title: Pectus excavatum and pectus carinatum patients suffer from lower quality of life and impaired body image: a control group comparison of psychological characteristics prior to surgical correction.
abstract: OBJECTIVE
  The aim of this study was to evaluate the effects of anterior chest-wall deformities on disease-specific and health-related quality of life, body image, and psychiatric comorbidity prior to surgical correction.
  
  
  METHODS
  A total of 90 patients (71 with pectus excavatum, 19 with pectus carinatum) presenting themselves for pectus repair and 82 control subjects were recruited for this study. The objective severity of the deformity was determined through the funnel-chest index by Hümmer and the Haller index. Disease-specific quality of life was measured with the Nuss Questionnaire modified for Adults (NQ-mA) and health-related quality of life was determined by the Short-Form-36 Health Survey (SF-36). Body image was assessed via the Body Image Questionnaire (FKB-20), the Dysmorphic Concern Questionnaire (DCQ), and a self-evaluation of the subjective impairment of the appearance. The Diagnostic Interview for Mental Disorders - Short Version (Mini-DIPS), the General Depression Scale (Allgemeine Depressionsskala, ADS), and a self-rating of self-esteem were used to evaluate general psychological impairment.
  
  
  RESULTS
  Compared with control group results, physical quality of life was reduced in patients with pectus excavatum, while mental quality of life was decreased in patients with pectus carinatum (p<0.05). Body image was highly disturbed in all the patients and differed significantly from the control group (p<0.01). Patients with pectus carinatum appeared to be less satisfied with their appearance than those with pectus excavatum (p=0.07). Body image distress was multivariately associated with both reduced mental quality of life and low self-esteem (p<0.001). Body image did not influence physical quality of life. Patients displayed no elevated rates of mental disorders according to Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria.
  
  
  CONCLUSIONS
  Since self-perception is a major contributor to therapeutic decision making, a systematic evaluation of body image should be included in the assessment of patients with chest deformities. Body image concerns may be even more relevant to the decision-making process than physical restrictions. Exaggerated dysmorphic concerns should be prospectively investigated in their ability to influence the extent of satisfaction with the surgical outcome.
authors: Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Schwabachanlage 6, 91054 Erlangen, Germany. cornelia.steinmann@uk-erlangen.de
authors: Cornelia
authors: C
authors: Steinmann
authors: Stefanie
authors: S
authors: Krille
authors: Astrid
authors: A
authors: Mueller
authors: Peter
authors: P
authors: Weber
authors: Bertram
authors: B
authors: Reingruber
authors: Alexandra
authors: A
authors: Martin
mesh_terms: D000293:Adolescent; D000328:Adult; D001828:Body Image; D016022:Case-Control Studies; D005660:Funnel Chest / Q000523:psychology* / Q000601:surgery; D006801:Humans; D001523:Mental Disorders / Q000209:etiology; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D011788:Quality of Life; D012649:Self Concept; D012720:Severity of Illness Index; D013249:Sternum / Q000002:abnormalities* / Q000601:surgery; D055815:Young Adult