Skip to main content

Advertisement

SpringerLink
Log in

Anxiety and Depression in Adults with Congenital Heart Disease: When to Suspect and How to Refer

  • Congenital Heart Disease (RA Krasuski, Section Editor)
  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Adults with congenital heart disease face many potential psychosocial challenges. This review focuses on their experiences of clinically significant anxiety and depression and provides recommendations for appropriately timed referrals to mental health professionals.

Recent Findings

Adults with congenital heart disease have a higher probability of experiencing symptoms consistent with mood and anxiety disorders, yet risk factors are not well understood. Although patients as a group are often interested in psychological treatment, there is currently under-recognition and under-treatment of mental health concerns.

Summary

As provider and patient awareness of the biopsychosocial implications of living with congenital heart disease continues to grow, the focus of comprehensive care is broadening to include attention to psychosocial well-being. Care teams are encouraged to create a culture that fosters open and ongoing dialog about emotional well-being, including depression and anxiety, and includes reliable processes for mental health referrals.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Gilboa SM, Devine OJ, Kucik JE, Oster ME, Riehle-Colarusso T, Nembhard WN, et al. Congenital heart defects in the United States: estimating the magnitude of the affected population in 2010. Circulation. 2016;134:101–9.

    Article  Google Scholar 

  2. Jackson JL, Leslie CE, Hondorp SN. Depressive and anxiety symptoms in adult congenital heart disease: prevalence, health impact and treatment. Prog Cardiovasc Dis. 2018;61(3-4):294–9.

    Article  Google Scholar 

  3. Kovacs AH, Silversides C, Saidi A, Sears SF. The role of the psychologist in adult congenital heart disease. Cardiol Clin. 2006;24:607–18.

    Article  Google Scholar 

  4. Pagé MG, Kovacs AH, Irvine J. How do psychosocial challenges associated with living with congenital heart disease translate into treatment interests and preferences? A qualitative approach. Psychol Health. 2012;27:1260–70.

    Article  Google Scholar 

  5. Bromberg JI, Beasley PJ, D’Angelo EJ, Landzberg M, DeMaso DR. Depression and anxiety in adults with congenital heart disease: a pilot study. Heart Lung. 2003;32:105–10.

    Article  Google Scholar 

  6. Kovacs AH, Saidi AS, Kuhl EA, Sears SF, Silversides C, Harrison JL, et al. Depression and anxiety in adult congenital heart disease: predictors and prevalence. Int J Cardiol. 2009;137:158–64.

    Article  Google Scholar 

  7. Horner T, Liberthson R, Jellinek MS. Psychosocial profile of adults with complex congenital heart disease. Mayo Clin Proc. 2000;75:31–6.

    Article  CAS  Google Scholar 

  8. •• Westhoff-Bleck M, Briest J, Fraccarollo D, Hilfiker-Kleiner D, Winter L, Maske U, et al. Mental disorders in adults with congenital heart disease: unmet needs and impact on quality of life. J Affect Disord. 2016;204:180–6. This study demonstrated that mood and anxiety disorders are under-identified and under-treated in the ACHD setting.

    Article  Google Scholar 

  9. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Fifth ed. Arlington: American Psychiatric Association; 2013.

    Book  Google Scholar 

  10. Raskin JD, Gayle MC. DSM-5: do psychologists really want an alternative? J Humanist Psychol. 2016;56:439–56.

    Article  Google Scholar 

  11. Kasmi L, Calderon J, Montreuil M, Geronikola N, Lambert V, Belli E, et al. Neurocognitive and psychological outcomes in adults with dextro-transposition of the great arteries corrected by the arterial switch operation. Ann Thorac Surg. 2018;105:830–6.

    Article  Google Scholar 

  12. Opic P, Roos-Hesselink JW, Cuypers JA, Witsenburg M, van den Bosch A, van Domburg RT, et al. Longitudinal development of psychopathology and subjective health status in CHD adults: a 30- to 43-year follow-up in a unique cohort. Cardiol Young. 2016;26:547–55.

    Article  Google Scholar 

  13. • Gleason LP, Deng LX, Khan AM, Drajpuch D, Fuller S, Ludmir J, et al. Psychological distress in adults with congenital heart disease: focus beyond depression. Cardiol Young. 2019;29:185–9. In this study, elevated symptoms of anxiety were found to be more common than elevated symptoms of depression, although the combination was associated with poorer quality of life.

    Article  Google Scholar 

  14. Eifert GH, Thompson RN, Zvolensky MJ, Edwards K, Frazer NL, Haddad JW, et al. The cardiac anxiety questionnaire: development and preliminary validity. Behav Res Ther. 2000;38:1039–53.

    Article  CAS  Google Scholar 

  15. Ferguson M, Kovacs AH. An integrated adult congenital heart disease psychology service. Congenit Heart Dis. 2016;11:444–51.

    Article  Google Scholar 

  16. • Jackson JL, Hassen L, Gerardo GM, Vannatta K, Daniels CJ. Medical factors that predict quality of life for young adults with congenital heart disease: what matters most? Int J Cardiol. 2016;202:804–9. These researchers observed that poorer NYHA functional class, and not lesion severity, negatively impacted emotional quality of life.

