Hostname: page-component-669899f699-tpknm Total loading time: 0 Render date: 2025-04-25T08:05:58.369Z Has data issue: false hasContentIssue false
  • English
  • Français

Parental post-traumatic stress, overprotective parenting, and emotional and behavioural problems for children with critical congenital heart disease

Published online by Cambridge University Press:  09 August 2021

Linda G. McWhorter Open the ORCID record for Linda G. McWhorter [Opens in a new window] ,
Jennifer Christofferson ,
Trent Neely ,
Aimee K. Hildenbrand ,
Melissa A. Alderfer ,
Amy Randall ,
Anne E. Kazak  and
Erica Sood Open the ORCID record for Erica Sood [Opens in a new window]
Linda G. McWhorter*
Affiliation:
Division of Behavioral Health, Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA Institute for Graduate Clinical Psychology, College of Health and Human Services, Widener University, Chester, PA, USA
Jennifer Christofferson
Affiliation:
Department of Research, Center for Healthcare Delivery Science, Nemours Children’s Health System, Wilmington, DE, USA
Trent Neely
Affiliation:
Brothers by Heart/Sisters by Heart, El Segundo, CA, USA
Aimee K. Hildenbrand
Affiliation:
Division of Behavioral Health, Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA Department of Research, Center for Healthcare Delivery Science, Nemours Children’s Health System, Wilmington, DE, USA Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
Melissa A. Alderfer
Affiliation:
Department of Research, Center for Healthcare Delivery Science, Nemours Children’s Health System, Wilmington, DE, USA Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
Amy Randall
Affiliation:
Mended Little Hearts of Wisconsin, Mended Hearts/Mended Little Hearts
Anne E. Kazak
Affiliation:
Department of Research, Center for Healthcare Delivery Science, Nemours Children’s Health System, Wilmington, DE, USA Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
Erica Sood
Affiliation:
Division of Behavioral Health, Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA Department of Research, Center for Healthcare Delivery Science, Nemours Children’s Health System, Wilmington, DE, USA Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
*
Author for correspondence: Linda McWhorter, PhD, Institute for Graduate Clinical Psychology, Widener University, One University Place, Chester, PA19013, USA. Tel: (610) 499-1385; Fax: 610-499-4625. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To examine relationships amongst parental post-traumatic stress symptoms, parental post-traumatic growth, overprotective parenting, and child emotional/behavioural problems in families of children with critical CHD.

Method:

Sixty parents (15 fathers) of children aged 1–6 completed online questionnaires assessing parental post-traumatic stress symptoms and post-traumatic growth, overprotective parenting, and child emotional/behavioural problems. Bivariate correlations and mediational analyses were conducted to evaluate overprotective parenting as a mediator of the association between parental post-traumatic stress symptoms and child emotional/behavioural problems.

Results:

Parents reported significant post-traumatic stress symptoms, with over 18% meeting criteria for post–traumatic stress disorder and 70% meeting criteria in one or more clusters. Parental post-traumatic growth was positively correlated with intrusion (r = .32, p = .01) but it was not associated with other post-traumatic stress symptom clusters. Parental post-traumatic stress symptoms were positively associated with overprotective parenting (r = .37, p = .008) and total child emotional/behavioural problems (r = .29, p = .037). Overprotective parenting was positively associated with total child emotional/behavioural problems (r = .45, p = .001) and fully mediated the relationship between parental post-traumatic stress symptoms and child emotional/behavioural problems.

Conclusion:

Overprotective parenting mediates the relationship between parental post-traumatic stress symptoms and child emotional and behavioural problems in families of children with CHD. Both parental post-traumatic stress symptoms and overprotective parenting may be modifiable risk factors for poor child outcomes. This study highlights the need for interventions to prevent or reduce parental post-traumatic stress symptoms and to promote effective parenting following a diagnosis of CHD.

