. 2024 Jan 23;83(3):430-441.

doi: 10.1016/j.jacc.2023.10.043.

Anxiety and Depression in Adults With Congenital Heart Disease

Adrienne H Kovacs¹, Koen Luyckx², Corina Thomet³, Werner Budts⁴, Junko Enomoto⁵, Maayke A Sluman⁶, Chun-Wei Lu⁷, Jamie L Jackson⁸, Paul Khairy⁹, Stephen C Cook¹⁰, Shanthi Chidambarathanu¹¹, Luis Alday¹², Mette-Elise Estensen¹³, Mikael Dellborg¹⁴, Malin Berghammer¹⁵, Bengt Johansson¹⁶, Andrew S Mackie¹⁷, Samuel Menahem¹⁸, Maryanne Caruana¹⁹, Gruschen Veldtman²⁰, Alexandra Soufi²¹, Susan M Jameson²², Edward Callus²³, Shelby Kutty²⁴, Erwin Oechslin²⁵, Liesbet Van Bulck²⁶, Philip Moons²⁷; APPROACH-IS Consortium, International Society for Adult Congenital Heart Disease

Affiliations

¹ Equilibria Psychological Health, Toronto, Ontario, Canada.
² School Psychology and Development in Context, KU Leuven-University of Leuven, Leuven, Belgium; UNIBS, University of the Free State, Bloemfontein, South Africa.
³ Center for Congenital Heart Disease, Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
⁴ Division of Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium; KU Leuven Department of Cardiovascular Sciences, KU Leuven-University of Leuven, Leuven, Belgium.
⁵ Department of Education, Toyo University, Tokyo, Japan.
⁶ Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands; Department of Cardiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands.
⁷ Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
⁸ Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, Ohio, USA.
⁹ Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, Canada.
¹⁰ IU Health Adult Congenital Heart Disease Program, IU School of Medicine, Indianapolis, Indiana, USA.
¹¹ Pediatric Cardiology, Frontier Lifeline Hospital (Dr K. M. Cherian Heart Foundation), Chennai, India.
¹² Division of Cardiology, Hospital de Niños, Córdoba, Argentina.
¹³ Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
¹⁴ Adult Congenital Heart Unit, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden; Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
¹⁵ Department of Health Sciences, University West, Trollhättan, Sweden; The Queen Silva Children's Hospital, Gothenburg, Sweden.
¹⁶ Department of Surgery and Perioperative Sciences, Umeå University, Umeå, Sweden.
¹⁷ Division of Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada.
¹⁸ Department of Paediatrics and School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia.
¹⁹ Department of Cardiology, Mater Dei Hospital, Birkirkara Bypass, Malta.
²⁰ Adult Congenital Heart Disease Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
²¹ Department of Cardiac Rehabilitation, Médipôle Hôpital Mutualiste, Lyon-Villeurbanne, France.
²² Adult Congenital Heart Program at Stanford, Lucile Packard Children's Hospital and Stanford Health Care, Palo Alto, California, USA.
²³ Clinical Psychology Service, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
²⁴ Adult Congenital Heart Disease Center University of Nebraska Medical Center/ Children's Hospital and Medical Center, Omaha, Nebraska, USA.
²⁵ Toronto Adult Congenital Heart Disease Program, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada.
²⁶ KU Leuven Department of Public Health and Primary Care, KU Leuven-University of Leuven, Leuven, Belgium; Research Foundation Flanders (FWO), Brussels, Belgium.
²⁷ KU Leuven Department of Public Health and Primary Care, KU Leuven-University of Leuven, Leuven, Belgium; Centre for Person-Centered Care (GPCC), University of Gothenburg, Gothenburg, Sweden; Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden; Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa. Electronic address: philip.moons@kuleuven.be.

PMID: 38233017
DOI: 10.1016/j.jacc.2023.10.043

Free article

Anxiety and Depression in Adults With Congenital Heart Disease

Adrienne H Kovacs et al. J Am Coll Cardiol. 2024.

Free article

. 2024 Jan 23;83(3):430-441.

doi: 10.1016/j.jacc.2023.10.043.

