Mental Health Disorders in Children With Congenital Heart Disease

Abstract

BACKGROUND: Data on anxiety, depression, and attention-deficit/hyperactivity disorder (ADHD) are lacking for youth with congenital heart disease (CHD), particularly those with simple CHD. This study aims to characterize these disorders in youth with CHD compared to those without CHD. METHODS: A comparative cross-sectional study was conducted by using the electronic medical records of a large tertiary care hospital between 2011 and 2016. Inclusion criteria were youth aged 4 to 17 years with >1 hospitalization or emergency department visits. Exclusion criteria were patients with arrhythmias or treatment with clonidine and/or benzodiazepines. The primary predictor variable was CHD type: simple, complex nonsingle ventricle, and complex single ventricle. The primary outcome variable was a diagnosis and/or medication for anxiety and/or depression or ADHD. Data were analyzed by using logistic regression (Stata v15; Stata Corp, College Station, TX). RESULTS: We identified 118 785 patients, 1164 with CHD. Overall, 18.2% (n = 212) of patients with CHD had a diagnosis or medication for anxiety or depression, compared with 5.2% (n = 6088) of those without CHD. All youth with CHD had significantly higher odds of anxiety and/or depression or ADHD. Children aged 4 to 9 years with simple CHD had ∼5 times higher odds (odds ratio: 5.23; 95% confidence interval: 3.87–7.07) and those with complex single ventricle CHD had ∼7 times higher odds (odds ratio: 7.46; 95% confidence interval: 3.70–15.07) of diagnosis or treatment for anxiety and/or depression. Minority and uninsured youth were significantly less likely to be diagnosed or treated for anxiety and/or depression or ADHD, regardless of disease severity. CONCLUSIONS: Youth with CHD of all severities have significantly higher odds of anxiety and/or depression and ADHD compared to those without CHD. Screening for these conditions should be considered in all patients with CHD.

Specific patterns of executive functioning weaknesses among children after heart transplant

“…Given this population's global EF difficulties, it is thus unsurprising that diagnoses of attention‐deficit/hyperactivity disorder (ADHD) are clinically prevalent within this population 28,49–51 . While ADHD and EF are not synonymous, they are certainly linked.…”

“…Such weaknesses are associated with poor adherence to medical regimens, which is of utmost importance to ensure long‐term survival and graft success 22–24 . These risks are further compounded by findings that children with histories of HT are more at risk of depression and anxiety than healthy controls 25–28 . More specifically, recent research revealed that 27.7% of children with histories of HT met criteria for depression or anxiety, which is in contrast to the prevalence among the general youth population (approximately 7%) 25 .…”

Boosting exposure and response prevention with imagery-based techniques: a case study tackling sexual obsessions in an adolescent

“…Key family factors and life events throughout Tom's upbringing, particularly key bereavements (predisposing factors), might have enhanced Tom's perception that 'bad things will happen'. Tom's heart problems as a child (including frequent hospital visits and family stress) appeared to have contributed to his vulnerabilities to anxiety (DeMaso et al, 2017;Gonzalez et al, 2021), as exemplified by some of his earlier 'OCD-like' rituals. Additionally, the homophobic culture in the UK (for example, the use of 'gay' as an insult) may have reinforced the idea that sexual obsessions are 'unacceptable' when adolescents seek to 'fit in'.…”

Optimising neurodevelopmental and psychosocial outcomes for survivors with CHD: a research agenda for the next decade

“…11 Meanwhile, important neurodevelopmental and psychosocial impairments in these surviving patients have become evident. [12][13][14][15] These morbidities negatively impact functional outcomes and health-related quality of life for children with CHD and complicate or delay the transition to independent adulthood. [16][17][18] Risk for neurodevelopmental and psychosocial impairments is influenced by a complex interplay among genetic, foetal, surgical, perioperative, family, and social factors, 19 requiring a multi-pronged approach to neuroprotection and intervention to mitigate impairments and maximise outcomes.…”