Anxiety and Depression in Adults With Congenital Heart Disease
Adrienne H. KovacsKoen LuyckxCorina ThometWerner BudtsJunko EnomotoMaayke A. SlumanChun‐Wei LuJamie L. JacksonPaul KhairyStephen C. CookShanthi ChidambarathanuLuis AldayMette‐Elise EstensenMikael DellborgMalin BerghammerBengt JohanssonAndrew S. MackieSamuel MenahemMaryanne CaruanaGruschen VeldtmanAlexandra SoufiSusan M. JamesonEdward CallusShelby KuttyErwin OechslinLiesbet Van BulckPhilip Moons
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Key result
Elevated anxiety or depression affects ~30% of ACHD patients and is linked to poorer QOL.
- P<0.001
- n=3,815
Journal of the American College of Cardiology published a graphical abstract
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Why the study?
A comprehensive understanding of adult congenital heart disease outcomes requires evaluating psychological functioning, including depression and anxiety symptoms, in a global sample.
Key Points
- To determine the prevalence and predictors of elevated anxiety and depression symptoms in adults with congenital heart disease and evaluate their association with quality of life and health status.
- In this substudy of the multicenter international APPROACH-IS trial (NCT02150603), 3,815 participants across 15 countries completed the Hospital Anxiety and Depression Scale (HADS).
- Cut-off scores of 8 or higher on the anxiety (HADS-A) and depression (HADS-D) subscales defined clinically elevated symptoms.
- Participants rated quality of life (QOL) and health status (HS) using 0 to 100 linear analogue scales, analyzed across symptom categories via analysis of variance.
- Overall, 1,148 participants (30.1%) reported elevated psychological distress: 18.3% had elevated HADS-A only, 2.9% had elevated HADS-D only, and 8.9% had elevations on both subscales.
- Elevated anxiety was more prevalent than depression in all 15 countries, with HADS-A rates ranging from 12.9% to 38.2% and HADS-D rates ranging from 6.5% to 21.2%.
- Both QOL and HS decreased significantly with worsening HADS-A (QOL F=251.6, HS F=235.0; P < 0.001) and HADS-D severity (QOL F=328.6, HS F=272.8; P < 0.001).
Study Design
Type
Cross-Sectional (n=3,815)
Multicenter
Yes
Structured PICO
P
Population
3,815 adults with congenital heart disease from 15 countries, mean age 34.8 years, assessed for anxiety and depression symptoms.
O
Outcome
Prevalence of elevated depression and anxiety symptoms (HADS-A and HADS-D scores ≥ 8) and their association with quality of life (QOL-LAS) and health status (HS-VAS)patient reported
Main Result
p-value: p=<0.001
Almost one-third of adults with congenital heart disease report elevated symptoms of depression and/or anxiety, which are significantly associated with poorer quality of life and health status.
Limitations
- Selection bias
- Cross-sectional design
- Use of self-reported symptom measures rather than structured clinical interviews
- Assessment limited to symptoms of depression and generalized anxiety
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“We have known about psychological challenges faced by people with congenital heart disease for decades. We as a writing group agreed that it is time to move from awareness to implementation of strategies to manage psychological distress and foster resilience in clinical care settings, ideally through the integration of a mental health professionals.”
“Decades of research describes the psychological and social stressors and challenges that can present across the lifespan for people with CHD. It's long overdue that we move beyond awareness to action and providing more resources and expert mental health care for people living with CHD.”
“We renewed our emphasis on mental health and neurocognitive assessment. Our patients have a lot of challenges with anxiety and depression, so it's important to discuss that with patients or consider sending them for further evaluation.”
Implication
Prevalent anxiety/depression symptoms in congenital heart disease link to poorer quality of life; supports screening yet leaves open whether treatment improves outcomes.
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).
Discussion
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Cite This Study
Kovacs et al. (2024) conducted a cross-sectional in Congenital heart disease (n=3,815). Elevated symptoms of depression and/or anxiety vs. No elevated symptoms was evaluated on Quality of life (QOL) and health status (HS) differences by symptom category (p=<0.001). Almost one-third of adults with congenital heart disease reported elevated symptoms of depression and/or anxiety, which were associated with significantly lower quality of life and health status.
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