Authors

Affiliations

¹ Equilibria Psychological Health, Toronto, Ontario, Canada.
² School Psychology and Development in Context, KU Leuven-University of Leuven, Leuven, Belgium; UNIBS, University of the Free State, Bloemfontein, South Africa.
³ Center for Congenital Heart Disease, Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
⁴ Division of Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium; KU Leuven Department of Cardiovascular Sciences, KU Leuven-University of Leuven, Leuven, Belgium.
⁵ Department of Education, Toyo University, Tokyo, Japan.
⁶ Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands; Department of Cardiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands.
⁷ Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
⁸ Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, Ohio, USA.
⁹ Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, Canada.
¹⁰ IU Health Adult Congenital Heart Disease Program, IU School of Medicine, Indianapolis, Indiana, USA.
¹¹ Pediatric Cardiology, Frontier Lifeline Hospital (Dr K. M. Cherian Heart Foundation), Chennai, India.
¹² Division of Cardiology, Hospital de Niños, Córdoba, Argentina.
¹³ Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
¹⁴ Adult Congenital Heart Unit, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden; Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
¹⁵ Department of Health Sciences, University West, Trollhättan, Sweden; The Queen Silva Children's Hospital, Gothenburg, Sweden.
¹⁶ Department of Surgery and Perioperative Sciences, Umeå University, Umeå, Sweden.
¹⁷ Division of Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada.
¹⁸ Department of Paediatrics and School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia.
¹⁹ Department of Cardiology, Mater Dei Hospital, Birkirkara Bypass, Malta.
²⁰ Adult Congenital Heart Disease Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
²¹ Department of Cardiac Rehabilitation, Médipôle Hôpital Mutualiste, Lyon-Villeurbanne, France.
²² Adult Congenital Heart Program at Stanford, Lucile Packard Children's Hospital and Stanford Health Care, Palo Alto, California, USA.
²³ Clinical Psychology Service, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
²⁴ Adult Congenital Heart Disease Center University of Nebraska Medical Center/ Children's Hospital and Medical Center, Omaha, Nebraska, USA.
²⁵ Toronto Adult Congenital Heart Disease Program, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada.
²⁶ KU Leuven Department of Public Health and Primary Care, KU Leuven-University of Leuven, Leuven, Belgium; Research Foundation Flanders (FWO), Brussels, Belgium.
²⁷ KU Leuven Department of Public Health and Primary Care, KU Leuven-University of Leuven, Leuven, Belgium; Centre for Person-Centered Care (GPCC), University of Gothenburg, Gothenburg, Sweden; Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden; Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa. Electronic address: philip.moons@kuleuven.be.

PMID: 38233017
DOI: 10.1016/j.jacc.2023.10.043

Abstract

Background: A comprehensive understanding of adult congenital heart disease outcomes must include psychological functioning. Our multisite study offered the opportunity to explore depression and anxiety symptoms within a global sample.

Objectives: In this substudy of the APPROACH-IS (Assessment of Patterns of Patient-Reported Outcomes in Adults With Congenital Heart Disease-International Study), the authors we investigated the prevalence of elevated depression and anxiety symptoms, explored associated sociodemographic and medical factors, and examined how quality of life (QOL) and health status (HS) differ according to the degree of psychological symptoms.

Methods: Participants completed the Hospital Anxiety and Depression Scale, which includes subscales for symptoms of anxiety (HADS-A) and depression (HADS-D). Subscale scores of 8 or higher indicate clinically elevated symptoms and can be further categorized as mild, moderate, or severe. Participants also completed analogue scales on a scale of 0 to 100 for QOL and HS. Analysis of variance was performed to investigate whether QOL and HS differed by symptom category.

Results: Of 3,815 participants from 15 countries (age 34.8 ± 12.9 years; 52.7% female), 1,148 (30.1%) had elevated symptoms in one or both subscales: elevated HADS-A only (18.3%), elevated HADS-D only (2.9%), or elevations on both subscales (8.9%). Percentages varied among countries. Both QOL and HS decreased in accordance with increasing HADS-A and HADS-D symptom categories (P < 0.001).

Conclusions: In this global sample of adults with congenital heart disease, almost one-third reported elevated symptoms of depression and/or anxiety, which in turn were associated with lower QOL and HS. We strongly advocate for the implementation of strategies to recognize and manage psychological distress in clinical settings. (Patient-Reported Outcomes in Adults With Congenital Heart Disease [APPROACH-IS]; NCT02150603).

Keywords: adult congenital heart disease; anxiety; depression; quality of life.

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Conflict of interest statement

Funding Support and Author Disclosures This work was supported by the Research Fund–KU Leuven (Leuven, Belgium) through grant OT/11/033, by the Swedish Heart-Lung Foundation (Sweden) through grant number 20130607, by the University of Gothenburg Centre for Person-Centered Care (Gothenburg, Sweden), by the Cardiac Children’s Foundation (Taiwan) through grant CCF2013_02, by the Research Foundation Flanders through grant 1159522N, and by the Ricerca Corrente funding from the Italian Ministry of Health to IRCCS Policlinico San Donato. Furthermore, this work was endorsed by and conducted in collaboration with the International Society for Adult Congenital Heart Disease. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Comment in

Addressing Psychologic Distress in Adults With Congenital Heart Disease: Replacing Anxiety With Hope.
Valente AM, Baraona Reyes F. Valente AM, et al. J Am Coll Cardiol. 2024 Jan 23;83(3):442-443. doi: 10.1016/j.jacc.2023.10.040. J Am Coll Cardiol. 2024. PMID: 38233018 No abstract available.

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Anxiety and Depression in Adults With Congenital Heart Disease

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Anxiety and Depression in Adults With Congenital Heart Disease

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