Serrano-Ikkos, Esther; (1998) Psychosocial influences on outcome after paediatric cardiac surgery, including transplantation. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

This thesis is based on a study that explored the impact of individual and family factors on medical outcome and psychological adjustment following heart and heart-lung transplantation. Thirty eight children referred for heart transplantation (age range: birth- 17 yrs, mean: 8 yrs, 2 mths), sixty eight for heart-lung transplantation (age range: 9 mths- 17 yrs, mean: 11 yrs, 1 mths) and fifty nine children requiring conventional cardiac surgery (age range: 2 yrs-17 yrs 9 mth, mean: 8 yrs, 9 mths) were included in the study. Parents and children, aged 5 or older, underwent separate standardized interviews; and standardized questionnaires were completed by parents, schoolteachers and children, aged 7yrs 6 mths or older. Assessments were made when the children were put on the waiting list and one year post-operatively. The groups did not differ initially with regard to child's mental status and psychosocial functioning or with regard to marital and family adjustment or attitudes to other family members (parent-patient and partner-partner). Overall, 24% of the children had a psychiatric diagnosis and 60% had impaired functioning; over 40% of the parents were psychiatrically distressed and half of the families showed adjustment difficulties. Post- operatively, there was a reduction in the proportion of children with psychiatric disturbance (p=.0005) and the children's psychosocial functioning was enhanced (p=.001). Parental distress lessened (p<.04) but there was deterioration in the marital relationship (p<.02) and less warmth towards the partner (p[less than].04). The overall levels of family adjustment were similar pre-and post-operatively. Psychological measures were not associated with survival, but were associated with physical health pre and post-operatively. Heart-lung transplantation (p=.01), living in a single or reconstituted family (p=.05), critical comments towards partner (p<.05) and family maladjustment (p=.003) were associated with poor adherence to medical treatment which was found in a third of the transplant recipients. The study has important clinical implications and highlights the need for effective psychosocial interventions in children undergoing heart and heart-lung transplantation.

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