Psychosocial functioning of the adult with congenital heart disease

Patients with congenital heart disease (N=362, aged 20-46 years), belonging to five diagnostic groups, atrial septal defect (ASD, N=93), ventricular septal defect (VSD, N=97), tetralogy of Fallot (ToF, N=77), transposition of the great arteries (TGA, N=55) and pulmonary stenosis (PS, N=40) were subjected to extensive medical and psychological examination, 20-33 years after their first open heart surgery. The mean ages in these diagnostic groups were 32.8, 29.5, 30.2, 26.0 and 31.3 years, respectively. All the patients were seen by the same psychologist, who examined their psychosocial functioning using a structured interview and questionnaires. The proportion of adult patients with a history of special education was 27%. Of these patients, 85% attended schools for learning-disabled or mentally handicapped children and 15% for chronically ill children. The proportions of patients with a history of special education were significantly higher in the diagnostic categories tetralogy of Fallot (33% (22-44)) and transposition of the great arteries (40% (27-53)) than in the atrial septal defect group (13% (6-20)). The authors found that the patient sample appeared to be significantly overrepresented in the lower level occupations, and underrepresented in the scientific occupations, compared to the control group. No significant differences in occupational status were found between the diagnostic categories were identified. As to the duration of employment, Riijen et al note that the patient sample did not differ from the control group, nor were there any significant differences between diagnostic categories. In the decision to work part-time, the congenital heart disease played a role in 21% of the cases. The patients' estimation of career possibilities seemed "favourable and equal" for all the diagnostic categories, they said. In accordance with the educational attainments, this patient sample had lower level of occupations "significantly" more often than the control group.The authors concluded that the sample of adult patients with congenital heart disease had residual problems regarding its educational and occupational status. They state that these findings could be a reflection of disadvantaged positions in childhood, such as high attendance of special education in the past. They note, however, that overall, the sample of patients with congenital heart disease seemed capable of leading normal lives and seemed motivated to make good use of their abilities. Reference...