title: Child ego state is associated with high prevalence of repeated hospitalizations in patients with heart failure.
abstract: OBJECTIVE
  Inadequate self-care management is a leading cause of re-hospitalization in patients with heart failure (HF). Psychological factors such as some ego functions interfere with self-care behaviour modification, leading to poor outcomes in patients with several chronic diseases. However, characteristics of ego states in patients with repeated hospitalization for HF remain undefined.
  
  
  RESULTS
  The present study enrolled 40 HF outpatients with previous history of HF hospitalization and receiving self-care management. Patients' psychological characteristics were assessed by Patient Health Questionnaire (PHQ-9) for screening depressive symptoms, and the Tokyo University Egogram (TEG) New Version II for analysing human behaviour based on five functional ego states; critical parent, nurturing parent, adult, free child, and adapted child (AC). Twelve patients (30.0%) had previous history of repeated (two or more) HF hospitalization. Most of them (75%) had a history of at least one or more re-hospitalizations related to inadequate self-care. Patients with repeated HF hospitalization had significantly lower AC score, which represents uncooperative and uncompromising behaviours, compared with those without repeated HF hospitalization (P< 0.05). There were no significant differences in other parameters, including PHQ-9, between the two groups.
  
  
  CONCLUSIONS
  Low AC ego state was associated with high prevalence of repeated hospitalization in patients with HF. Assessing ego functions may be helpful to tailor educational approaches in these patients.
authors: Department of Cardiovascular Medicine Matsue Red Cross Hospital Matsue Japan.
authors: Kiyotaka
authors: K
authors: Yanagihara
authors: Division of Cardiovascular Medicine, Department of Molecular Medicine and Therapeutics, Faculty of Medicine Tottori University Yonago Japan.
authors: Yoshiharu
authors: Y
authors: Kinugasa
authors: Department of Cardiovascular Medicine Matsue Red Cross Hospital Matsue Japan.
authors: Kinya
authors: K
authors: Shirota
authors: Department of Cardiovascular Medicine Matsue Red Cross Hospital Matsue Japan.
authors: Yoshiaki
authors: Y
authors: Inoue
authors: Department of Cardiovascular Medicine Matsue Red Cross Hospital Matsue Japan.
authors: Hiroshige
authors: H
authors: Ishii
authors: Department of Cardiovascular Medicine Matsue Red Cross Hospital Matsue Japan.
authors: Fumiyo
authors: F
authors: Tsunoda
authors: Division of Neuropsychiatry Tottori University Yonago Japan.
authors: Masaaki
authors: M
authors: Iwata
authors: Division of Cardiovascular Medicine, Department of Molecular Medicine and Therapeutics, Faculty of Medicine Tottori University Yonago Japan.
authors: Shinobu
authors: S
authors: Sugihara
authors: Department of Clinical Psychology Tottori University Graduate School of Medical Sciences Yonago Japan.
authors: Shinya
authors: S
authors: Takeda
authors: Department of Cardiovascular Medicine Matsue Red Cross Hospital Matsue Japan.
authors: Masayuki
authors: M
authors: Hirai
authors: Department of Cardiovascular Medicine Matsue Red Cross Hospital Matsue Japan.
authors: Asao
authors: A
authors: Mimura
authors: Division of Cardiovascular Medicine, Department of Molecular Medicine and Therapeutics, Faculty of Medicine Tottori University Yonago Japan.
authors: Masahiko
authors: M
authors: Kato
authors: Division of Cardiovascular Medicine, Department of Molecular Medicine and Therapeutics, Faculty of Medicine Tottori University Yonago Japan.
authors: Kazuhiro
authors: K
authors: Yamamoto
keywords: Egogram; Heart failure; Patient education; Re‐hospitalization; Self‐care behaviour