Depression in adults with congenital heart disease-public health challenge in a rapidly expanding new patient population

Table 2 Risk factors for depression in congenital heart disease and theoretical model

Disease model	Risk factor in congenital heart disease patients
Psychoanalytical model (Freud S)	Psychological trauma in oral phase)due to illness, hospitalizations and separation from parents.
Attachment theory (Bowlby)	Separation from parents. Parent’s subcon-scious fear of bonding with a sick child that may not live long?
Biological model: Neurotransmitter imbalance	High stress during a vulnerable phase of development permanently alters physiol-ogical stress response.
Biological model: Brain organic cause	Cerebral insults secondary to heart disease and open-heart surgery.
Learning theory	“Learned helplessness” due to chain of adverse life-events, perceived or real lack of control during illness and hospitalizations, and socio-economic disadvantages.