Assessment of psychosocial functioning and its risk factors in children with pectus excavatum

Yi Ji, Wenying Liu, Siyuan Chen, Bing Xu, Yunman Tang, Xuejun Wang, Gang Yang, Liming Cao, Yi Ji, Wenying Liu, Siyuan Chen, Bing Xu, Yunman Tang, Xuejun Wang, Gang Yang, Liming Cao

Abstract

Background: Psychosocial functioning is poor in patients with pectus excavatum (PE). However, a comprehensive understanding of this issue does not exist. The aim of this study was to assess the severity of psychosocial problems as associated with PE, as well as to identify its risk factors.

Methods: A comparative study was performed at the Sichuan Academy of Medical Sciences/Sichuan Provincial People's Hospital in Chengdu, China. Patients age 6 to 16 who admitted to the outpatient department for the evaluation or treatment for PE were included in the study. In addition to parental reports of child psychosocial problems on the Achenbach Child Behavior Checklist (CBCL), parents also filled in other structured questionnaires, including socio-demographic variables, patients' medical and psychological characteristics. The severity of malformation was assessed by CT scan. For comparison, an age- and gender- matched control group was recruited from the general population. The socio-demographic and scores on CBCL were compared between patients and control subjects. Univariate and multivariate analysis were performed to examine risk factors for psychosocial problems in patients.

Results: No statistically significant differences were found with respect to social-demographic variables between children with PE and control subjects. Compared with control subjects, children with PE displayed higher prevalence of psychosocial problems in the different scales of the CBCL questionnaire such as 'withdraw', 'anxious-depressed', 'social problems' and 'total problems'. Both univariate and multivariate analyses suggested that age, severity of malformation, and being teased about PE were significantly associated with patients' psychosocial problems.

Conclusions: The information derived from this study supports the opinion that children with PE have more psychosocial problems than children from the general population. Multiple medical and psychosocial factors were associated with patients' impairment of psychosocial functioning.

Figures

Figure 1
Figure 1
Chest of a 8-years-old boy with asymptomatic PE.
Figure 2
Figure 2
Haller Index. The Haller Index (HI) is defined as the ratio of the maximum internal transverse diameter of the chest (A) and the minimum anteroposterior diameter at the same level (B).
Figure 3
Figure 3
Frequency distribution of patients' age. Of all patients, 252 patients first perceived their deformity when they were 4, 5 or 6 years old. Only 3 patients first perceived the chest wall deformity older than 10 years. A: Patients' age at time of the study. B: Age at which patient became aware of pectus excavatum.

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