Anxiety and Depression in Adults With Congenital Heart Disease

• Published in: Journal of the American College of Cardiology Vol. 83; no. 3; pp. 430 - 441
• Main Authors: Kovacs, Adrienne H., Luyckx, Koen, Thomet, Corina, Budts, Werner, Enomoto, Junko, Sluman, Maayke A., Lu, Chun-Wei, Jackson, Jamie L., Khairy, Paul, Cook, Stephen C., Chidambarathanu, Shanthi, Alday, Luis, Estensen, Mette-Elise, Dellborg, Mikael, Berghammer, Malin, Johansson, Bengt, Mackie, Andrew S., Menahem, Samuel, Caruana, Maryanne, Veldtman, Gruschen, Soufi, Alexandra, Jameson, Susan M., Callus, Edward, Kutty, Shelby, Oechslin, Erwin, Van Bulck, Liesbet, Moons, Philip
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 23.01.2024
• Subjects: adult congenital heart disease; anxiety; depression; Health Sciences; Hälsovetenskaper; Nursing science; quality of life; Vårdvetenskap; HS-VAS; HADS; HS; PRO; HADS-A; HADS-D; QOL; anxiety; adult congenital heart disease; QOL-LAS; depression; quality of life; CHD; New York Heart Association class; distress syndrome; sex difference; major clinical study; Article; clinical feature; health status; social status; Hospital Anxiety and Depression Scale; prevalence; age distribution; controlled study; disease classification; demography; congenital heart disease; patient-reported outcome; symptomatology; anxiety disorder; adult; female; human; male; quality of life assessment
• ISSN: 0735-1097; 1558-3597; 1558-3597
• DOI: 10.1016/j.jacc.2023.10.043

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. 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. 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. 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). 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) [Display omitted]