The Relationships among Perceived Parental Bonding, Illness Perception, and Anxiety in Adult Patients with Congenital Heart Diseases

Nayeon Shin; Youha Jang; Younhee Kang

doi:10.4040/jkan.2017.47.2.178

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Shin, Jang, and Kang: The Relationships among Perceived Parental Bonding, Illness Perception, and Anxiety in Adult Patients with Congenital Heart Diseases

Original Article

J Korean Acad Nurs 2017;47(2):178-187.

Published online: 15 January 2017

DOI: https://doi.org/10.4040/jkan.2017.47.2.178

The Relationships among Perceived Parental Bonding, Illness Perception, and Anxiety in Adult Patients with Congenital Heart Diseases

Nayeon Shin, Youha Jang, Younhee Kang

College of Nursing, Ewha Womans University, Seoul, Korea

Address reprint requests to : Kang, Younhee College of Nursing, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, Korea Tel: +82-2-3277-4483 Fax: +82-2-3277-2850 E-mail: yxk12@ewha.ac.kr

Received 24 June 2016 Revised 27 September 2016 Accepted 31 October 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

Abstract

Purpose

The purposes of this study were to identify the relationships among perceived parental bonding, illness perception, and anxiety and to determine the influences of perceived parental bonding and illness perception on anxiety in adult patients with congenital heart diseases.

Methods

In this study a descriptive correlational design with survey method was utilized. The participants were 143 adult patients with congenital heart disease being cared for in the cardiology out-patient clinic of A medical center. Data were collected using the Parental Bonding Instrument, Illness Perception Questionnaire Revised Scale, and Cardiac Anxiety Questionnaire Scale. Data were analyzed using descriptive statistics, independent t-test, one-way ANOVA, Pearson correlation analysis, and hierarchial regression analyses.

Results

There showed significant positive relationships of anxiety with maternal overprotection, consequences, and personal control respectively. Among predictors, maternal overprotection (b=.45), consequence (b=.26), and personal control (b=-.03) had statistically significant influence on anxiety.

Conclusion

Nursing interventions to decrease maternal overprotection and negative consequence, and to enhance personal control are essential to decrease the anxiety of adult patients with congenital heart diseases.

Keywords: Congenital heart defects, Family relations, Perception, Anxiety

References

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Table 1.

Differences in Anxiety by Demographic and Clinical Characteristics (N=143)

Characteristics	Categories	n (%)		Anxiety
			M±SD	t/F/c² (p)	Duncan‘s test
Gender	Male	70 (48.9)	1.30±0.30	-2.33 (.052)
	Female	73 (51.0)	1.10±0.11
Age (yr)	19~29	108 (75.5)	2.41±0.12	8.45 (.015)*
	30~39	11 (7.6)	2.19±0.57
	40~49	13 (9.2)	1.26±0.16
	≥50	11 (7.6)	1.52±0.28
Education (yr)	Middle school (≤9)	2 (1.4)	1.00±0.39	1.70 (.188)
	High school (10~12)	79 (56.1)	1.87±0.19
	Undergraduate school (13~16)	57 (38.7)	2.00±0.58
	Graduate school (≥16)	5 (3.8)	1.29±0.19
Marriage	Married	26 (18.2)	2.70±0.62	1.58 (.200)
	Not married	115 (80.4)	1.60±0.32
	Divorced	2 (1.4)	2.11±0.55
Occupation	Yes	87 (60.8)	1.88±0.31	1.11 (.241)
	No	56 (39.2)	2.51±0.52
ACHD subtype	Simple^a	71 (45.9)	1.21±0.31	6.45 (<.001)	a,b,c<d
	Moderate^b	50 (29.4)	2.06±0.76
	Severe^c	12 (18.8)	3.06±1.52
	Complex^d	10 (5.9)	3.19±0.81
Cohabitation	Yes	122 (85.3)	1.42±0.15	0.06 (.956)
	No	21 (14.7)	2.12±0.62
Comorbidity	Yes	113 (79.0)	2.91±0.87	0.84 (.400)
	No	30 (21.0)	1.82±0.17
Dental treatment	Yes	126 (88.1)	1.27±0.72	0.80 (.422)
	No	17 (11.9)	2.80±0.34
Foot edema	Yes	8 (5.6)	2.23±0.72	1.17 (.060)
	No	135 (94.4)	1.83±0.66
Number of operations	0	56 (39.4)	1.51±0.43	4.90 (.004)
	1	32 (22.3)	1.78±0.51
	2	37 (25.8)	2.15±0.33
	≥3	18 (12.5)	2.88±1.15
Exercise	Yes	43 (30.1)	1.96±0.24	-1.67 (.095)
	No	100 (69.9)	1.36±0.82
Regular hospital visits	Yes	111 (77.6)	2.77±0.13	-0.43 (.666)
	No	32 (22.4)	1.88±0.29

^*Kruskal wallis test; ACHD=Adult congenital heart disease; Simple=Aortic valve disease, ventricular septal defect, patent ductus arteriosus, etc; Moderate=Ebstein's anoamaly, tetralogy of Fallot, etc; Severe=Single ventricle, transposition of the great arteries, cyanotic heart disease, etc; Complex=Functional single ventricle with atrial fibrillation, hypoplastic left heart syndrome with ventricular tachycardia, etc.

Table 2.

