Cohen Miri, Mansoor Daniela, Langut Haya, Lorber Avraham
Social Work Department, Rambam-Health Care Campus, Haifa, Israel.
Psychosom Med. 2007 May;69(4):313-8. doi: 10.1097/PSY.0b013e318051542c. Epub 2007 May 17.
To assess health-related quality of life (HRQoL), depressed mood, and self-esteem in adolescents with heart disease and compare them with age-matched healthy adolescents (control group).
Ninety adolescents (aged 12 to 18 years with congenital or acquired heart disease) and 87 controls completed the HRQoL (TAAQOL-CHD), Center for Epidemiologic Studies Depression scale, and Rosenberg self-esteem questionnaires. Relevant medical details were collected. The patients and their parents were asked to rate their perceived severity of heart disease.
Adolescents with severe heart disease reported higher levels of depressed mood and lower self-esteem than did adolescents with moderate and mild heart disease and age-matched healthy controls. Adolescents with severe heart disease also reported worse HRQoL than those with moderate and mild disease. According to the multiple regression analysis, 44% of variance of HRQoL was explained by the study variables. Disease severity alone explained 11% of the variance, but when entered with the other study variables, depressed mood, self-esteem, and adolescents' perceived severity of disease were the only significant contributors to the explained variance of HRQoL. An exploratory mediation analysis, using the Sobel test, was therefore applied, and it showed that depressed mood and perceived disease severity, but not self-esteem, mediated the relationship between disease severity and HRQoL.
Lower HRQoL was found in adolescents with severe heart disease. Psychosocial factors have a significant effect on the psychological state of adolescents, and they should be addressed and treated.
评估患有心脏病的青少年的健康相关生活质量（HRQoL）、抑郁情绪和自尊，并将其与年龄匹配的健康青少年（对照组）进行比较。
90名青少年（年龄在12至18岁，患有先天性或后天性心脏病）和87名对照组完成了HRQoL（TAAQOL-CHD）、流行病学研究中心抑郁量表和罗森伯格自尊问卷。收集了相关医学细节。要求患者及其父母对他们感知到的心脏病严重程度进行评分。
与患有中度和轻度心脏病的青少年以及年龄匹配的健康对照组相比，患有严重心脏病的青少年报告的抑郁情绪水平更高，自尊更低。患有严重心脏病的青少年报告的HRQoL也比患有中度和轻度疾病的青少年更差。根据多元回归分析，研究变量解释了HRQoL方差的44%。仅疾病严重程度就解释了11%的方差，但当与其他研究变量一起纳入时，抑郁情绪、自尊和青少年感知到的疾病严重程度是HRQoL解释方差的唯一显著贡献因素。因此，应用了探索性中介分析，使用索贝尔检验，结果表明抑郁情绪和感知到的疾病严重程度，而非自尊，介导了疾病严重程度与HRQoL之间的关系。
发现患有严重心脏病的青少年HRQoL较低。社会心理因素对青少年的心理状态有显著影响，应予以关注和治疗。
