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The Psychosocial Situation of Adults with Congenital Heart Disease in Iran
Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background and objectives:Adults with congenital heart disease (CHD) are a new group of patients with a prevalence of 4 per 1000. They have evolved as a result of significant improvements in medical management during the past decades. However, adults with CHD experience various medical and social challenges that may influence their psychosocial functioning. Providing appropriate medical, rehabilitation and social care for adults with CHD, and indeed improving their well-being require the evaluation of their current psychosocial situation. This thesis aims to increase the understanding of the mental health, somatic symptoms, social support, style of coping, quality of life and life satisfaction of adults with CHD and to examine the possible contributing factors in the context of a developing country; issues not addressed in the current literature.Methods:This thesis is based on four studies. Study I recruited 347 consecutive CHD patients (18-64 years) from two heart hospitals in Tehran, Iran. The study iscross-sectional and focused on sex differences in socio-economic status, lifestyle and medical characteristics of adults with CHD. Studies II, III and IV havea cross-sectional case-control design comparing the aforementioned CHD patients with 353 non-CHD participants, matched by sex and age. Outcome variables were anxiety, depressive and somatic symptoms (Study II), styles of coping (Study III), and life satisfaction/quality of life (Study IV). The data were analysed with bivariate and multivariate methods. Multivariate linear regression analyses were performed to scrutinize the association of demographic/socio-economic variables, social support, mental health, and medical variables with the aforementioned outcome variables among adults with CHD (Studies II, III, IV). Results:Study I showed that women with CHD were more often married and had children and were less often employed, but had healthier behaviour compared to men. Even though most of the patients received regular medical viiicare from different typesof medical professionals, half of them had no knowledge about the type of their cardiac defect. Study II showed that CHD patients experienced more anxiety and somatic symptoms than the healthy controls, whereas there were no differences in depressive symptoms. Perceived financial strain, lower social support and low annual income were positively associated with worse outcome in mental health and somatic symptoms. None of the medical variables were related to anxiety, depressive and somatic symptoms. Study III showed that the styles of coping of the CHD patients were comparable to those of the control group and CHD per se was not associated with a certain style of coping, except for palliative reaction pattern. Problem-focused styles of coping were associated with being never married, parenthood, higher level of anxiety and somatic symptoms, lower level of depressive symptoms and higher social support. Emotion-focused styles of coping were associated with annual income and higher level of anxiety. None of theadopted coping strategies were related to the heart disease variables. Study IV showed that adults with CHD had poorer quality of life and lower life satisfaction than the control group. However, CHD was associated only with decreased overall quality of life and its physical health domain, and life and health satisfaction. Among CHD patients, higher quality of life was associated with female sex, younger age, employment status, having less emotional distress and higher social support, while life satisfaction was associated with female sex, being employed, less emotional distress and higher social support. Conclusions:The results support the notion that psychosocial factors contribute to the well-being of adults with CHD.Socio-economic factors, emotional health and social support are significant determinants in nearly all outcomes of interest which need to be considered by health care providers and policy makers in their efforts to improve the health ofadults with CHD. However, longitudinal studies are warranted to establish causal linksand qualitative studies are recommended to deepen the understanding of coping and quality of life.

Place, publisher, year, edition, pages
Sundsvall: Faculty of Human Sciences, Mid Sweden University , 2013. , 71 p.
Series
Mid Sweden University doctoral thesis, ISSN 1652-893X ; 168
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:miun:diva-20877ISBN: 978-91-87557-14-9 (print)OAI: oai:DiVA.org:miun-20877DiVA: diva2:681752
Public defence
2013-11-22, M 108, Holmgatan 10, Sundsvall, 11:52 (English)
Opponent
Supervisors
Available from: 2013-12-20 Created: 2013-12-20 Last updated: 2014-02-03Bibliographically approved
List of papers
1. Gender differences in health conditions and socio-economic status of adults with congenital heart disease in a developing country
Open this publication in new window or tab >>Gender differences in health conditions and socio-economic status of adults with congenital heart disease in a developing country
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2013 (English)In: Cardiology in the Young, ISSN 1047-9511, E-ISSN 1467-1107, Vol. 23, no 02, 209-218 p.Article in journal (Refereed) Published
Abstract [en]

Background Providing appropriate care for adults with congenital heart disease requires the evaluation of their current situation. There is limited research in Iran about these patients, particularly in relation to gender differences in the demographic/socio-economic and lifestyle factors, as well as disease parameters.

