THE INFLUENCE OF AGE AT WHICH CHILDREN UNDERGO ELECTIVE CARDIAC SURGERY OR CARDIAC CATHETER INTERVENTION ON THE COURSE OF PSYCHOLOGICAL DISTRESS AND COPING OF PARENTS.
                                                                                         
Utens E, Versluis-Den Bieman H, Witsenburg M, Bogers A, Hess J, Verhulst F.
Departrnents of Child and Adolescent Psychiatry, Paediatric Cardiology and Cardiothoracic
Surgery, Erasmus Medical Centre, Rotterdam, the Netherlands, and Geman Heart Centre
Munich, Germany.
 
Purpose of the present study was to assess the influence of age at a cardiac procedure of children who underwent elective cardiac surgery ("surgery") or cardiac catheter intervention ("intervention") for congenital heart defects between 3 months and seven years of age, on the development of psychological distress and styles of coping of their parents (both fathers and mothers).
 
Methods: The study sample consisted of parents of a consecutive series of patients who underwent their first elective open cardiac surgical procedure or elective catheter intervention, for a non-life threatening and a, at that moment, non-function-impairing congenital heart defect, between May  1994-May 1997, in the University Hospital Rotterdam. Patients who were between 3 months and 7 years of age at the time of "surgery" or "intervention" were included. Postoperative measurements were performed between November 1995-November 1998. Due to the longitudinal nature of the study, only data of parents who completed questionnaires both pre-and-ostoperative1y were included. Parents completed questionnaires on average respectively 5 weeks prior to and 18.7 months after the cardiac procedure of their child. ("Surgery-mothers": N=67, "Surgery-fathers": N= 60, "Intervention-mothers": N=17, "intervention-fathers": N=16).
To assess psychological distress the General Health Questionnaire was used and to assess coping styles the Utrecht Coping List.
 
Results: Overall, no significant influence was found of the age at which children underwent elective cardiac surgery or elective catheter intervention on the pre-to postprocedural development of distress and the coping styles of their parents.
Significant effects were found for the type of medical procedure: across time, parents of operated children reported on average significantly higher levels of psychological distress than parents of children who underwent cardiac catheter intervention.
After the procedure, parents of children who underwent either type of procedure, reported significantly lower levels of psychological distress than reference groups. Significant differences in coping styles were found between parents of patients and reference groups after the procedure had been performed.
 
Conclusion: Our results do not indicate an optimal age at which the elective cardiac procedures should be performed, from the viewpoint of psychological wellbeing of the parents. The practice of performing an elective catheter intervention in preference above elective cardiac surgery, when both are applicable, seems also to be justified from the viewpoint of parental wellbeing. Future studies should focus on how the overall favourable results of the parents influence the development of children who underwent these elective procedures.
 
The present study was supported by grants from the Netherlands Heart Foundation (no. 92.353 and no. 97.044)

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