Woolf-King Sarah E, Anger Alexandra, Arnold Emily A, Weiss Sandra J, Teitel David
Department of Psychology, Syracuse University, Syracuse, NY
Department of Medicine, University of California, San Francisco, San Francisco, CA.
J Am Heart Assoc. 2017 Feb 1;6(2):e004862. doi: 10.1161/JAHA.116.004862.
Parents of children with critical congenital heart defects (PCCHDs) may be at high risk for mental health morbidity; however, the literature is not well characterized. Given that compromised parental mental health can lead to long-term cognitive, health-related, and behavioral problems in children, a systematic review of this literature could provide informed recommendations for continued research and enhance the care of families of children living with critical congenital heart defects.
We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines that resulted in 30 studies on the mental health of PCCHDs. The literature revealed that PCCHDs are at an elevated risk for psychological problems, particularly in the immediate weeks and months following cardiac surgery. Up to 30% of PCCHDs have symptoms consistent with a diagnosis of posttraumatic stress disorder, with over 80% presenting with clinically significant symptoms of trauma; 25% to 50% of PCCHDs reported clinically elevated symptoms of depression and/or anxiety, and 30% to 80% reported experiencing severe psychological distress. There was high variability in measurements used to assess study outcomes, methodological quality, and sociocultural composition of the parents included in the studies.
There is an urgent need for additional research on the severity, course, persistence, and moderators of these mental health problems over time, and for the development and testing of screening approaches and interventions that can be feasibly delivered in the context of ongoing pediatric cardiac care.
患有严重先天性心脏病患儿的父母（PCCHDs）可能有较高的心理健康问题发病风险；然而，相关文献对此描述并不充分。鉴于父母心理健康受损会导致儿童出现长期的认知、健康相关及行为问题，对该文献进行系统综述可为后续研究提供有依据的建议，并改善患有严重先天性心脏病患儿家庭的护理。
我们按照系统评价与Meta分析的首选报告项目指南进行了系统综述，最终纳入了30项关于PCCHDs心理健康的研究。文献显示，PCCHDs出现心理问题的风险升高，尤其是在心脏手术后的数周和数月内。高达30%的PCCHDs有符合创伤后应激障碍诊断的症状，超过80%有临床上显著的创伤症状；25%至50%的PCCHDs报告有临床上抑郁和/或焦虑症状升高，30%至80%报告经历过严重的心理困扰。用于评估研究结果的测量方法、方法学质量以及研究中纳入的父母的社会文化构成存在很大差异。
迫切需要进一步研究这些心理健康问题随时间推移的严重程度、病程、持续性及调节因素，以及开发和测试可在持续的儿科心脏护理背景下切实可行地实施的筛查方法和干预措施。
