PEDIATRICS Vol. 98 No. 2 August 1996, pp. 249-255
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Psychosocial Function During Treatment for Familial Hypercholesterolemia

Serena Tonstad MD, MPH1, Torunn Stene Nøvik MD, MPH2, and Inger Helene Vandvik MD, PhD3

1 Lipid Clinic, Medical Department A, National Hospital, Oslo, Norway
2 National Center for Child and Adolescent Psychiatry, Oslo, Norway
3 Division of Child and Adolescent Psychiatry, National Hospital, Oslo, Norway

Objective. To determine whether children treated for familial hypercholesterolemia (FH) have greater psychosocial dysfunction compared with their peers.

Children. Children were 86 boys and 66 girls 7-16 years of age attending a lipid clinic. They were screened and instructed to follow a diet low in saturated fat and cholesterol 18 months to 9 years earlier (mean, 4 years), and their mean dietary intake, estimated by a quantitative food frequency questionnaire, was within recommended limits. One-fourth had lost a parent or had a parent who had had cardiovascular disease due to FH (parental disease group).

Methods. Results of the Child Behavior Checklist, Teacher's Report Form, and Youth Self-Report were compared with a population sample. A semistructured interview, the Child Assessment Schedule, was administered to the children with FH and a well-functioning comparison group from the population (epidemiologic cohort; n = 62).

Results. Psychosocial scores were similar in the children with FH and the population sample. The Child Assessment Schedule showed that, compared with the epidemiologic cohort, children with FH did not have increased symptoms in any area of function, and scores for family, mood, and expression of anger were lower (less symptomatic). The prevalence of psychiatric diagnoses was 10%, which was not greater than expected. Children from the parental disease group had higher symptom scores in the areas of school and expression of anger than the rest of the children with FH. Their mean Children's Global Assessment Score (CGAS, which gives average children scores of 70-79) was slightly lower (77 vs 79). Belonging to the parental disease group predicted a lower CGAS in multivariate regression analyses, as did male sex, parental divorce, and low parental educational level. These factors explained up to 19% (95% confidence interval, 9%-31%) of the variance in CGAS.

Conclusions. We found that the prevalence of psychosocial dysfunction was not greater than expected in children treated for FH. Psychosocial function within the group was associated with the usual demographic characteristics and with the loss or disease of a parent, beyond the period of bereavement or immediately after the event.

Submitted on July 6, 1995
Accepted on October 16, 1995




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