招請講演　Part 2：妊娠・出産の医学心理社会的問題<br>Psychopathology in young female with congenital heart disease

Clinical/Child Psychologist, Erasmus Medical Center-Sophia Children’s Hospital, Rotterdam, the Netherlands
Elisabeth Utens

Since knowledge about specific psychosocial problems of adults with ConHD was limited, 2 cohort studies were executed in Rotterdam to investigate psychosocial functioning in these patients.
In these longitudinal studies, all consecutive patients who underwent their first open heart surgery for ConHD between 19,680-180 in the Erasmus Medical Center Rotterdam, and who were younger than 15 years of age at the time of surgery, were eligible. The first follow-up was executed between 1989-1991 (T1) and the second follow-up, of the same cohort, between 2000-2001 (T2). Follow-up intervals were respectively: 9-23 years (T1) and 20-33 years (T2) after the first cardiac surgery. 498 patients participated in the first study (response rate: 87.7%). 362 of them participated in the second follow-up (age-range: 20-46 years, response rate: 90%). The studies showed favourable psychosocial outcomes: overall, patient seemed capable of leading normal lives. 　Results of the second-follow-up (T2).
Overall, outcomes were favourable as to living situation, marital status, having offspring and social functioning (leisure time activities). However, educational and occupational levels were lower compared to reference groups.
As to psychopathology: both patients’ self-reports (on the Young Adult Self-Report) and significant others’ reports (on the Young Adult Behavior Checklist) showed significantly greater proportions of patients who scored in the deviant, psychopathological range compared to the normative reference group. Parents and partners of patients rated the patients’ behaviour as more deviant from the norm than patients themselves, on a broad range of problem areas.
Significant predictors for long-term psychopathological problems reported by patients themselves were: being female, restrictions by the scar as felt by patients, low exercise capacity and physical restrictions imposed by physicians.
Especially young female ConHD females (20-27 years) showed higher levels of psychopathology compared to the reference group, and also compared to older female patients (28-32 years). Furthermore, female patients showed more psychopathology than male patients. ConHD females reported less favourable coping styles compared to reference females, such as less active problem solving. Furthermore younger female patients reported more role limitations due to physical functioning than older female patients. 44.4% of the female patients reported that the ConHD somehow had been a limiting factor in the choice of having children (compared to 20.1% of the male patients).
The unfavourable results for the young ConHD females may be explained by disease specific uncertainties concerning sexual relationships, pregnancy, delivery and offspring. These uncertainties may have a great impact on the lives of young ConHD females, since these issues involve their own bodily functioning. This may also explain why younger ConHD females show more limitations due to physical health compared to older ConHD females. Older ConHD females may have overcome these uncertainties once they have established a stable relationship and a satisfactory family life.
In patient education special attention should be paid to restrictions female patients subjectively experience regarding the scar, abilities of pregnancy, delivery, raising their children and life expectancy.