Psychiatric morbidity and work participation in patients with congenital ventricular septal defects: a case-controlled study

Abstract

Background: The burden of psychiatric morbidity, level of education, and work participation are currently unknown in patients with congenital ventricular septal defects (VSD).

Methods and results: In a Danish population-based cohort study using nationwide medical registries, the burden of psychiatric disorders, use of psychotropic agents, level of education, and work participation were examined in patients with isolated congenital VSD and controls from the general population matched by age and sex. Subjects with known chromosomal abnormalities were excluded. To compute estimates, Cox proportional regression model, Fine and Gray's competing risk regression, and Kaplan-Meier failure function were used. We included 8006 patients and 79 568 controls born before 2018. Median follow-up was 23 years. Compared with controls, patients with VSD displayed a hazard ratio (HR) of 1.24 [95% confidence interval (CI): 1.17-1.32] for any psychiatric disorder where the hazard for intellectual disabilities was most pronounced [HR of 3.66 (95% CI: 2.98-4.50)]. The use of psychotropic agents was higher in patients compared with controls [HR 1.14 (95% CI: 1.09-1.20)]. The work participation was lower in patients with VSD compared with controls (P < 0.001) and was lower in patients with VSD with a psychiatric disorder compared with those without (P < 0.001). The 40-year cumulative incidence of permanent social security benefits was 29% in patients with psychiatric disorders (vs. 21% in controls with psychiatric disorders) and 8% in patients without psychiatric disorders (vs. 4% in controls).

Conclusion: Patients with isolated VSD suffer from a higher burden of psychiatric disorders and display lower work participation compared with matched controls from the general Danish population. It is important to consider longer-term impacts on mental health, education, and subsequent employment in patients with VSD, in addition to cardiovascular effects, as these factors severely affect quality of life and have direct socioeconomic implications on an individual and societal level.

Keywords: Congenital heart disease; Education; Nationwide; Psychiatric disorders; Ventricular septal defect; Work participation.

Graphical Abstract

Figure 1

Flowchart of the inclusion process of patients with an isolated congenital ventricular septal defect.

Figure 2

Cumulative incidence of psychiatric disorders with death as competing risk in patients with an isolated congenital ventricular septal defect and matched controls from the general Danish population.

Figure 3

Cumulative incidence of retrieval of permanent social security benefits with death as competing risk in patients with an isolated congenital ventricular septal defect and matched controls from the general Danish population.

Figure 4

Cumulative incidence of retrieval of permanent social security benefits stratified by presence of psychiatric disorder and with death as competing risk in patients with an isolated congenital ventricular septal defect and matched controls from the general Danish population. PD, psychiatric disorder.