Materials and methods The sample consisted of 347 congenital heart disease patients in the age group of 18–64 years, including 181 women, assessed by an analytical cross-sectional study. The patients were recruited from the two major heart hospitals in Tehran. Data were collected using questionnaires.

Results The mean age of the patients was 33.24 years. Women were more often married and more often had offspring than men (p < 0.001). Educational level and annual income were similar between women and men. Unemployment was higher among women (p < 0.001), but financial strain was higher among men (p < 0.001). Smoking, alcohol, and water-pipe use was higher among men than among women (p < 0.001). Cardiac factors, for example number of cardiac defects, were similar among women and men, except that there were more hospitalisations owing to cardiac problems, for example arrhythmia, among men. Disease was diagnosed mostly at the hospital (57.4%). Most medical care was provided by cardiologists (65.1%). Only 50.1% of patients had knowledge about their type of cardiac defect.

Conclusion Gender differences exist in the socio-economic and lifestyle characteristics of adults with congenital heart disease, in some cases related to the disease severity. Our findings also point to the need for interventions to increase patients’ knowledge about, and use of, healthier lifestyle behaviours, irrespective of gender. Furthermore, providing appropriate jobs, vocational training, and career counselling may help patients to be more productive.

Keyword
Grown-up with congenital heart disease, lifestyle, socio-demographic status
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:miun:diva-16083 (URN)10.1017/S1047951112000625 (DOI)000318623000007 ()2-s2.0-84879804094 (Scopus ID)
Available from: 2012-04-16 Created: 2012-04-16 Last updated: 2015-06-30Bibliographically approved
2. Anxiety, depressive and somatic symptoms in adults with congenital heart disease
Open this publication in new window or tab >>Anxiety, depressive and somatic symptoms in adults with congenital heart disease
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2013 (English)In: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 74, no 1, 49-56 p.Article in journal (Refereed) Published
Abstract [en]

Objective

Despite the improvement in life-expectancy of adults with congenital heart disease, they may experience unique medical and social challenges that could impact on their psychological functioning. The aims of this study were to address the experience of anxiety, depressive and somatic symptoms among adults with congenital heart disease in comparison with that of non-heart diseased persons considering the role of various factors (e.g. socio-economic).

Methods

In cross-sectional case–control study, the participants consisted of 347 patients with congenital heart disease (18–64 years, 52.2% female) and 353 matched (by sex/age) non-heart diseased persons. The participants completed a questionnaire. The data were analyzed with bivariate and multivariate methods.

Results

In bivariate analyses, scores in anxiety and somatic symptoms were higher among patients than the healthy controls (both at p ≤ 0.001), whereas the groups did not differ in depressive symptoms. Following multiple-linear-regression-analyses, only the association between congenital heart disease and somatic symptoms was confirmed. Among the patients, perceived financial strain was significantly related to anxiety, depressive and somatic symptoms; lower perceived social support to anxiety and depression; and low annual income to somatic symptoms. Additionally, somatic symptoms were associated with anxiety and depressive symptoms, and vice versa. And no medical variables were related to anxiety, depressive and somatic symptoms.

Conclusions

Congenital heart disease was only independently associated with somatic symptoms. Financial strain, social support and co-existence of emotional distress with somatic symptoms should be considered in developing appropriate interventions to improve the well-being of patients with congenital heart disease. However, longitudinal research is warranted to clarify causality.

Keyword
Congenital heart disease; Grown-up; Mental health; Psychosomatic; Social functioning
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:miun:diva-17227 (URN)10.1016/j.jpsychores.2012.10.006 (DOI)000313390100010 ()2-s2.0-84871686549 (Scopus ID)
Available from: 2013-01-18 Created: 2012-10-23 Last updated: 2015-07-01Bibliographically approved
3. Style of Coping and its Determinants in Adults with Congenital Heart Disease in a Developing Country
Open this publication in new window or tab >>Style of Coping and its Determinants in Adults with Congenital Heart Disease in a Developing Country
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2014 (English)In: Congenital Heart Disease, ISSN 1747-079X, E-ISSN 1747-0803, Vol. 9, no 4, 349-360 p.Article in journal (Refereed) Published
Abstract [en]

Objective The objective of this study is to compare coping strategies between adults with and without congenital heart disease and to scrutinize the associations between different available resources (e.g., social support) and adoption of certain coping strategies.