    Article  Google Scholar 

  17. Moons P, Kovacs AH, Luyckx K, Thomet C, Budts W, Enomoto J, et al. Patient-reported outcomes in adults with congenital heart disease: Inter-country variation, standard of living and healthcare system factors. Int J Cardiol. 2018;251:34–41.

    Article  Google Scholar 

  18. Callus E, Utens EM, Quadri E, Ricci C, Carminati M, Giamberti A, et al. The impact of actual and perceived disease severity on pre-operative psychological well-being and illness behaviour in adult congenital heart disease patients. Cardiol Young. 2014;24:275–82.

    Article  Google Scholar 

  19. Kovacs AH, Utens EM. More than just the heart: transition and psychosocial issues in adult congenital heart disease. Cardiol Clin. 2015;33:625–34.

    Article  Google Scholar 

  20. Ong L, Nolan RP, Irvine J, Kovacs AH. Parental overprotection and heart-focused anxiety in adults with congenital heart disease. Int J Behav Med. 2011;18:260–7.

    Article  Google Scholar 

  21. Kim MY, Johnson JL, Sawatzky R. Relationship between types of social support, coping strategies, and psychological distress in individuals living with congenital heart disease. J Cardiovasc Nurs. 2019;34:76–84.

    Article  Google Scholar 

  22. Apers S, Kovacs AH, Luyckx K, Thomet C, Budts W, Enomoto J, et al. Consortium A-I and Isachd. Quality of life of adults with congenital heart disease in 15 countries: evaluating country-specific characteristics. J Am Coll Cardiol. 2016;67:2237–45.

    Article  Google Scholar 

  23. Lichtman JH, Bigger JT Jr, Blumenthal JA, Frasure-Smith N, Kaufmann PG, Lesperance F, et al. Depression and coronary heart disease. Recommendations for screening, referral, and treatment. A science advisory from the American Heart Association Prevention Committee to the Council on Cardiovascular Nursing, Council on Clinical Cardiology, Council on Epidemiology and Prevention, and Interdisciplinary Council on Quality of Care Outcomes Research. Endorsed by the American Psychiatric Association. Prog Cardiovasc Nurs. 2009;24:19–26.

    Article  Google Scholar 

  24. Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA, et al. ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American college of cardiology/American heart association task force on practice guidelines (writing committee to develop guidelines on the management of adults with congenital heart disease) developed in collaboration with the american society of echocardiography, heart rhythm society, international society for adult congenital heart disease, society for cardiovascular angiography and interventions, and society of thoracic surgeons. J Am Coll Cardiol. 2008;52:e143–263.

    Article  Google Scholar 

  25. Jha MK, Qamar A, Vaduganathan M, Charney DS, Murrough JW. Screening and Management of Depression in patients with cardiovascular disease: JACC state-of-the-art review. J Am Coll Cardiol. 2019;73:1827–45.

    Article  Google Scholar 

  26. Roseman M, Saadat N, Riehm KE, Kloda LA, Boruff J, Ickowicz A, et al. Depression screening and health outcomes in children and adolescents: a systematic review. Can J Psychiatr. 2017;62:813–7.

    Article  Google Scholar 

  27. Thombs BD, Saadat N, Riehm KE, Karter JM, Vaswani A, Andrews BK, et al. Consistency and sources of divergence in recommendations on screening with questionnaires for presently experienced health problems or symptoms: a comparison of recommendations from the Canadian Task Force on Preventive Health Care, UK National Screening Committee, and US Preventive Services Task Force. BMC Med. 2017;15:150.

    Article  Google Scholar 

  28. Thombs BD, Ziegelstein RC. Primary care doctors should not screen their patients for depression. Expert Rev Neurother. 2017;17:645–7.

    Article  CAS  Google Scholar 

  29. Kovacs AH, Sears SF, Saidi AS. Biopsychosocial experiences of adults with congenital heart disease: review of the literature. Am Heart J. 2005;150:193–201.

    Article  Google Scholar 

  30. Stout KK, Daniels CJ, Aboulhosn JA, Bozkurt B, Broberg CS, Colman JM, et al. 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;139:e698–800.

    PubMed  Google Scholar 

  31. Kovacs AH, Bendell KL, Colman J, Harrison JL, Oechslin E, Silversides C. Adults with congenital heart disease: psychological needs and treatment preferences. Congenit Heart Dis. 2009;4:139–46.

    Article  Google Scholar 

  32. Callus E, Pravettoni G. The role of clinical psychology and peer to peer support in the management of chronic medical conditions–a practical example with adults with congenital heart disease. Front Psychol. 2018;9:731.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Boston Children’s Hospital, Boston, MA, USA

    Alexandra Roseman

  2. Knight Cardiovascular Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, UHN-62, Portland, OR, 97239, USA

    Adrienne H. Kovacs

Authors
  1. Alexandra Roseman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Adrienne H. Kovacs
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Adrienne H. Kovacs.

Ethics declarations

Conflict of Interest

Alexandra Roseman and Adrienne H. Kovacs declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Congenital Heart Disease

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Roseman, A., Kovacs, A.H. Anxiety and Depression in Adults with Congenital Heart Disease: When to Suspect and How to Refer. Curr Cardiol Rep 21, 145 (2019). https://doi.org/10.1007/s11886-019-1237-2

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11886-019-1237-2

Keywords

Search

Navigation