Keywords

Congenital heart diseaseoverprotective parentingpost-traumatic stresspost-traumatic stress disorderneurodevelopmental outcomes
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 5 , May 2022 , pp. 738 - 745
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Hoffman, JL, Kaplan, S. The incidence of congenital heart disease. J Am Coll Cardiol 2002; 39: 1890–1900.CrossRefGoogle ScholarPubMed
Marino, BS, Lipkin, PH, Nideewburger, JW et al. Neurodevelopmental outcomes in children with congenital heart disease: evaluation and management: A scientific statement from the American Heart Association. Circulation 2012; 126: 1143–1172.CrossRefGoogle ScholarPubMed
Woolf-King, SE, Anger, A, Arnold, EA et al. Mental health among parents of children with critical congenital heart defects: A systematic review. J Am Heart Assoc 2017; 6: e004862.CrossRefGoogle ScholarPubMed
Wray, J, Cassedy, A, Ernst, MM et al. Psychosocial functioning of parents of children with heart disease—Describing the landscape. Eur J Pediatr 2018; 177: 1811–1821.CrossRefGoogle ScholarPubMed
DeMaso, DR, Labella, M, Taylor, GA et al. Psychiatric disorders and function in adolescents with d-transposition of the great arteries. J Pediatr 2014; 165: 760–766.CrossRefGoogle ScholarPubMed
Ernst, MM, Marino, BS, Cassedy, A et al. Biopsychosocial predictors of quality of life outcomes in pediatric congenital heart disease. Pediatr Cardiol 2018; 39: 79–88.CrossRefGoogle ScholarPubMed
Christie, H, Hamilton-Giachritsis, C, Alves-Costa, F et al. The impact of parental posttraumatic stress disorder on parenting: A systematic review. Eur J Psychotraumatol 2019; 10: 1–13.CrossRefGoogle ScholarPubMed
Lisanti, AJ. Parental stress and resilience in CHD: A new frontier for health disparities research. Cardiol Young 2018; 9: 1142–1150.CrossRefGoogle Scholar
Meakins, L, Ray, L, Hegadoren, K et al. Parental vigilance in caring for their children with hypoplastic left heart syndrome. Pediatr Nurs 2015; 41: 31–50.Google ScholarPubMed
Vrijmoet-Wiersma, CJ, Ottenkamp, J, van Roozendaal, M et al. A multicentric study of disease-related stress, and perceived vulnerability, in parents of children with congenital cardiac disease. Cardiol Young 2009; 19: 608–614.CrossRefGoogle ScholarPubMed
Rempel, GR, Harrison, MJ. Safeguarding precarious survival: parenting children who have life-threatening heart disease. Qual Health Res 2007; 17: 824–837.CrossRefGoogle ScholarPubMed
McLeod, BD, Wood, JJ, Weisz, JR. Examining the association between parenting and childhood anxiety: A meta-analysis. Clinical Psychology Review 2007; 27: 155–172.CrossRefGoogle ScholarPubMed
Orgilés, M, Penosa, P, Morales, A et al. Maternal anxiety and separation anxiety in children aged between 3 and 6 years: the mediating role of parenting style. J Dev Behav Pediatr 2018; 39: 621–628.CrossRefGoogle ScholarPubMed
Day, KL, Dobson, KG, Schmidt, LA et al. Exposure to overprotective parenting and psychopathology in extremely low birth weight survivors. Child Care Health Dev 2017; 44: 234–239.CrossRefGoogle ScholarPubMed
Tedeschi, RG, Calhoun, LG. Posttraumatic growth: conceptual foundations and empirical evidence. Psychol Inquiry 2004; 15: 1–18.CrossRefGoogle Scholar
Hafstad, GS, Gil-Rivas, V, Kilmer, RP et al Parental adjustment, family functioning, and posttraumatic growth among Norwegian children and adolescents following a natural disaster. Am J Orthopsychiatry 2010; 80: 248–257.CrossRefGoogle ScholarPubMed
Bernstein, M, Pfefferbaum, B. Posttraumatic growth as a response to natural disasters in children and adolescents. Curr Psychiatry Rep 2018; 20: 37.CrossRefGoogle ScholarPubMed
Hoffman, MF, Karpyn, A, Christofferson, J et al. Fathers of children with congenital heart disease: sources of stress and opportunities for intervention. Ped Crit Care Med 2020; http://doi.org/10.1097/PCC.0000000000002388.CrossRefGoogle Scholar
Sood, E, Wysocki, T, Alderfer, MA et al. Topical review: Crowdsourcing as a novel approach to qualitative research. J Pediatr Psychol 2021; 46: 189–196.CrossRefGoogle ScholarPubMed
Gramszlo, C, Karpyn, A, Christofferson, J et al. Supporting parenting during infant hospitalisation for CHD. Cardiol Young 2020; 30: 1422–1428.CrossRefGoogle ScholarPubMed
Palinkas, LA, Horwitz, SM, Green, CA et al. Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Adm Policy Ment Health 2015; 42: 533–544.CrossRefGoogle ScholarPubMed
Harris, PA, Taylor, R, Thielke, R et al. Research electronic data capture (REDCap) – A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42: 377–381.CrossRefGoogle ScholarPubMed
Albuquerque, S, Narciso, I, Pereira, M. Posttraumatic growth in bereaved parents: A multidimensional model of associated factors. Psychol Trauma 2018; 10: 199–207.CrossRefGoogle ScholarPubMed
