Landolt M A, Ystrom E, Stene-Larsen K, Holmstrøm H, Vollrath M E
Department of Psychosomatics and Psychiatry,University Children's Hospital,Zurich,Switzerland.
Division of Mental Health,Norwegian Institute of Public Health,Oslo,Norway.
Psychol Med. 2014 Dec;44(16):3421-33. doi: 10.1017/S0033291713002894. Epub 2013 Nov 29.
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.
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.
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.
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.
先天性心脏病（CHD）会增加患病儿童及其父母出现心理健康问题的风险。目前尚不清楚这些问题的风险因素在家庭中是共同存在还是特定于个体家庭成员。
挪威母婴队列研究（MoBa；n = 93,009）的前瞻性数据与全国性的CHD登记处相链接，共识别出408名患有CHD的儿童。通过问卷调查评估母亲在孩子6个月、18个月和36个月大时关于孩子内化问题及自身困扰的报告。应用结构模型区分心理健康问题的家庭（共同）因素和个体特定因素。
在所有时间点，CHD都是儿童及其母亲出现问题的重要风险因素。CHD分别平均导致儿童和母亲问题变异的31%和39%。CHD家庭特有的共同家庭因素和个体特定因素均对心理健康问题的风险有影响。个体特定风险因素对母亲问题的稳定性有影响，而这些因素对儿童的影响仅持续较短时间。在18个月和36个月时，发现母亲和孩子的心理健康之间存在随时间的相互影响。
儿童CHD的负担在家庭成员之间分担，但也具有个体特异性。本研究指出，需要采取个体和家庭相结合的方法，为患有CHD的儿童及其父母提供心理支持。
