In the Journals

Mental illness odds elevated in congenital heart disease

Amber D. Khanna

Among adolescents and adults with congenital heart disease, mental illness is a significantly more prevalent comorbidity in those who experienced at least two cardiac procedures during a 3-year period or had greater lesion complexity than in others.

According to the study published in The American Journal of Cardiology, adolescents with congenital heart disease have a greater risk for being diagnosed with developmental disorders, anxiety disorders, attention, conduct, behavior, impulse control disorders and mood disorders; and adult experienced a higher prevalence of mood disorders, anxiety disorders and substance-related disorders.

“A wide spectrum of mental illnesses is highly prevalent in adults with congenital heart disease. It is important ask patients about symptoms and have an appropriate referral network in place so the patients can receive optimal, comprehensive care,” Amber D. Khanna, MD, MS, assistant professor of medicine in the departments of internal medicine and pediatrics, division of cardiology, University of Colorado Anschutz Medical Campus, told Cardiology Today. “[The] rates were higher than I anticipated given the methodology of the paper. By using diagnostic billing codes, we are still likely underestimating the true scope of the problem.”

Using the population-level Colorado heart defect surveillance system, researchers analyzed the data of 2,192 adolescents aged 11 to 17 years (42% girls), and 6,924 adults aged 18 to 64 years (53% women), with congenital heart disease between 2011 and 2013.

This study aimed to evaluate the incidence of mental illness in adolescent and adult patients with congenital heart disease as well as study the relationship between age, defect severity and mental illness and determine how preexisting genetic syndromes may be related mental illness prevalence.

Researchers found that 20% of the adolescent cohort were diagnosed with a form of mental illness, the most frequent including developmental disorders (8%), anxiety disorders (6%), attention, conduct, behavior, impulse control disorders (6%) and mood disorders (5%).

Of the adult cohort, 33% had some form of mental illness, most frequently mood disorders (13%), anxiety disorders (13%), and substance-related disorders (6%).

In both adolescents and adults with congenital heart disease, researchers found the following associations between the disease, treatment and mental illness:

  • Greater lesion complexity was linked to increased odds of anxiety and developmental disorders;
  • Receiving at least two cardiac procedures during the 3-year surveillance period lead to a threefold increase in the likelihood of mental illness diagnosis in adolescents and a 4.5-fold increase in adults; and
  • Patients with a genetic syndrome were also more likely to be diagnosed with a mental illness.

“Immediately, we can start screening patients for the most common forms of mental illness: anxiety and mood disorders. If they are not receiving mental health care, referrals can be made to those services,” Khanna said. “In the near future, we can advocate for improved access to these services. Some adult congenital heart disease centers have mental health professionals embedded in their clinics. This should be expanded to a larger population of patients. In the long run, I would love to see better understanding of the pathophysiology of the link between congenital heart disease and mental illness. By understanding that link, we can start to reduce the attributable burden of mental illness.”

For future research, Khanna said the researchers are interested in exploring differences between men and women with congenital heart disease and comorbid mental illnesses and greater focus on examining post-traumatic stress symptoms. – by Scott Buzby

For more information:

Amber D. Khanna, MD, MS, can be reached at 1500 Park Central Drive

Highlands Ranch, CO 80129; email: amber.khanna@cuanschutz.edu; Twitter: @DrAmberKhanna.

Disclosure: Khanna reports no relevant financial disclosures.

Amber D. Khanna

Among adolescents and adults with congenital heart disease, mental illness is a significantly more prevalent comorbidity in those who experienced at least two cardiac procedures during a 3-year period or had greater lesion complexity than in others.

According to the study published in The American Journal of Cardiology, adolescents with congenital heart disease have a greater risk for being diagnosed with developmental disorders, anxiety disorders, attention, conduct, behavior, impulse control disorders and mood disorders; and adult experienced a higher prevalence of mood disorders, anxiety disorders and substance-related disorders.

“A wide spectrum of mental illnesses is highly prevalent in adults with congenital heart disease. It is important ask patients about symptoms and have an appropriate referral network in place so the patients can receive optimal, comprehensive care,” Amber D. Khanna, MD, MS, assistant professor of medicine in the departments of internal medicine and pediatrics, division of cardiology, University of Colorado Anschutz Medical Campus, told Cardiology Today. “[The] rates were higher than I anticipated given the methodology of the paper. By using diagnostic billing codes, we are still likely underestimating the true scope of the problem.”

Using the population-level Colorado heart defect surveillance system, researchers analyzed the data of 2,192 adolescents aged 11 to 17 years (42% girls), and 6,924 adults aged 18 to 64 years (53% women), with congenital heart disease between 2011 and 2013.

This study aimed to evaluate the incidence of mental illness in adolescent and adult patients with congenital heart disease as well as study the relationship between age, defect severity and mental illness and determine how preexisting genetic syndromes may be related mental illness prevalence.

Researchers found that 20% of the adolescent cohort were diagnosed with a form of mental illness, the most frequent including developmental disorders (8%), anxiety disorders (6%), attention, conduct, behavior, impulse control disorders (6%) and mood disorders (5%).

Of the adult cohort, 33% had some form of mental illness, most frequently mood disorders (13%), anxiety disorders (13%), and substance-related disorders (6%).

In both adolescents and adults with congenital heart disease, researchers found the following associations between the disease, treatment and mental illness:

  • Greater lesion complexity was linked to increased odds of anxiety and developmental disorders;
  • Receiving at least two cardiac procedures during the 3-year surveillance period lead to a threefold increase in the likelihood of mental illness diagnosis in adolescents and a 4.5-fold increase in adults; and
  • Patients with a genetic syndrome were also more likely to be diagnosed with a mental illness.

“Immediately, we can start screening patients for the most common forms of mental illness: anxiety and mood disorders. If they are not receiving mental health care, referrals can be made to those services,” Khanna said. “In the near future, we can advocate for improved access to these services. Some adult congenital heart disease centers have mental health professionals embedded in their clinics. This should be expanded to a larger population of patients. In the long run, I would love to see better understanding of the pathophysiology of the link between congenital heart disease and mental illness. By understanding that link, we can start to reduce the attributable burden of mental illness.”

For future research, Khanna said the researchers are interested in exploring differences between men and women with congenital heart disease and comorbid mental illnesses and greater focus on examining post-traumatic stress symptoms. – by Scott Buzby

For more information:

Amber D. Khanna, MD, MS, can be reached at 1500 Park Central Drive

Highlands Ranch, CO 80129; email: amber.khanna@cuanschutz.edu; Twitter: @DrAmberKhanna.

Disclosure: Khanna reports no relevant financial disclosures.