Psychiatric morbidity in adults with congenital heart disease: Rare disease or frequent problem?

In adult congenital heart disease (ACHD) evaluation with self-rating scales suggest a prevalence of depression and anxiety disorders comparable with the general population.

Methods: In a cross-sectional study mental health professionals performed a Structured Clinical Interview for DSM-IV. Results were compared with Beck Depression Inventory-2 (BDI-2) and Hospital Anxiety and Depression Scale (HADS).

Results: 120 patients (53 women, mean age 35.5±12.9 years) were included. 48.3% (N=58) had psychiatric disorders (axis I): major depression (22.5%; N=27), general anxiety disorder (12.5%; N=15) and chronic persistant depression (12.5%; N=15). This is significantly higher compared to the general population (4.2% depression; 6.4% anxiety disorder). Both, HADS and BDI-2 were highly specific but not sensitive: HADS≥11: Depression: Sensitivity (S) 0,166. Specificity (SP) 0,97; Anxiety disorder: S=0.197, SP=0,99. BDI-2≥20: Depression S=0.398, SP=0,99. Post evaluation specific psychiatric therapy increased significantly (12,3% vs. 40.8%; p<0.0001).

Conclusions: In ACHD depression and anxiety disorders are frequently present,but rarely diagnosed resulting in undertreatment of mood disorders. Self-rating instruments as HADS and BDI-2 are not adequate for psychological evaluation. We recommend routine mental health professionals assessment for psychiatric disorders in ACHD patients.