Psychological Distress in Patients with Pectus Excavatum as an Indication for Therapy

Background: Adolescents with pectus excavatum (PE) are often affected by their body shape. The aim of our approach was to quantify the patients’ individual psychological distress and to create a psychological indication for treatment. Methods: 10 adolescents (8 male, median age 16 years, interquartile range 15 - 17 yrs.) with PE were examined at our psychological department. Using standardized psychological tests, projective tests and interviews psychologists validated the patients’ individual psychological status. All patients were offered psychological therapy and correction of the deformity. In addition, the children were followed-up by a telephone questionnaire (median follow-up after starting therapy 12.8 months (5.9 - 18.0). Results: No patient had a relevant physiological limitation. The median follow-up since presentation to our psychologists was 15.0 months (9.1 - 20.6). 8 patients (5 were operated, 2 used the vacuum bell, 1 will undergo surgery) had distinct psychological limitations especially concerning the dimensions attractiveness, self-esteem and somatisation. They demonstrated increased insecurity, anxiety and denegation of their body. Since all patients were within puberty the psychological distress due to the PE has to be interpreted as disadvantageous for their further development. 7 patients completed the follow-up questionnaire and reached a median score of 80.8% (76.4% - 86.8%), which indicates a good improvement in all patients. Conclusions: We conclude that the psychological indication for treatment is justified, since our results support this indication.