Comorbidity as a mediator of depression in adults with congenital heart disease: A population-based cohort study

Abstract

Background The population of adults with congenital heart disease (CHD) has increased dramatically with a high prevalence of acquired cardiac and non-cardiac comorbidities. However, the relationship among congenital heart disease, physical comorbidities, and psychological health in this population is not well studied. Aims The purpose of this study was to investigate (a) the association between adult congenital heart disease and the occurrence of depression and (b) whether physical comorbidities mediated the association between congenital heart disease and the occurrence of depression. Methods This retrospective cohort study was followed from 1 January 2010–31 December 2013, based on the data from the National Health Insurance Research Database 2010 in Taiwan. We used mediation analysis in survival data to assess the mediated effect. The hazard ratios were adjusted by age, sex, area of residence, and estimated propensity scores. Results We recruited 2122 adult congenital heart disease patients and 8488 matched controls. Nearly half of patients diagnosed with simple congenital heart disease, 39.0% had complex congenital heart disease, and 11.2% had unclassified congenital heart disease. Adult congenital heart disease patients had a significantly higher risk of depression than matched controls (adjusted hazard ratio = 1.43 and 1.48, for all and complex congenital heart disease, respectively, p<0.05). Coronary artery disease and chronic obstructive pulmonary disease were the significant comorbidities mediating the relationship between adult congenital heart disease and depression, the proportions mediated by coronary artery disease or chronic obstructive pulmonary disease were 35.5% and 12.9%, respectively. Conclusions Helping patients to prevent psychological and physical acquired disease is imperative. Coronary artery disease is a potent mediator between congenital heart disease and depression, especially for patients with complex congenital heart disease.

Lifetime risk of comorbidity in patients with simple congenital heart disease: a Danish nationwide study

“…Previous studies comparing patients with CHD of all severities, including simple CHD, to controls found similar tendencies of patients with CHD having a higher prevalence of comorbidities compared with non-CHD controls. 15 , 24 , 25 In contrast to our findings, one study found that patients with CHD had a higher prevalence of neoplasms compared with controls in a 18- to 64-year-old cohort. 15 The difference may be due to their inclusion of severe CHD, as repeated radiation from chest X-rays, computed tomography scans, and procedures with catheterizations, often required in patients with severe CHD, is associated with a higher risk of neoplasms.…”

Heart Failure and Patient‐Reported Outcomes in Adults With Congenital Heart Disease from 15 Countries

“… 15 In a recent population‐based study, adults with CHD had a significantly higher risk of depression than matched controls (adjusted hazard ratio, 1.43), with coronary artery disease and chronic obstructive pulmonary disease identified as significant comorbidities mediating the relationship between adult CHD and depression. 16 Depressive symptomatology was also independently impacted by the presence of HF in the current study. Therefore, the interaction between mood disorders and HF in adults with CHD may be multifactorial and involve similar mechanisms invoked in those with HF attributable to acquired heart disease.…”

Significantly increased risk of chronic obstructive pulmonary disease amongst adults with predominantly mild congenital heart disease

“…Bracher et al studied comorbidities in a cohort of 1725 CHD cases from a single centre, reporting a 6.7% prevalence of either obstructive or restrictive lung disease, which was not further subclassified 16 . Yang et al carried out a case–control comparison of comorbidities in 2122 CHD patients and 8488 controls to determine mediators of any relationship between CHD and depression 6 . This study, alone among previous investigations, did find an increased relative risk of COPD in CHD cases (OR 2.08, 95% CI 1.75, 2.47), but the database utilised did not contain smoking data, so no adjustment for the main COPD risk factor could be made.…”

“…Such work has identified comorbid diseases that are more prevalent among adults with CHD, including various forms of cardiovascular disease 4 and chronic renal disease 5 , 6 . Although recent studies have suggested that the burden of chronic obstructive pulmonary disease (COPD) amongst adults with CHD may be greater than previously thought 6 , 7 , no sizeable prospective study with the capacity to adjust for important environmental factors predisposing to COPD has yet been conducted.…”

“…Such work has identified comorbid diseases that are more prevalent among adults with CHD, including various forms of cardiovascular disease 4 and chronic renal disease 5 , 6 . Although recent studies have suggested that the burden of chronic obstructive pulmonary disease (COPD) amongst adults with CHD may be greater than previously thought 6 , 7 , no sizeable prospective study with the capacity to adjust for important environmental factors predisposing to COPD has yet been conducted. Moreover, although isolated bicuspid aortic valve (BAV) represents the commonest cardiovascular malformation, it is under-represented within the spectrum of congenital heart disease studies, and data on pulmonary comorbidity in BAV is lacking.…”