title: The importance of self-perceptions to psychosocial adjustment in adolescents with heart disease.
abstract: BACKGROUND
  This study examined the importance of self-perceptions as determinants of psychosocial adjustment reported by adolescents with heart disease and compared adolescents with heart disease to healthy norms.
  
  
  METHODS
  Ninety-two adolescents with heart disease from a single Midwestern institution provided reports of self-perceptions (health, self-worth, competence, and importance), internalizing behavior problems (IPs; e.g., anxiety and depression) and externalizing behavior problems (EPs; e.g., attention problems and aggression), and health-related quality of life (HRQOL). Hierarchical linear regression was used to assess the impact of self-perceptions, as well as clinical factors (e.g., illness severity, time since last hospitalization, and medications) and demographic characteristics on outcomes.
  
  
  RESULTS
  Self-perceptions explained the most variance in behavioral and HRQOL outcomes (R(2)adj = 0.34 for IP, 0.24 for EP, and 0.33 for HRQOL, p < .001). Male gender and lower household income were associated with more behavior problems. Clinical variables were only related to HRQOL. Compared with healthy norms, IPs were significantly more common in male adolescents and HRQOL was lower (p < .001).
  
  
  CONCLUSIONS
  Adolescents with heart disease are at risk for internalizing behavior problems and reduced HRQOL; however, positive self-perceptions appear to be protective. Self-perceptions are critical and should be addressed by clinicians.
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Mussatto
authors.forename: Kathleen J
authors.initials: KJ
authors.lastname: Sawin
authors.forename: Rachel
authors.initials: R
authors.lastname: Schiffman
authors.forename: Jane
authors.initials: J
authors.lastname: Leske
authors.forename: Pippa
authors.initials: P
authors.lastname: Simpson
authors.forename: Bradley S
authors.initials: BS
authors.lastname: Marino
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000374:Aggression / Q000523:psychology*; D001007:Anxiety / Q000175:diagnosis*; D002648:Child; D002653:Child Behavior Disorders / Q000523:psychology*; D003863:Depression / Q000175:diagnosis*; D005260:Female; D006331:Heart Diseases / Q000523:psychology*; D006801:Humans; D016014:Linear Models; D008297:Male; D000297:Psychology, Adolescent; D002666:Psychology, Child; D011594:Psychometrics; D011788:Quality of Life / Q000523:psychology*; D012649:Self Concept; D012720:Severity of Illness Index; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires
keywords: Adolescent; adjustment; congenital heart disease; self-perception
references.citation: Pediatrics. 2010 Sep;126(3):498-508
references.pmid: 20805147
references.citation: Qual Life Res. 2006 May;15(4):663-73
references.pmid: 16688499
references.citation: Int J Cardiol. 2007 Jan 18;114(3):352-7
references.pmid: 16891004
references.citation: Ann Thorac Surg. 2007 Apr;83(4):1425-30
references.pmid: 17383351
references.citation: Pediatrics. 2009 Nov;124(5):e942-9
references.pmid: 19841109
references.citation: Int J Cardiol. 2008 Mar 28;125(1):66-73
references.pmid: 17433472
references.citation: Pediatrics. 2008 May;121(5):e1060-7
references.pmid: 18450848
references.citation: Circulation. 2003 Aug 19;108(7):857-62
references.pmid: 12900343
references.citation: BMC Pediatr. 2009 Jan 22;9:6
references.pmid: 19161602
references.citation: Circulation. 2006 Feb 28;113(8):1123-9
references.pmid: 16490823
references.citation: Cardiol Young. 2006 Feb;16(1):67-75
references.pmid: 16454880
references.citation: Med Care. 2001 Aug;39(8):800-12
references.pmid: 11468499
references.citation: Nurs Res. 2006 Sep-Oct;55(5):300-7
references.pmid: 16980830
references.citation: Heart. 2005 Sep;91(9):1193-8
references.pmid: 16103557
references.citation: J Adolesc Health. 2006 Apr;38(4):401-8
references.pmid: 16549301
references.citation: Acta Paediatr. 1993 Jan;82(1):71-6
references.pmid: 8453226
references.citation: Cardiol Young. 2005 Apr;15(2):133-40
references.pmid: 15845155
references.citation: J Pediatr Psychol. 2007 Jun;32(5):527-41
references.pmid: 17182669
references.citation: Eur Heart J. 1998 May;19(5):801-7
references.pmid: 9717016
references.citation: J Behav Med. 2002 Apr;25(2):175-93
references.pmid: 11977437
references.citation: Med Care. 1999 Feb;37(2):126-39
references.pmid: 10024117
references.citation: Cardiol Young. 2005 Feb;15 Suppl 1:174-8
references.pmid: 15934713
references.citation: J Clin Nurs. 2005 Mar;14(3):394-402
references.pmid: 15707450
references.citation: Psychosom Med. 2007 May;69(4):313-8
references.pmid: 17510294
references.citation: Circulation. 2011 Sep 20;124(12):1361-9
references.pmid: 21875911
references.citation: J Pediatr Psychol. 1993 Oct;18(5):549-59
references.pmid: 8295079
references.citation: SCI Nurs. 2003 Summer;20(2):72-85
references.pmid: 14626030
references.citation: Cardiol Young. 2008 Feb;18(1):3-9
references.pmid: 18093362
references.citation: Ambul Pediatr. 2003 Nov-Dec;3(6):329-41
references.pmid: 14616041
references.citation: Int J Cardiol. 2002 Nov;86(1):19-26
references.pmid: 12243847
references.citation: J Adolesc Health. 1991 Nov;12(7):539-44
references.pmid: 1772892
references.citation: Dev Med Child Neurol. 2010 Dec;52(12):1139-44
references.pmid: 20804511
references.citation: Pediatr Clin North Am. 2004 Dec;51(6):1625-39, ix
references.pmid: 15561177
references.citation: Arch Dis Child. 2007 Feb;92(2):137-41
references.pmid: 17030557
references.citation: Qual Life Res. 2008 May;17(4):613-26
references.pmid: 18347927
references.citation: Qual Life Res. 2005 Feb;14(1):35-43
references.pmid: 15789939
references.citation: Cardiol Young. 2006 Apr;16(2):157-64
references.pmid: 16553978
references.citation: J Pediatr Psychol. 1991 Apr;16(2):137-49
references.pmid: 2061786
references.citation: Clin Pediatr (Phila). 2002 Jan-Feb;41(1):17-24
references.pmid: 11866361