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.

Brain abnormalities in cognition, anxiety, and depression regulatory regions in adolescents with single ventricle heart disease

“…Depression and anxiety symptoms are commonly seen in over 50% of adolescents and adults with SVHD (Bromberg et al, ; Cohen et al, ). Unfortunately, most SVHD patients go underdiagnosed and undertreated (Pauliks ). In our study, multiple brain areas, including the cingulate, insula, cerebellum, and para‐hippocampal gyrus showed tissue injury.…”

Risk of Dementia in Adults With Congenital Heart Disease

“…Our findings extend the knowledge of long-term neurological impairment and mental health functional morbidities in the population with CHD. Although previous studies have reported elevated risks of adverse neurodevelopmental outcomes among individuals with CHD, including increased occurrence of depression, autism, and epilepsy compared with the general population, [6][7][8]19,[32][33][34][35] our study examined an older adult population to determine the later-life consequences of this neurological outcome. Although the underlying pathophysiological mechanisms are not completely understood, the potential etiologic factors appear multifactorial and consistent with previous findings within the neurodevelopmental scientific literature.…”

Efficiency of the home cardiac rehabilitation program for adults with complex congenital heart disease

“…Many abnormalities in complex congenital heart disease such as ventricular dysfunction, pulmonary hypertension, and muscle weakness have contributed to an impairment of physical fitness. Exercise intolerance in ACHD has also led to a poor quality of life . Therefore, improving exercise capacity is important in the care of patients with ACHD.…”

“…Exercise intolerance in ACHD has also led to a poor quality of life. 2,3 Therefore, improving exercise capacity is important in the care of patients with ACHD.…”