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Quality of Life, Depressed Mood, and Self-Esteem in Adolescents With Heart Disease

From the Social Work Department (M.C., D.M.), Rambam-Health Care Campus, Haifa, Israel; Pediatric Cardiology (H.L., A.L.), Meyer Children’s Hospital, Rambam-Health Care Campus, Haifa, Israel; School of Social Work (M.C.), Faculty of Social Welfare and Health Studies, Haifa University, Israel; Bruce Rappaport Faculty of Medicine (A.L.), Technion, Haifa, Israel.

Address correspondence and reprint requests to Avraham Lorber, Pediatric Cardiology, Meyer Children’s Hospital, Rambam-Health Care Campus, Haifa, Israel. E-mail: a_lorber{at}rambam.health.gov.il

Objective: 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).

Methods: 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.

Results: 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.

Conclusions: 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.

Key Words: adolescents • health-related quality of life • heart disease • depressed mood • self-esteem • perceived disease severity

Abbreviations: HRQoL = health-related quality of life.