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

Abstract

There is a growing population of adults with congenital heart disease (CHD) due to improved survival beyond childhood. It has been suggested that adults with CHD may be at increased risk for mental health problems, particularly depression. The reported incidence of depression in CHD varies from 9% to 30%. This review examines the evidence for a higher depression rate in CHD vs general population. Possible explanations are offered from a variety of disease models, ranging from brain injury to the psychoanalytical approach. Risk factors for an abnormal emotional adjustment and depression include early exposure to stress from illness and medical interventions in infancy, separation from the parents during hospitalizations and brain organic syndromes. Later in life, patients often have to cope with physical limitations. Recent improvements in care may be protective. Current patients may benefit from an earlier age at first surgical intervention, fewer reoperations and inclusion to the mainstream schooling, among other factors. At this point, there is little systematic knowledge about evidence-based therapeutic interventions for depression in adults with CHD. Health care providers of patients with CHD should be aware of mental health challenges and may take a more proactive approach to identifying patients at risk for depression.

Keywords: Congenital heart disease, Cardiopulmonary bypass, Depression, Outcomes research

Core tip: More and more adults with congenital heart disease (CHD) survive to adulthood. Having survived grave illness in infancy, these patients appear to be at increased risk for mental health problems as adults. This review specifically examines the relationship of CHD and depression. Risk factors and protective strategies are explored. There still is little knowledge on specific treatment for depression in the growing patient population of adults with CHD. When health care providers are aware of depression in adults with CHD this may improve access to appropriate care.