Outcomes of Congenital Heart Disease: A Review

Angela Green


Pediatr Nurs. 2004;30(4) 

In This Article

Behavioral and Psychiatric Outcomes

In a European study that assessed long-term problem behaviors using standardized tools, higher problem scores in 10-15-year-olds were associated with a greater number of cardiac surgical procedures, deep hypothermic circulatory arrest, prematurity, low systemic oxygen saturation, and older age at surgical repair (Utens, Verhulst, et al., 1998). Turkish researchers identified low socioeconomic status, low parent education, greater number of children in the family, worsening of hemodynamic status, and severity of hemodynamic status as predictors of problem behaviors including withdrawn and aggressive behaviors, somatic complaints, and anxiety/depression (Yildiz, Savaser, & Tatlioglu, 2001). Both of these studies, however, lacked comparison groups. An older study compared problem behaviors in children with complex CHD and those with innocent murmurs. Children with complex CHD were more withdrawn, experienced more social problems, and engaged in fewer activities (Casey, Sykes, Craig, Power, & Mulholland, 1996).

Psychopathology is not uncommon in adolescents and adults with CHD. However, the reported incidence varies from study to study. In a 1995 study, Bjornstad, Spurkland, and Lindberg reported that 46% of Norwegian adolescents with severe CHD met the Diagnostic and Statistical Manual criteria for psychiatric diagnoses including anxiety disorders, major depression, attention deficit disorders, and conduct disorders. Over 30% of the group was described as having severe dysfunction (Bjornstad, Spurkland, & Lindberg, 1995).

In adults with CHD, the incidence of depression and anxiety disorders has been reported to be around 30%-40% (Horner et al., 2000; Popelova, Slavik, & Skovranke, 2001). Depression has been strongly associated with increased age, unemployment, and poorer functional status as determined by the New York Heart Association Classification (Popelova et al., 2001).

A Dutch study found that young adults with CHD were more likely to have abnormal scores on a standardized instrument for psychopathology than normal peers, with particularly abnormal scores in males aged 22 to 25 (Utens, Bieman, et al., 1998). British researchers, however, examined the incidence of anxiety and depression in a heterogeneous group of adults with CHD and reported that the incidence of 36% was significantly lower than that found in adults attending an orthopedic clinic at the same institution (Cox, Lewis, Stuart, & Murphy, 2002).


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