Summary of Descriptive Statistics for Parental Bonding, Illness Perception, and Anxiety (N=143)

Variables	M±SD	Min	Max	Range
Parental bonding
Mother Care	22.87±8.97	6	36	0~36
Overprotection	22.85±9.41	4	30	0~39
Father Care	21.29±9.13	8	32	0~36
Overprotection	22.09±9.36	0	30	0~39
Illness perception
Identity	7.99±2.94	2	14	0~28
Timeline (acute/chronic)	17.98±4.35	6	26	6~30
Consequences	16.09±5.24	6	29	6~30
Personal control	18.20±2.65	10	24	6~30
Treatment control	16.52±3.46	6	25	5~25
Illness coherence	18.14±3.40	11	25	5~25
Timeline cyclical	10.26±3.21	4	18	4~20
Emotional representations	15.04±4.26	6	26	6~30
Anxiety	1.24±0.31	0	5	0~5
Fear	1.36±0.47	0	5	0~5
Attention	1.04±0.59	0	5	0~5
Avoidance	1.19±0.51	0	5	0~5

Table 3.

Correlation Matrix for Parental Bonding, Illness Perception, and Anxiety (N=143)

Variables			Parental bonding				Ilness perception
	X1	X2	P1	P2	P3	P4	I1	I2	I3	I4	I5	I6	I7	I8
		r (p)		r (p)						r (p)
Age (X1)	1.00
Number of operations	.13	1.00
(X2)	(.068)
Parental bonding
Maternal care (P1)	.24	.11	1.00
	(.15)	(.423)
Maternal	.28	.14	-.16	1.00
	overprotection (P2)	(<.001)	(.062)	(.053)
Paternal care (P3)	.17	-.21	.23	-.13	1.00
	(.224)	(<.001)	(.001)	(.472)
Paternal	-.16	.14	.17	-.13	-12	1.00
	overprotection (P4)	(.003)	(.513)	(.325)	(.552)	(.692)
Ilness perception
Identity (I1)	-.28	.19	-.13	-.22	-.24	-.13	1.00
	(.003)	(<.001)	(.678)	(.770)	(.607)	(.793)
Timeline (acute/	.13	.30	-.27	-.10	-.13	-.17	-.19	1.00
	chronic) (I2)	(.284)	(.001)	(.373)	(.200)	(.098)	(.230)	(.361)
Consequences (I3)	.21	.27	.15	.22	.13	.15	.25	.10	1.00
	(<.001)	(<.001)	(.520)	(.821)	(.761)	(.627)	(.292)	(.432)
Personal control (I4)	-.18	-.30	-.11	.24	-.14	.25	.11	-.17	-.23	1.00
	(<.001)	(.151)	(.770)	(.604)	(.098)	(.211)	(.172)	(.162)	(.352)
Treatment contol (I5)	.22	-.13	.12	.15	27	.18	.18	.14	-.19	.27	1.00
	(.009)	(.201)	(.806)	(.520)	(.195)	(.419)	(.371)	(.111)	(.071)	(.082)
Illness coherence (I6)	.10	.21	.11	.19	.20	.25	.22	.16	-.29	.20	.11	1.00
	(.003)	(.311)	(.185)	(.269)	(.848)	(.330)	(.123)	(.062)	(.243)	(.099)	(.102)
Timeline cyclical (I7)	.24	.18	-.01	.11	-.11	.12	.25	.27	.10	-.19	.17	.18	1.00
	(.001)	(<.001)	(.868)	(.162)	(.187)	(.352)	(.191)	(.203)	(.301)	(.136)	(.327)	(.201)
Emotional	-.31	-.27	-.14	.12	-.23	14	.13	.19	.13	.15	.15	.24	-.12	1.00
	(<.001) representations (I8)	(<.001)	(.571)	(.707)	(.678)	(.501)	(.227)	(.333)	(.132)	(248)	(.115)	(.131)	(.351)
Anxiety	-.11	.42	-.13	.31	.17	.31	.27	-.14	.16	-.19	-.16	-.12	-.19	-.23
	(.039)	(p<.001)	(.122)	(.017)	(.390)	(.866)	(.932)	(.092)	(.046)	(.021)	(.475)	(.146)	(.920)	(.678)

Table 4.

Regression Coefficients of Predictors on Anxiety (N=143)

Variables	Categories	Model 1			Model 2
		b	t	p	b	t	p
Constant			9.24	<.001		-_0.01	.989
ACHD subtype*	Simple	-.07	-0.80	.422	-.07	-0.83	.408
	Moderate	-.05	-0.65	.581	-.06	-0.79	.513
	Severe	-.01	-0.20	.743	-.03	-0.36	.695
Number of operations		.22	2.35	.020	.11	1.18	.240
Age		-.03	-0.38	.698	-.01	-0.17	.858
Parental bonding	Maternal overprotection				.45	2.01	.046
Illness perception	Consequences				.26	2.55	.012
	Personal control				-_.03	1.92	.047
F (p)			2.28 (.017)			3.20(<.001)
R²			.07			.30

^*Dummy variable: ACHD subtype (reference group: complex); ACHD=Adult congenital heart disease; Simple=Aortic valve disease, ventricular septal defect, patent ductus arteriosus, etc; Moderate=Ebstein's anoamaly, tetralogy of Fallot, etc; Severe=Single ventricle, transposition of the great arteries, cyanotic heart disease, etc; Complex=Functional single ventricle with atrial fibrillation, hypoplastic left heart syndrome with ventricular tachycardia, etc.

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