Anxiety and Depression in Adults With Congenital Heart Disease

Abstract

Introduction: Anxiety and depression can worsen outcome in patients with heart disease. We elucidate the prevalence of anxiety and depression in a cohort of adults with congenital heart disease (ACHD).

Materials and methods: Prospective screening for anxiety or depression was performed in 204 consecutive patients of the outpatient clinic of our tertiary care center using the Hospital Anxiety and Depression Scale (HADS) questionnaire and the distress thermometer (DT) as a potential ultra-short screening test. Functional data were assessed at liberty of the responsible physician. HADS scores ≥ 8 were considered doubtful and scores ≥ 11 as confirmed cases of anxiety or depression, respectively. HADS results were compared with a historical group of 100 patients with non-Hodgkin Lymphoma (NHL) as well as German reference values from the literature.

Results: Patients from the ACHD cohort were 28 ± 10 years old (mean ± SD, 54% male), 34% had a simple, 51% a moderate, including 52 patients with transposition of the great arteries after arterial switch operation, and 15% a heart defect of severe complexity. Prevalence of depression in ACHD was comparable to the German normal population (5.9% ACHD vs. 5.4% control). In contrast, prevalence of anxiety was higher than expected from reference values (12.7% ACHD vs. 5.6% control). There was a positive association between psychological distress and NYHA class [anxiety: OR 2.67 (95% CI, 1.50-4.76) p = 0.001; depression: OR 2.93 (95% CI, 1.60-5.35) p = 0.0005], but not with age, gender, or heart defect severity. Percentages of patients with ACHD with anxiety were significantly higher than in a cohort of patients with indolent non-Hodgkin lymphoma (NHL) but comparable to those with aggressive NHL (HADS-A ≥ 11: ACHD 12.7%, indolent NHL 2.2%, aggressive NHL 13.2%; p = 0.037 ACHD vs. indolent NHL; p = 0.929 ACHD vs. aggressive NHL). The distress thermometer screening test had only a fair discriminatory ability (AUC 0.708; p = 0.002) and is therefore of limited usability.

Conclusion: Adults with congenital heart disease exhibit an increased risk for anxiety disorders independently of the severity of the underlying heart defect. Anxiety prevalence was comparable to a historical cohort of patients with aggressive NHL underlining the importance of a routine screening for psychosocial distress in adults with congenital heart disease.

Keywords: ACHD adult congenital heart disease; Hospital Anxiety and Depression Scale (HADS); anxiety; depression; locus of control.

FIGURE 1

Percentage of subjects with confirmed cases of anxiety or depression (HADS cut-off value ≥ 11). The figure compares the congenital heart disease cohort with the lymphoma cohort and the reference value from the literature. *p = 0.009 ACHD vs. aggressive lymphoma; ^#p = 0.037 ACHD vs. indolent lymphoma.

FIGURE 2

Multivariate regression analysis evaluating associations with HADS anxiety (A) and depression (B) levels.

FIGURE 3

Left: Multivariate regression analysis evaluating associations of locus of control (LoC) with (A) HADS A-anxiety and (C) HADS-D-depression levels. Right: Receiver operating curve analysis evaluating discriminatory ability of Distress Thermometer for (B) HADS A-anxiety and (D) HADS-D-depression levels.