Nearly one third of adults with congenital heart disease (CHD) report higher rates of depression or anxiety, which is associated with a lower quality of life (QOL) and health status (HS), as shown in a new global substudy of the APPROACH-IS trial. Adrienne H. Kovacs, PhD, of Equilibria Psychological Health, Toronto, and colleagues reported these data in a manuscript published Monday online in the Jan. 23 issue of the Journal of the American College of Cardiology. Psychological function is an important factor in the management of adult CHD. Depression has been studied significantly in the field of heart disease, but anxiety warrants more attention. The APPROACH-IS (Assessment of Patterns of Patient-Reported Outcomes in Adults With Congenital Heart Disease-International Study) was a multicenter, international study examining patient-reported outcomes (PROs) in patients with CHD, including psychological distress outcomes. The investigators in this substudy evaluated the occurrence of elevated symptoms of depression and anxiety, the sociodemographic and medical factors that may contribute to psychological distress, and how QOL and HS were impacted by the degrees of varying psychological symptoms. The Hospital Anxiety and Depression Scale (HADS) was used to evaluate anxiety and depression scores. If someone scored above 8 on the anxiety or depression subscales, or both, they were considered to have clinically elevated symptoms, which were then classified as mild, moderate or severe. For QOL and HS, analog scales were completed on a scale of 0 to 100. QOL and HS were further examined for differences by symptom category using an analysis of variance. A total of 3,815 participants were included in this study (15 countries; mean age=34.8±12.9 years, 52.7% female; 73.8% white, 20.0% Asian), and 30.1% of the patients reported elevated symptoms on one or both subscales of the HADS (HADS-anxiety only=18.3%; HADS-depression only=2.9%; both subscales=8.9%). These percentages varied between countries as well. QOL and HS decreased as the subscale symptom categories increase (p<0.001). The primary limitation of this study was selection bias because all patients could complete the surveys and remain in contact with the CHD health care system. Additionally, PROs were used to determine anxiety and depression symptoms and cannot be used in place of psychiatric diagnosis. Overall, about one third of patients with CHD experience heightened symptoms of depression and/or depression, and in turn have worsening QOL and HS. “We strongly advocate for the implementation of strategies to recognize and manage psychological distress in clinical settings,” the authors concluded. In an accompanying editorial, Anne M. Valente, MD, of Boston Children’s Hospital, and Fernando Baraona Reyes, MD, of Brigham and Women’s Hospital, Boston, wrote about the impact of CHD on psychological well-being and potential clinical impacts of studies examining anxiety and depression in this patient population. The editorialists had some concerns about implementing mental health protocols. “Although providers may attempt to destigmatize conversations about mental health, cultural background or previous experience may limit a patient’s comfort level with sharing,” they wrote. “Although asking about mental health in clinical encounters may seem obvious, we recognize that even accredited ACHD [adults with congenital heart disease] centers often do not have dedicated resources for mental health therapy.” The editorialists concluded by noting that clinical centers have the opportunity to add mental health professionals to care management teams and raise awareness about the issue-at-hand. “This recognition will aid in making appropriate treatment recommendations, thus creating a culture of psychologically safe, informed care,” they wrote. Sources: Kovacs AH, Luyckx K, Thomet C, et al. Anxiety and Depression in Adults With Congenital Heart Disease. J Am Coll Cardiol. 2023;83:430-441. Valente AM, Reyes FB. Addressing Psychologic Distress in Adults With Congenital Heart Disease: Replacing Anxiety With Hope. J Am Coll Cardiol. 2023;83:442-443. Image Credit: Charlie's – stock.adobe.com