Patients and methods: This prospective, case-control study included a total of 103 children (52 males, 51 females; mean age: 59.1±56.1 months; range, 1 month-18 years) who underwent congenital heart surgery and their mothers between September 2019 and April 2020. The children who underwent cardiac surgery and their mothers were included as the study group (n=48). The control group (n=55) included healthy children and their mothers. Sociodemographic data of the children and their mothers were recorded. The World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaire was administered to the mothers.

Results: Both groups were similar in terms of age, sex, height, and birth weight, maternal age, education and marital status, and presence of comorbidities (p>0.05). The scores in a 0-100 scale of physical health, psychological health, social relationships and environment domains of the WHOQOL-BREF were statistically lower in the study group (p<0.05). Intensive care duration was negatively correlated with all domains of the WHOQOL-BREF (p<0.05). The domains except for the environment were negatively correlated with the hospital stay (p<0.05).

Conclusion: Lower scores of WHOQOL-BREF were achieved in mothers whose children underwent congenital cardiac surgery. Length of intensive care and hospital stay was negatively correlated with the WHOQOL-BREF. Routine screening and counseling may be valuable in this patient population.

Recognizing the differences in the quality of life (QoL) of the mothers of children undergoing heart surgery compared to mothers of healthy children prepares the ground for screening and supportive treatments in this regard. Determining the psychological and social assessment of these mothers and identifying those who need professional support may explain the source of a social problem.[5] In the present study, we aimed to evaluate the level of QoL of mothers of children undergoing cardiac surgery.

Socio-demographic data of the children and their mothers were recorded. The World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaire was administered to all mothers who participated in the study. The results were compared between the groups. Data including health status, physical health, psychological health, social relations, and environmental status were evaluated.

Statistical analysis
Statistical analysis was performed using the Microsoft Office Excel, Jamoviproject (2020), Jamovi (version 1.6.1) and JASP (version 0.13.1). Descriptive data were expressed in mean±standard deviation (SD), median (min-max) or number and frequency, where applicable. Normality test of numerical variables was checked using the Kolmogorov-Smirnov and Shapiro-Wilk tests. The independent t-test was used to compare two independent groups, while the Mann-Whitney U test was used when normal distribution assumption was unmet. For multiple comparisons, the Kruskal-Wallis test was used. The Pearson chi-square test was performed to examine the relationship between variables. A p value of <0.05 was considered statistically significant.

Table 1: Demographic and clinical characteristics of the children included in the study

In the study group, the most common diagnoses were ventricular septal defect in 22 (45.8%) patients and atrial septal defect in 15 (31.3%) patients. Among the diseases in the other group, aortic coarctation was observed in four (8.3%) patients (Table 2).

Table 2: Distribution of diseases in children in the study group

The mean age of the mothers was 35.0±7.8 years. Primary-secondary school graduation was the most common (55.3%) educational status. Maternal age and education status were similar between the groups (p=0.445 and p=0.552). Ninety-five of the mothers (92.2%) were married. The number of mothers with a coexisting disease was 17 (16.5%). The most common comorbidity requiring drug therapy was hypothyroidism/hyperthyroidism (n=8). Four mothers (3.88%) used antidepressant drugs and two of them (1.94%) started using drugs due to poor health status of their children. There was no significant difference between the groups in terms of marital status and having comorbidities (p=0.105 and p=0.057) (Table 3).

Table 3: Demographic and clinical characteristics of the mothers included in the study

According to the WHOQOL-BREF, the raw score and percentage point percentages of the fields (health status, physical health, psychological health, social relations and environment status) in the study group were significantly lower than the control group (p<0.05 for all) (Table 4).

Table 4: Comparison of WHOQOL-BREF raw score and percentage score between groups

There were significant negative correlations between the length of stay in the ICU and hospital, and the raw score and percentage scores of all WHOQOLBREF subdomains (p<0.05 for all) (Table 5).

Table 5: Correlation of WHOQOL-BREF raw score and percentage scores with age, intensive care and length of stay in the study group

Changes in the psychological status and QoL of sick children and their families affect many stages of treatment, but should also be considered as a social problem. Statistical findings and quality scales are used to improve the QoL of the mothers of these children.[7]

Cardiac surgery procedures can be fearful for pediatric patients and their families. The individual who needs the most support at this stage is the mother. The mother must be supported psychologically and mentally at every stage of the treatment. The key is that clinicians have emphasized physical and psychological health, social relationships, and environment domains of mothers. Assessment of QoL by using specific tests can be a guide for determining the need for support and therapy. Also, these tests are useful in evaluating the treatment plan and effectiveness.

In our study, four mothers used antidepressant drugs and only two of them were related to their children’ cardiac diseases. However, awareness of mothers about their psychological status is significantly low, leading to poor QoL. Providing professional psychological counseling can be beneficial both in terms of increasing awareness and identifying patients who would be given advanced treatment such as drug therapy or psychiatric support. By increasing the awareness, it may be possible to draw the attention of physicians, nurses, and other health personnel who provide health services to this issue.

However, all QoL scores were significantly lower in the study group, length of stay in the ICU and hospital were related to poor QoL scores. We believe that these mothers deserve to be taken into account specifically.

Quality of life should be improved by recognizing and supporting mothers who are in a difficult process by determining what the changes in QoL are and their severity.[8] In this way, both the psychological development of sick children and their mothers is supported and social psychological recovery is contributed. For this purpose, in our study, we evaluated the QoL with a questionnaire study among mothers of children with heart disease who underwent surgery.

The data in this study are based on the responses of the voluntary participating mothers to the questionnaires. As the results were subjective, they may have been affected by ethnic changes. The statistical significance between changes could have been increased with a higher number of participants.

In conclusion, the physical health, psychological health, social relations and environmental status of the mothers of children undergoing cardiac surgery seem to be significantly lower compared to healthy mothers. We believe that it is important to increase the QoL of these mothers with psychological support.

Declaration of conflicting interests
The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Funding
The authors received no financial support for the research and/or authorship of this article.

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