title: The impact of actual and perceived disease severity on pre-operative psychological well-being and illness behaviour in adult congenital heart disease patients.
abstract: OBJECTIVE
  The purpose of this study was to investigate whether the objective medical parameters related to congenital heart disease and patients' ratings of cardiac disease severity were related to psychological well-being and illness behaviour during the pre-operative period.
  
  
  METHODS
  A total of 143 patients (63 male patients; 16-73 years old) with congenital heart disease evaluated the severity of their cardiac condition using a numerical rating scale ranging from 0, indicating the least severe condition, to 100, indicating the most severe condition. Psychological well-being was assessed using the Psychological General Well-Being Index (total score ≤ 60 indicating severe distress) and illness behaviour using the Illness Behavior Questionnaire.
  
  
  RESULTS
  Pre-operative psychological well-being was not related to the objective medical parameters reflecting cardiac disease severity. In contrast, total psychological well-being scores correlated significantly with patients' subjective ratings of disease severity (p < 0.001). When compared with the reference values from the Italian population, the mean scores of the patients on psychological well-being were similar. As regards the Illness Behavior Questionnaire, the scores on denial were higher and those on hypochondria were lower compared with other hospitalised patients.
  
  
  CONCLUSIONS
  This study shows that the perception of cardiac disease severity, and not the medical parameters in congenital heart disease, is related to the patients' pre-operative psychological state. Thus, more importance needs to be given to assessing the patients' pre-operative perception and psychological state independently of cardiac severity. Targeted interventions with regard to the cardiac condition are recommended.
authors.affiliation: 1 Department of Pediatric Cardiology and Adult with Congenital Heart Defect, IRCCS Policlinico San Donato, Milan, Italy.
authors.forename: Edward
authors.initials: E
authors.lastname: Callus
authors.affiliation: 2 Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Elisabeth M W J
authors.initials: EM
authors.lastname: Utens
authors.affiliation: 1 Department of Pediatric Cardiology and Adult with Congenital Heart Defect, IRCCS Policlinico San Donato, Milan, Italy.
authors.forename: Emilia
authors.initials: E
authors.lastname: Quadri
authors.affiliation: 3 Fondazione Don C.Gnocchi, Piazzale Morandi, Milan, Italy.
authors.forename: Cristian
authors.initials: C
authors.lastname: Ricci
authors.affiliation: 1 Department of Pediatric Cardiology and Adult with Congenital Heart Defect, IRCCS Policlinico San Donato, Milan, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Carminati
authors.affiliation: 4 Department of Pediatric Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Giamberti
authors.affiliation: 1 Department of Pediatric Cardiology and Adult with Congenital Heart Defect, IRCCS Policlinico San Donato, Milan, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Chessa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001294:Attitude to Health; D003717:Denial, Psychological; D005260:Female; D006330:Heart Defects, Congenital / Q000503:physiopathology / Q000523:psychology* / Q000601:surgery; D006801:Humans; D006998:Hypochondriasis / Q000523:psychology; D055809:Illness Behavior; D008297:Male; D008875:Middle Aged; D010549:Personal Satisfaction; D057234:Preoperative Period; D011788:Quality of Life; D012720:Severity of Illness Index; D013315:Stress, Psychological / Q000523:psychology*; D011795:Surveys and Questionnaires; D055815:Young Adult