title: Exploring causal pathways of child behavior and maternal mental health in families with a child with congenital heart disease: a longitudinal study.
abstract: BACKGROUND
  A congenital heart defect (CHD) can increase the risk of mental health problems in affected children and their parents. The extent to which risk factors for these problems are shared in families or are specific to the individual family member is unclear.
  
  
  METHODS
  Prospective data from the Norwegian Mother and Child Cohort Study (MoBa; n = 93,009) were linked with a nationwide CHD registry, and 408 children with CHD were identified. Mothers' reports on child internalizing problems and their own distress were assessed by questionnaires at child ages 6, 18 and 36 months. A structural model was applied to distinguish between familial (shared) factors and individual-specific factors for mental health problems.
  
  
  RESULTS
  CHD was a substantial risk factor for problems in children and their mothers at all time points. CHD contributed on average 31% and 39% to the variance in children's and mothers' problems respectively. Both shared familial and individual-specific factors unique to CHD families contributed to risk for mental health problems. Whereas individual-specific risk factors contributed to the stability of problems in mothers, the effect of these factors lasted only a short time in children. Mutual influences over time were found between the mother's and the child's mental health at 18 and 36 months.
  
  
  CONCLUSIONS
  The burden of CHD in a child is shared between family members but is also specific to the individual. This study points to a need for both an individual and a family-based approach to provide psychological support to children with CHD and their parents.
authors.affiliation: Department of Psychosomatics and Psychiatry,University Children's Hospital,Zurich,Switzerland.
authors.forename: M A
authors.initials: MA
authors.lastname: Landolt
authors.affiliation: Division of Mental Health,Norwegian Institute of Public Health,Oslo,Norway.
authors.forename: E
authors.initials: E
authors.lastname: Ystrom
authors.affiliation: Division of Mental Health,Norwegian Institute of Public Health,Oslo,Norway.
authors.forename: K
authors.initials: K
authors.lastname: Stene-Larsen
authors.affiliation: Department of Pediatrics,Oslo University Hospital,Norway.
authors.forename: H
authors.initials: H
authors.lastname: Holmstrøm
authors.affiliation: Division of Mental Health,Norwegian Institute of Public Health,Oslo,Norway.
authors.forename: M E
authors.initials: ME
authors.lastname: Vollrath
mesh_terms: D000328:Adult; D002652:Child Behavior; D002653:Child Behavior Disorders / Q000453:epidemiology / Q000523:psychology*; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D006330:Heart Defects, Congenital / Q000453:epidemiology / Q000523:psychology*; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D008603:Mental Health / Q000706:statistics & numerical data*; D009035:Mothers / Q000523:psychology* / Q000706:statistics & numerical data; D009664:Norway / Q000453:epidemiology; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors; D013315:Stress, Psychological / Q000523:psychology*; D011795:Surveys and Questionnaires