (u = 999,000; p = 0,000). Pacientes com CC complexas relataram mais alterações de pensamento (u = 442,000; p = 0,027) e internalização (u = 429,000; p = 0,021). Comparativamente com a população portuguesa, os nossos participantes apresentaram melhor QV nos domínios relações sociais (t = 2,333; p = 0,022) e ambiente (t = 3,754; p = 0,000). Os pacientes que não foram submetidos a intervenções cirúrgicas revelaram melhor QV nos domínios físico (t = −1,989; p = 0,050), de relações sociais (t = −2,012; p = 0,048) e QV geral (u = 563,000; p = 0,037). A presença de um melhor suporte social está relacionada com uma melhor QV nos pacientes em todos os domínios avaliados, com destaque para o físico (t = 3,287; p = 0,002) e relações sociais * Autor para correspondência. Correio eletrónico: memilia.areias@cespu.pt (M.E.G. Areias).

Types of social supports predicting health-related quality of life among adult patients with CHD in the Institut Jantung Negara (National Heart Institute), Malaysia

“…Coelho et al 37 reported that better social supports contributed to improvement of physical quality of life; however, in our study, none of the types of social supports significantly predicted the Physical Super-Dimension of HRQoL.…”

“…These patients had worse psychosocial adjustment as they required constant care from their caregivers and had limited exposure to school and leisure activities. Patients with complex CHD were also found to have more negative thoughts and internalisation 37 …”

“…Patients with complex CHD were also found to have more negative thoughts and internalisation. 37 Wray and Sensky 42 proposed that patients who received treatment have better quality of life; however, a few others have reported that patients who went through surgical treatment had lower quality of life, due to high level of anxiety, low functional capacity, and psychological maladjustment. 43,44 In our study, types of interventions and the severity of illness were not significant predictors for all dimensions of HRQoL because the majority of patients involved in this study had recovered from the acute effects of surgery and interventions.…”

Becoming a Teenager after Early Surgical Ventricular Septal Defect (VSD) Repair: Longitudinal Biopsychological Data on Mental Health and Maternal Involvement

“…In clinical classification systems such as the DSM-IV, internalizing problems are described as emotional problems that can include disorders such as anxiety and depression, while externalizing or behavior problems comprise disorders such as ADHD or antisocial behavior [ 18 ]. In addition, children with CHD are reported to have a higher lifetime prevalence of psychiatric disorders, such as attention deficit/hyperactivity disorder (ADHD) or anxiety disorders [ 19 , 20 , 21 ]. Still, a recent review found most of these dysfunctions to be high in prevalence but mild [ 8 ], which accounts specifically for less severe conditions, as with VSD [ 22 ].…”

“…Nevertheless, results on the perceived HRQOL of children with CHD are still inconsistent. Some studies reported satisfactory overall HRQOL with no differences or even better scores compared to non-affected controls [ 19 , 27 , 28 , 29 ], whereas other studies found these children to be at a greater risk of impaired HRQOL [ 30 , 31 , 32 ]. These differences could be attributed to variability in method designs, such as the age of the children at the time of assessment [ 33 ] or the severity of CHD [ 32 ].…”