Suttle, M, Hall, MW, Pollack, MM et al. The association between therapeutic alliance and parental health outcomes following a child’s death in the pediatric intensive care unit. J Pediatr Intensive Care 2021; online.CrossRefGoogle Scholar
Weathers, FW, Litz, BT, Keane, TM et al. The posttraumatic stress disorder Checklist for DSM-5. 2013; Scale available at www.ptsd.va.gov.Google Scholar
American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th Ed.). Arlington VA. 2013.CrossRefGoogle Scholar
Blevins, CA, Weathers, FW, Davis, MT et al. The posttraumatic stress disorder checklist for DSM-5 (PCL-5): development and initial psychometric evaluation. J Trauma Stress 2015; 28: 489–498.CrossRefGoogle ScholarPubMed
Cann, A, Calhoun, LG, Tedeschi, RG et al. A short form of the Posttraumatic Growth Inventory. Anxiety Stress Coping 2010; 23: 127–137.CrossRefGoogle Scholar
Sleddens, EF, O’Connor, TM, Watson, KB et al. Development of the Comprehensive General Parenting Questionnaire for caregivers of 5–13 year olds. Int J Behav Nutr Phys Act 2014; 11: 15.CrossRefGoogle ScholarPubMed
van der Horst, K, Sleddens, EF. Parenting styles, feeding styles and food-related parenting practices in relation to toddlers’ eating styles: a cluster-analytic approach. PLOS ONE 2017; 12: e0178149.CrossRefGoogle Scholar
Saylor, CF, Swenson, CC, Stokes Reynolds, S, et al. The Pediatric Emotional Distress Scale: A brief screening measure for young children exposed to traumatic events. J Clin Child Psychol 1999; 28: 70–81.CrossRefGoogle ScholarPubMed
IBM SPSS Statistics for Windows [computer program] Version 24.0. Armonk, NY: IBM Corp, 2016.Google Scholar
Hayes, AF. Introduction to mediation, moderation, and conditional process analysis: A regression-based approach 2nd edn. In: Little, TD (ed) Methodology in the social sciences series. 2017.Google Scholar
Gonzalez, VJ, Kimbro, RT, Cutitta, KE et al. Mental health disorders in children with congenital heart disease. Pediatrics 2021; online.CrossRefGoogle Scholar
Kazak, AE, Alderfer, MA, Streisand, R et al. Treatment of posttraumatic stress symptoms in adolescent survivors of childhood cancer and their families: A randomized clinical trial. J Fam Psychol 2004; 183: 493–504.CrossRefGoogle Scholar
Jotzo, M, Poets, CF. Helping parents cope with the trauma of premature birth: an evaluation of a trauma-preventive psychological intervention. Pediatrics 2005; 115: 915–919.CrossRefGoogle ScholarPubMed
Kasparian, K, Kan, JM, Sood, E et al. Mental health care for parents of babies with congenital heart disease during intensive care unit admission: systematic review and statement of best practice. Early Hum Dev 2019; 139: 104837.CrossRefGoogle ScholarPubMed
Medoff-Cooper, B, Marino, BS, Fleck, DA. Telehealth home monitoring and postcardiac surgery for congenital heart disease. Pediatrics 2020; online.CrossRefGoogle Scholar
Boman, KK, Kjällander, Y, Eksborg, S et al. Impact of prior traumatic life events on parental early stage reactions following a child’s cancer. PLOS ONE 2013; 8: e57556.CrossRefGoogle ScholarPubMed
Nelson, LP, Gold, JI. Posttraumatic stress disorder in children and their parents following admission to the pediatric intensive care unit: A review. Pediatr Crit Care Med 2012; 13: 338–347.CrossRefGoogle Scholar
Vishnevsky, T, Cann, A, Calhoun, LG et al. Gender differences in self-reported posttraumatic growth: A meta-analysis. Psychol Women Quarterly 2010; 34: 110–120.CrossRefGoogle Scholar
US Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Healthy People 2020 [Internet]. Washington, DC [Retrieved 2021].Google Scholar
Garner, AS, Shonkoff, JP, Siegel, BS et al. Early childhood adversity, toxic stress, and the role of the pediatrician: translating developmental science into lifelong health. Pediatrics 2012; 129: e224–e231.Google ScholarPubMed
Kirkinis, K, Pieterse, AL, Martin, C. Racism, racial discrimination, and trauma: A systematic review of the social science literature. Ethnicity Health 2021; 26: 392–412.CrossRefGoogle ScholarPubMed
Malawa, Z, Gaarde, J, Spellen, S. Racism as a root cause approach: A new framework. Pediatrics 2021; [online] 147.CrossRefGoogle Scholar
Davey, B, Sinha, R, Lee, JH, et al. Social determinants of health and outcomes for children and adults with congenital heart disease: a systematic review. Pediatr Res 2020; 17: 1–20.Google Scholar
Oh, SS, Galanter, J, Thakur, N et al. Diversity in clinical and biomedical research: A promise yet to be fulfilled. PLoS Med 2015; 12: e1001918.CrossRefGoogle ScholarPubMed
Bartlett, D, Chiarello, LA, Hjorngaard, T et al. Moving from parent “consultant” to parent “collaborator”: one pediatric research team’s experience. Disabil Rehabil 2017; 39: 2228–2235.CrossRefGoogle ScholarPubMed