Depression and anxiety in adult congenital heart disease: Predictors and prevalence

Kovacs, Adrienne H.; Saidi, Arwa S.; Kuhl, Emily A.; Sears, Samuel F.; Silversides, Candice; Harrison, Jeanine L.; Ong, Lephuong; Colman, Jack; Oechslin, Erwin; Nolan, Robert P.

doi:10.1016/j.ijcard.2008.06.042

« Previous Next »International Journal of Cardiology
Volume 137, Issue 2 , Pages 158-164, October 2009

Depression and anxiety in adult congenital heart disease: Predictors and prevalence

Adrienne H. Kovacs
- Adult Congenital Heart Disease Program, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Canada
- Behaviour Cardiology, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Canada
- Corresponding author. Adrienne H. Kovacs, PhD, University Health Network, 585 University Avenue, 5-North-523, Toronto, ON, M5G 2N2, Canada. Tel.: +1 416 340 4871; fax: +1 416 340 5014.
Arwa S. Saidi
- Division of Pediatric Cardiology, Department of Pediatrics, University of Florida, Gainesville, FL, United States
Emily A. Kuhl
- Department of Clinical & Health Psychology, University of Florida, Gainesville FL, United States
Samuel F. Sears
- Departments of Psychology and Internal Medicine, East Carolina University, Greenville, NC, United States
Candice Silversides
- Adult Congenital Heart Disease Program, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Canada
Jeanine L. Harrison
- Adult Congenital Heart Disease Program, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Canada
Lephuong Ong
- York University, Toronto, Canada
Jack Colman
- Adult Congenital Heart Disease Program, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Canada
Erwin Oechslin
- Adult Congenital Heart Disease Program, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Canada
Robert P. Nolan
- Behaviour Cardiology, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Canada

Received 29 March 2008; received in revised form 20 June 2008; accepted 28 June 2008. published online 19 August 2008.

Abstract

Background

Adult congenital heart disease (ACHD) patients face unique medical and social challenges that may contribute to psychological difficulties. The goals of this study were to identify predictors of symptoms of depression and anxiety and evaluate the prevalence of mood and anxiety disorders among North American ACHD patients.

Methods

In this cross-sectional study, consecutive patients were recruited from two ACHD outpatient clinics. All patients completed self-report psychosocial measures and a subset was randomly selected to participate in structured clinical interviews. Linear regression models were used to predict symptoms of depression and anxiety.

Results

A total of 280 patients (mean age=32 years; 52% female) completed self-report measures. Sixty percent had defects of moderate complexity and 31% had defects of great complexity. Significant predictors of depressive symptoms were loneliness (p<0.001), perceived health status (p<0.001), and fear of negative evaluation (p=0.02). Predictors of anxiety symptoms were loneliness (p<0.001) and fear of negative evaluation (p<0.001). Disease severity and functional class did not predict mood or anxiety symptoms. Fifty percent of interviewed patients (29/58) met diagnostic criteria for at least one lifetime mood or anxiety disorder, of whom 39% had never received any mental health treatment.

Conclusions

The results confirm an increased risk and under-treatment of mood and anxiety disorders in ACHD patients. Social adjustment and patient-perceived health status were more predictive of depression and anxiety than medical variables. These factors are modifiable and therefore a potential focus of intervention.

Keywords: Adult congenital heart disease, Depression, Anxiety, Social functioning