Post-traumatic stress disorder, anxiety, and depression among adults with congenital heart defects

Abstract

Background: Due to invasive treatments and stressors related to heart health, adults with congenital heart defects (CHDs) may have an increased risk of post-traumatic stress disorder (PTSD), anxiety, and/or depressive disorders. Our objectives were to estimate the prevalence of these disorders among individuals with CHDs.

Methods: Using IBM® MarketScan® Databases, we identified adults age 18-49 years with ≥2 outpatient anxiety/depressive disorder claims on separate dates or ≥1 inpatient anxiety/depressive disorder claim in 2017. CHDs were defined as ≥2 outpatient CHD claims ≥30 days apart or ≥1 inpatient CHD claim documented in 2007-2017. We used log-binomial regression to estimate adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) for associations between CHDs and anxiety/depressive disorders.

Results: Of 13,807 adults with CHDs, 12.4% were diagnosed with an anxiety or depressive disorder. Adults with CHDs, compared to the 5,408,094 without CHDs, had higher prevalence of PTSD (0.8% vs. 0.5%; aPR: 1.5 [CI: 1.2-1.8]), anxiety disorders (9.9% vs. 7.5%; aPR: 1.3 [CI: 1.3-1.4]), and depressive disorders (6.3% vs. 4.9%; aPR: 1.3 [CI: 1.2-1.4]). Among individuals with CHDs, female sex (aPR range: 1.6-3.3) and inpatient admission (aPR range 1.1-1.9) were associated with anxiety/depressive disorders.

Conclusion: Over 1 in 8 adults with CHDs had diagnosed PTSD and/or other anxiety/depressive disorders, 30-50% higher than adults without CHDs. PTSD was rare, but three times more common in women with CHDs than men. Screening and referral for services for these conditions in people with CHDs may be beneficial.

Keywords: MarketScan; anxiety; congenital heart; depression; post-traumatic stress disorder.

FIGURE 1

Counts of individuals meeting inclusion and exclusion criteria, IBM MarketScan^® Commercial Databases, 2017. ^aCHD(s): Congenital heart defect(s), defined by ICD-9-CM or ICD-10-CM inpatient and outpatient codes between 2007 and 2017. ^bIndividuals were considered to have a CHD if they had at least two ICD codes more than 30 days apart in outpatient encounter data, or at least one ICD code in inpatient encounter data. ^cAt least one inpatient or 2 outpatient ICD-10-CM codes diagnosed on separate days for depressive or anxiety disorders diagnosed in 2017