Patterns and Correlates of Changes in Emotional and Behavioral Problems Among Children with Congenital Heart Disease.

OBJECTIVE The objective of this study was to examine patterns of changes in emotional and behavioral problems among children with congenital heart disease (CHD) and investigate associated factors in different domains. METHOD The study sample comprised 327 pairs of children with CHD (aged 1.5-12 yrs) and their parents who participated in 2 waves of a survey in Taiwan from 2017 to 2019. The Child Behavior Checklist was used to evaluate the children's emotional and behavioral problems during both waves. The scores were later used to determine the patterns of changes in emotional and behavioral problems. Multinomial logistic regression was then applied to examine factors associated with varied patterns of changes in emotional and behavioral problems. RESULTS Five patterns of changes in emotional and behavioral problems were identified: "persistent normal," "initial problematic," "worsening," "persistent problematic," and "subclinical." Among the factors examined, parenting stress was consistently associated with different patterns of change in emotional and behavioral problems. Specifically, children with parents who had higher levels of parenting stress were more likely to belong to the "initial problematic," "persistent problematic," or "subclinical" groups than to the "persistent normal" group. Other significant factors included sex, number of surgeries, and perceived health of parents. CONCLUSION This study highlights the potential role of parenting stress in changes in emotional and behavioral problems. Accordingly, intervention programs aimed at relieving parenting stress may help reduce the development and worsening of emotional and behavioral problems among children with CHD.