DesignThe study has a cross-sectional case-control design.

SettingThe study was conducted in two university-affilliated heart hospitals in Tehran, Iran.

Patients The participants comprised 347 persons (18–64 years) with and 353 individuals without congenital heart disease, matched by gender and age.

Outcome Measures Coping strategies, assessed with the Utrecht Coping List-short form, were compared between both groups. Block-wise multiple regression analyses were conducted to scrutinize the associations between different independent variables (e.g., demographic/socioeconomic statuses) and adoption of certain styles of coping (dependent variables) among all participants and separately for each group.

Results The styles of coping in the patients were comparable with those of the control group. Multivariate analyses revealed that congenital heart disease per se was not associated with style of coping except for palliative reaction pattern. The active problem-solving coping style was associated with never married marital status, parenthood, unemployment, higher level of anxiety/somatic symptoms, lower level of depressive symptoms, and better social support. The avoidance behavior style was associated with having a low income, whereas the expression of emotion style was associated with higher anxiety symptoms, experience of financial strain, and income. None of the adopted coping strategies was related to the heart disease variables.

Conclusions The adults with congenital heart disease coped as well as adults without congenital heart disease. Marital status, parenthood, annual income, financial strain, psychological adjustment, and perceived social support were important explanatory factors in adopting a certain style of coping among adults with congenital heart disease. However, longitudinal studies with repeated measures are warranted.

Keyword
Adaptation, Grown-up Congenital Heart Disease, Heart Defect, Mental Health, Psychosocial, Social Support
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:miun:diva-19995 (URN)10.1111/chd.12150 (DOI)000340525400020 ()2-s2.0-84905590490 (Scopus ID)
Note

Publ online 6 nov 2013

Available from: 2013-10-12 Created: 2013-10-12 Last updated: 2015-07-01Bibliographically approved
4. Quality of life and life satisfaction among adults with and without congenital heart disease in a developing country
Open this publication in new window or tab >>Quality of life and life satisfaction among adults with and without congenital heart disease in a developing country
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2015 (English)In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 22, no 2, 169-179 p.Article in journal (Refereed) Published
Abstract [en]

Background Life-expectancy of adults with congenital heart disease (CHD) has improved world-wide, but there are limited data on these patients' experiences of quality of life (QoL), life satisfaction (LS), and their determinants (e.g. social support), particularly among patients from developing countries.

Design Cross-sectional case-control.

Methods A total of 347 CHD patients (18-64 years, 52.2% women) and 353 non-CHD participants, matched by sex/age, were recruited from two heart hospitals in Tehran, Iran. LS and QoL served as dependent variables, and demographic/socioeconomic status, mental-somatic symptoms, social support, and clinical factors (e.g. defect category) served as independent variables in multiple regression analyses once among all participants, and once only among CHD patients.

Results The CHD patients had significantly lower scores in LS and all domains of QoL than the control group. However, having CHD was independently negatively associated only with overall QoL, physical health, and life and health satisfaction. Additionally, multivariate analyses among the CHD patients revealed that female sex, younger age, being employed, less emotional distress, and higher social support were significantly associated with higher perceived QoL in most domains, while LS was associated with female sex, being employed, less emotional distress, and better social support. Neither QoL nor LS was associated with cardiac defect severity.

Conclusions The adults with CHD had poorer QoL and LS than their non-CHD peers in our developing country. Socio-demographics, emotional health, and social support were important 'determinants' of QoL and LS among the CHD patients. Longitudinal studies are warranted to establish causal links.

Keyword
Grown-up congenital heart disease; heart defect; mental health; psychosocial; social support
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:miun:diva-20112 (URN)10.1177/2047487313514017 (DOI)000348115400004 ()2-s2.0-84920942176 (Scopus ID)
Note

Publ online before print 18 nov 2013

Available from: 2013-11-02 Created: 2013-11-02 Last updated: 2015-07-01Bibliographically approved

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