Assessing the Psychological Impact of chronic heart disease on Adolescents at Qassim Region, Saudi Arabia: A Cross-Sectional Study

Introduction: Adolescents with chronic heart disease may experience psychological distress and impaired health-related quality of life (HRQoL) among other problems during this stage. However, evidence from Middle Eastern populations remains limited. This study assessed depression, anxiety, and HRQoL among adolescents with chronic heart disease in the Qassim Region of Saudi Arabia and examined factors associated with these outcomes. Methods: A cross-sectional study was conducted among adolescents aged 13–18 years attending follow-up care at Prince Sultan Cardiac Center-Qassim, Saudi Arabia, between July 2025 and May 2026. Sociodemographic and clinical data were collected using a structured questionnaire. Depression, anxiety, and HRQoL were assessed using the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Pediatric Quality of Life Inventory (PedsQL), respectively. Multivariable linear regression models were fitted to identify factors associated with depression, anxiety, and HRQoL. Results: A total of 158 adolescents participated. The median age was 13 years (IQR: 12–16), and 51.9% were male. Most participants were classified as New York Heart Association (NYHA) class I (81.0%), while 57.6% were categorized as Group C according to the simple congenital heart disease (CHD) severity classification. Median PHQ-9 and GAD-7 scores were 1 (IQR: 0–6) and 2 (IQR: 0–7), respectively, and the median PedsQL total score was 93 (IQR: 75–99). Most participants reported minimal depressive symptoms (68.4%), minimal anxiety symptoms (63.9%), and good HRQoL (67.1%). In adjusted analyses, school absence of less than one day per week was associated with lower depression scores (β = -3.5, 95% CI: -5.3 to -1.6; p < 0.001), lower anxiety scores (β = -3.8, 95% CI: -5.8 to -1.9; p < 0.001), and higher HRQoL scores (β = 8.9, 95% CI: 3.9–14.0; p < 0.001). NYHA class II-IV was associated with higher depression scores (β = 3.1, 95% CI: 1.3–4.8; p < 0.001). Higher depression (β = -2.0, 95% CI: -2.7 to -1.4; p < 0.001) and anxiety scores (β = -0.83, 95% CI: -1.4 to -0.25; p = 0.005) were independently associated with poorer HRQoL. Conclusions: Most adolescents with chronic heart disease reported minimal psychological distress and good HRQoL. Regular school attendance was consistently associated with better psychological outcomes and higher HRQoL, while depressive and anxiety symptoms were important determinants of reduced HRQoL. Routine psychosocial screening and interventions that promote school engagement may improve overall well-being among adolescents with chronic heart disease.