Individual and Contextual Determinants of Quality of Life in Adolescents With Congenital Heart Disease

Purpose: An essential goal of health care interventions is to promote quality of life. In line with recent biopsychosocial frameworks emphasizing individual and contextual resources for improving quality of life, the present prospective study aimed at identifying potential determinants of quality of life in a large sample of adolescents with congenital heart disease (CHD). In doing so, the present study focused on parental support, peer support, and sense of coherence (SOC), all representing key psychosocial constructs in adolescence. Methods: Adolescents with CHD (n at time 1 = 429; 46.6% girls) were assessed twice over a period of 9 months. Cross-lagged analysis from a structural equation modeling approach was used to examine the direction of effects among the study variables, simultaneously controlling for demographic and clinical parameters. Results: Important temporal sequences and developmental pathways were uncovered over time. Perceived health status, SOC, andparental support positively predicted quality of life over time; parental support was also found to positively predict SOC over time. Hence, parental support predicted both directly and indirectly (i.e., through SOC) quality of life over time. Finally, both perceived health status and SOC predicted peer support over time. Conclusions: The present longitudinal study using a large sample of adolescents with a wide spectrum of congenital heart defects substantially extended our knowledge base on biopsychosocial functioning and quality of life in this population. Both individual and contextual resources need to be taken into account to shed a comprehensive picture of quality of life in adolescents with CHD. (C) 2012 Society for Adolescent Health and Medicine. All rights reserved.