Abstract 18290: Sense of Coherence in Adolescents with Congenital Heart Disease: Development, Antecedents, and Outcomes

Abstract

Sense of coherence (SOC), a construct that reflects psychological and behavioral resilience, is found to promote health and quality of life (QOL). The development of a strong SOC in adolescents with congenital heart disease (CHD) can explain the relatively good QOL in afflicted patients. We investigated the development of SOC over time; and tested the hypothesis that developmental classes differ regarding antecedents (sex; age; disease complexity; perceived parenting) and outcomes (QOL; perceived health; depressive symptoms). Methods: We assessed 429 adolescents with CHD (mean age 16y; 53% boys) at three points in time (nine month intervals), recruited at a university hospital. Inclusion criteria were: confirmed CHD; aged 14-18y; last cardiac consult ≤5y ago; and being able to read and write Dutch. Exclusion criteria were: cognitive and/or physical limitations inhibiting filling out questionnaires; and prior heart transplantation. We measured SOC (SOC-13); perceived parenting (subscale of Parental Regulation Scale-Youth Self-Report; Psychological Control Scale-Youth Self-Report; Child Report of Parent Behavior Inventory); QOL (linear analog scale); perceived health (PedsQL); and depressive symptoms (CESD-20). Latent class growth analysis was used to identify developmental classes of SOC. Based on model fit tests, a solution with three classes was selected. Chi-square and multivariate tests were used to examine inter-class differences. Results: Class 1 (33% of the sample) was labeled Consistently High SOC; Class 2 (49%) Intermediate and Decreasing SOC; and Class 3 (18%) Chronically Low SOC. Significantly more boys than girls belonged to class 1. No significant age or disease complexity differences were found at time 1. Perceived parenting is a significant antecendent, with class 1 scoring highest on parental responsiveness and regulation, and class 3 scoring highest on psychological control at time 1. In terms of outcomes, class 1 scored highest on QOL and perceived health and class 3 scored highest on depressive symptoms at time 3. Conclusions: The development of SOC seems to be determined by sex and perceived parenting, and impacts on QOL, perceived health, and depressive symptoms. Enhancing SOC can be an important goal for interventions.