Enhancing mental health in adults with congenital heart disease: comparison of depression and anxiety screening tools

OBJECTIVES

Individuals with congenital heart disease (CHD) face daily life limitations, increasing the risk of anxiety and depression. Diagnosing these disorders in adults with CHD (ACHD) remains challenging in the clinical routine, because physical symptoms can be misattributed to a patient's physical condition. Several screening instruments are available, and studies revealed that they can be used to diagnose varying numbers of people with clinically relevant symptoms. Therefore, we compared frequently used screening tools for depression and anxiety in ACHD in Germany.

METHODS

Participants were recruited from the German National Register for Congenital Heart Defects. A total of 1486 patients aged 18 to 85 (Mage = 36.84; 60.8% female) were classified as simple, moderate or complex CHD. Self-reported measures of depression [Hospital Anxiety and Depression Scale (HADS-D); Patient Health Questionnaire-9 (PHQ-9)], anxiety [Hospital Anxiety and Depression Scale (HADS-A); Generalized Anxiety Disorder-7 (GAD-7)], psychotherapy utilization, secondary illnesses and sociodemographic characteristics, were recorded.

RESULTS

The PHQ-9 recorded about 39% more patients with depressive symptoms compared to the HADS-D. The GAD-7 detected approximately 15% more patients with anxiety symptoms in comparison to the HADS-A. PHQ-9 and GAD-7 demonstrated higher sensitivity (89.6%/86.8%) but lower specificity (48.1%/53.5%) compared to the HADS-D/HADS-A (sensitivity: 56.3%/78.0%; specificity: 87.8%/67.2%). No significant differences were found between the CHD severity levels.

CONCLUSIONS

The screening tools we compared were used to diagnose a significantly different number of patients with depression or anxiety in ACHD. Because even mild symptoms have a significant impact on quality of life, using PHQ-9 and GAD-7 in clinical practice is recommended to minimize false negatives and ensure mental health in ACHD.