Depression in adults with congenital heart disease-public health challenge in a rapidly expanding new patient population

Table 1 Selected quality of life indicators in adult congenital heart disease

Study	n	Exercise tolerance1	Health Self-assessment	Unemployed	Site
Nieminen et al[27]	2896	97% good	77% good	Not increased	Finland
Crossland et al[28]	299	N/A	N/A	33%, increased	United Kingdom
Lane et al[29]	276	Diminished	Diminished	Increased	United Kingdom
Moons et al[30]	629	95% < class 3	Good	6.7%	Belgium
Jefferies et al[31]	32	Diminished	Diminished	47%, increased	KY, United States
Kamphuis et al[32]	156	N/A	N/A	36%, increased	Holland

¹New York Heart Association Classification. N/A: Not assessed.

Table 2 Risk factors for depression in congenital heart disease and theoretical model

Disease model	Risk factor in congenital heart disease patients
Psychoanalytical model (Freud S)	Psychological trauma in oral phase)due to illness, hospitalizations and separation from parents.
Attachment theory (Bowlby)	Separation from parents. Parent’s subcon-scious fear of bonding with a sick child that may not live long?
Biological model: Neurotransmitter imbalance	High stress during a vulnerable phase of development permanently alters physiol-ogical stress response.
Biological model: Brain organic cause	Cerebral insults secondary to heart disease and open-heart surgery.
Learning theory	“Learned helplessness” due to chain of adverse life-events, perceived or real lack of control during illness and hospitalizations, and socio-economic disadvantages.

Table 3 Improvements in the treatment of children with congenital heart disease

Previously	In the current era
Difficult diagnosis-invasive testing	Noninvasive diagnosis by ultrasound
Presentation in critical condition	Earlier diagnosis, newborn intensive care
Emergency surgery or interventions	Emergency treatment rare
Long hospitalizations for weight gain	Neonatal surgery and short hospital stays
Limited visiting hours for parents	Parents involved in hospital care
Medical focus	Child life teams and psycho-social support
High surgical mortality and morbidity	Improved surgical mortality and morbidity
Admissions for infections	New immunization, improved antimicrobial treatment
Re-operation	More catheter interventions, shorter admissions
Limited rehabilitation options	Early intervention programs
Special education placement	Integration in the main-stream
Limited opportunities for peer support	Self-help groups, internet resources