Abstract
Chronic diseases of childhood and the associated emotional
problems are receiving major attention in the current
pediatric practice. Adolescents with congenital heart diseases
have significantly higher emotional problems compared to those
without chronic illnesses. Early detection and management of
emotional problems is essential to improve
the quality of life of the adolescents with congenital heart
diseases.
Key Words: Emotional
problems, Adolescents, Congenital heart diseases
Introduction
Chronic illness will have negative impact on academic
performance and intellectual development of children, which
will further compromise the emotional wellbeing of the
individual. [1] Congenital heart disease (CHD) is a chronic
illness with high prevalence worldwide, and is usually
diagnosed at birth. Several emotional disturbances are seen in
adolescents with congenital heart diseases including marked
anxiety, depression and low self - esteem. [2] Adolescent
congenital heart disease is increasing in prevalence as better
medical care results in more children surviving to
adolescence. [3] Advances in overall management have led to
an increasing number of adolescents with
congenital heart disease reaching adulthood. [4]
Special attention should be given to identify the adolescents
who are at risk for developing emotional disorders. This will
help to provide adequate therapy to prevent further morbidity.
Emotional problems in adolescents with severe congenital
heart diseases
In the study on 13 to 18 year old adolescents with severe
congenital heart diseases (CHD), Spurkland et al [5], found
higher rate of emotional problems in the complex CHD group.
The physical incapacity as well as the chronic family
difficulties negatively influenced the psychosocial
functioning and the emotional well being of the adolescents
with CHD. A comprehensive approach is essential in the
management of these patients.
Cohen et al [6] assessed the health related quality of life,
mood and self-esteem of ninety adolescents with congenital
heart diseases and compared them with healthy adolescents.
Adolescents with severe heart disease had worse health related
quality of life and had higher levels of depressed mood with
low self-esteem. Psychosocial factors influence the emotional
wellbeing of the adolescents which should be addressed and
managed. [6]
Wang et al [7] evaluated the prevalence of depression and
anxiety in 119 adolescents with heart disease and found that
9% had depression and 27% had anxiety. Good social support and
feeling of optimism were found to be significant factors which
could reduce the emotional problems. Though depression and
anxiety were common in this adolescent population with heart
disease, none of them were properly assessed or treated.
Depression in adolescents with congenital heart disease, can
exacerbate the physical consequences of the illness. [8]
Congenital heart disease patients with scholastic backwardness
usually have more anxiety and depression.
Emotional problems in adolescents with operated congenital
heart diseases
Adolescents with operated congenital heart disease are at risk
for long term emotional problems. [9] In this study on 125
adolescents aged 10 - 15 years with CHD, the child behaviour
checklist (CBCL) was used to identify the behavioural and
emotional problems. Several medical variables were analyzed.
Patients with greater number of heart operations, deep
hypothermic circulatory arrest, short gestational age, low
systemic oxygen saturation and older age at surgical repair
had more emotional problems. [9]
Utens et al [10] assessed the emotional problems in
adolescents; nine years after surgical correction for
congenital heart disease in childhood. On the youth self -
report, adolescents with congenital heart diseases obtained
significantly higher problem scores than same aged peers from
normative reference groups.
In the study to determine the psychological morbidity of
adolescents operated in childhood for congenital cyanotic
heart diseases, Toren P et al [11] found that these
adolescents are at risk for long term posttraumatic stress
symptoms. Emotional disorders in adolescents cause significant
impairment in the routine work, academic performance and
social interaction of the individual. [12]
Management
Periodic monitoring of adolescents' quality of life by experts
in adolescent guidance is essential. This enables early
detection of psychosocial issues, including low mood and
anxiety. When psychosocial problems are identified, screening
for depressive disorders and anxiety disorders is necessary.
For known high-risk adolescents (those with previous history
of stress in family, eating problems, poor
scholastic performance etc.) more frequent monitoring is
required. Interventions aimed at enhancing social support will
be beneficial for the patient and the family members.
Cognitive Behaviour Therapy (CBT) is effective in the
management of emotional problems of adolescents. CBT has been
researched extensively, and has demonstrated effectiveness in
emotional disorders. The application of CBT is an
individualized program that will help adolescents to identify
the negative thoughts and learn healthier coping skills. Merry
SN et al [13] after evaluation of sixteen studies including
3240 participants reported that psychological and educational
interventions reduced the risk of having a depressive disorder
in adolescents. There is evidence that psychological therapies
are effective for treating posttraumatic stress symptoms in
adolescents. The therapy with best evidence of effectiveness
was cognitive behaviour therapy, for which there was
significant improvement for up to one year following
treatment. [14]
Conclusion
There is high prevalence of emotional problems in adolescents
with congenital heart diseases. Physical limitations have
negative impact on the quality of life of these patients.
Depression and anxiety are common in adolescent population
with heart disease for which early intervention is necessary.
[7] Social support can improve the ability to cope with the
stress. Better school performance is usually associated
with better overall quality of life. Antecedents of emotional
disorders should be specifically targeted and evaluated by
experts in adolescent guidance. Psychological therapies
are effective in the management of emotional problems of
adolescents.
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