Perceptions of Disease-Related Stress: A Key to Better Understanding Patient-Reported Outcomes Among Survivors of Congenital Heart Disease.
BACKGROUND
Disease-related stressors for survivors of congenital heart disease (CHD) have been qualitatively described but not quantified nor examined in relationship to important patient-reported outcomes (PROs).


OBJECTIVE
The aims of this study are to (1) identify the types and degree of disease-related stress experienced by CHD survivors based on age, functional status, and sex, (2) examine differences in stress and PROs by age, functional status, and sex, and (3) determine the unique contribution of perceived stress to variability in PROs.


METHODS
A cross-sectional study of 173 adolescents and emerging and young adults who were recruited from both pediatric and adult CHD clinics was conducted. Participants rated the degree to which they found various aspects of CHD stressful and completed PROs of health-related quality of life and emotional distress. Differences in perceptions of stress across predictors were determined using analyses of variance and χ analyses. The relative contribution of perceived stress predicting PROs was examined using stepwise linear regression.


RESULTS
Two items emerged as being stressful for almost half of the sample, including concerns about future health and having scars or other signs of medical procedures. Adolescents reported less perceived stress than emerging or young adults, and survivors with even mild functional limitations reported higher perceived stress than did those without any symptoms. Perceptions of stress significantly contributed to variability in PROs above and beyond other predictors and was the only variable to explain unique variance in emotional distress.


CONCLUSIONS
Having even mild functional impairment may have significant deleterious consequences on PROs via increased perceptions of stress. Stress may be modifiable using cognitive behavioral therapy.
Jamie L. Jackson, PhD Research Assistant Professor, Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, and Department of Pediatrics, The Ohio State University, Columbus. Gina M. Gerardo, BS Graduate Student, Department of Psychology, The Ohio State University, Columbus. Curt J. Daniels, MD Director, Columbus Ohio Adult Congenital Heart Disease Program, Heart Center, Nationwide Children's Hospital, Columbus, Ohio, and Professor, Departments of Internal Medicine and Pediatrics, The Ohio State University, Columbus. Kathryn Vannatta, PhD Professor, Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, and Department of Pediatrics, The Ohio State University, Columbus. This work was supported by National Institutes of Health grant T32HL-098039 (to J.L. Jackson), The Heart Center at Nationwide Children's Hospital (K. Vannatta and C.J. Daniels), and Clinical and Translational Science Award grant UL1TR001070 at The Ohio State University and Nationwide Children's Hospital.
Jamie L
JL
Jackson
Gina M
GM
Gerardo
Curt J
CJ
Daniels
Kathryn
K
Vannatta
D000293:Adolescent; D000367:Age Factors; D003430:Cross-Sectional Studies; D004644:Emotions; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications / Q000523:psychology* / Q000628:therapy; D006801:Humans; D008297:Male; D000071066:Patient Reported Outcome Measures; D011788:Quality of Life; D012649:Self Concept; D012737:Sex Factors; D013315:Stress, Psychological / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology; D017741:Survivors / Q000523:psychology*; D055815:Young Adult
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