Relationships among depression, anxiety and suicidal ideation in parents of children with congenital heart defects: A dynamic triad

Table 1 Sociodemographic characteristics of the parents of the subjects and controls, n (%)

Variable	Child with heart defect (n = 50)	No defect (n = 50)	χ2	P value
Age of child in years
mean ± SD	5.0 ± 5.4	6.8 ± 6.2	1.5231	0.131
Median	3.0	4.5
Age of child in groups
< 1 year	13 (26.0)	6 (12,0)	3.741	0.291
1-4 years	18 (36.0)	19 (38.0)
5-9 years	10 (20.0)	11 (22.0)
≥ 10 years	9 (18.0)	14 (28.0)
Age of father in years
mean ± SD	41.4 ± 7.0	47.4 ± 7.9	4.026	< 0.001
Age of father in groups
< 40 years	17 (34.0)	5 (12.0)	11.023	0.004
40-49 years	28 (56.0)	28 (56.0)
≥ 50 years	5 (10.0)	16 (32.0)
Age of mother in years
mean ± SD	32.6 ± 6.7	38.9 ± 8.7	4.012	< 0.001
Age of mother in years
< 30 years	14 (28.0)	4 (8.0)	20.159	< 0.001
30-39 years	33 (66.0)	25 (50.0)
≥ 40 years	3 (6.0)	21 (42.0)
Educational attainment of father
No formal education	2 (4.0)	0 (0.0)	4.2032	0.240
Primary education	4 (8.0)	8 (16.0)
Secondary education	15 (30.0)	15 (30.0)
Tertiary education	29 (58.0)	27 (54.0)
Educational attainment of mother
Primary education	6 (12.0)	2 (4.0)	2.275	0.321
Secondary education	16 (32.0)	19 (38.0)
Tertiary education	28 (56.0)	29 (58.0)
Socioeconomic status
Low socioeconomic class	9 (18.0)	5 (10.0)	1.604	0.449
Middle socioeconomic class	14 (28.0)	13 (26.0)
High socioeconomic class	27 (54.0)	32 (64.0)

¹Mann-Whitney U test.

²Likelihood ratio.

Table 2 Assessment of anxiety symptoms via the Hospital Anxiety and Depression Scale, mean ± SD

Variable	Child with heart defect (n = 50)	No defect (n = 50)	Mann-Whitney U	P value
I wake early and then sleep badly the rest of the night	1.8 ± 0.9	1.1 ± 1.1	3.611	< 0.001
I feel miserable and sad	1.2 ± 1.2	0.5 ± 0.9	3.374	0.001
I have lost interest in things	1.1 ± 1.0	0.3 ± 0.7	4.124	< 0.001
I have good appetite	1.0 ± 0.9	0.3 ± 0.7	3.927	< 0.001
I feel life is not worth living	0.8 ± 1.0	0.3 ± 0.8	2.672	0.009
I am restless and can’t keep still	0.7 ± 0.9	0.7 ± 1.0	0.411	0.682
I feel as if I have slowed down	1.6 ± 1.2	0.8 ± 1.0	3.582	0.001
Anxiety symptoms (total score)	8.2 ± 4.8	4.1 ± 4.0	4.555	< 0.001

Table 3 Assessment of depressive symptoms via the Hospital Anxiety and Depression Scale, mean ± SD

Variable	Child with heart defect (n = 50)	No defect (n = 50)	Mann-Whitney U	P value
I get very frightened	1.3 ± 1.2	0.6 ± 1.0	3.102	0.002
I feel anxious when I get out of the house	0.8 ± 0.9	0.5 ± 0.9	1.703	0.092
I get palpitations	1.4 ± 1.1	1.0 ± 1.1	1.912	0.059
I feel scared or frightened	1.2 ± 1.1	0.5 ± 1.0	3.481	< 0.001
I still enjoy the things I used to	1.0 ± 0.9	0.5 ± 1.0	2.526	0.013
I am more irritable than usual	1.2 ± 1.2	0.8 ± 1.1	1.750	0.083
Worrying thoughts constantly go through my mind	2.0 ± 1.0	1.2 ± 1.2	3.309	0.001
Depressive symptoms (total score)	8.9 ± 5.1	5.1 ± 4.9	3.763	< 0.001

Table 4 Prevalence of anxiety and depressive symptoms, n (%)

Variable	Child with heart defect (n = 50)	No defect (n = 50)	χ2	P value
Prevalence of anxiety symptoms
Normal	25 (50.0)	38 (76.0)	8.873	0.031
Mild depression	13 (26.0)	8 (16.0)
Moderate depression	5 (10.0)	3 (6.0)
Severe depression	7 (14.0)	1 (2.0)
Anxiety symptoms
Yes	25 (50.0)	12 (24.0)	7.250	0.007
No	25 (50.0)	38 (76.0)
Prevalence of depressive symptoms
No symptom	24 (48.0)	37 (74.0)	9.517	0.036
Mild depression	8 (16.0)	5 (10.0)
Moderate depression	9 (18.0)	6 (12.0)
Severe depression	9 (18.0)	2 (4.0)
Depressive symptoms
Yes	26 (52.0)	13 (26.0)	7.104	0.008
No	24 (40.0)	37 (74.0)

Table 5 Assessment of suicidal ideation severity risk via the Columbia Suicide Severity Rating Scale, n (%)/mean ± SD

Variable	Intervention group (n = 50)	Control group (n = 50)	Mann-Whitney U	P value
Have wished oneself dead or sleep and not wake up	0.24 ± 0.43	0.06 ± 0.24	2.578	0.012
Have actually has thoughts of killing oneself	0.24 ± 0.43	0.04 ± 0.20	2.979	0.004
Have had thoughts about how one might do this	0.20 ± 0.40	0.02 ± 0.14	2.973	0.004
Have had these thoughts and the intention of acting them	0.18 ± 0.39	0.0 ± 0.0	3.280	0.002
Have started to work out or worked out details of how to kill oneself	0.08 ± 0.27	0.0 ± 0.0	2.064	0.044
Have ever done anything or started to do anything to end one’s life	0.08 ± 0.27	0.02 ± 0.14	1.376	0.173
Columbia Suicide Severity Rating Scale (total score)	1.02 ± 1.93	0.14 ± 0.53	3.103	0.003
Columbia Suicide Severity Rating Scale
No risk	36 (72.0)	46 (92.0)	15.5912	0.001
Low risk	5 (10.0)	3 (6.0)
Moderate risk	0 (0.0)	1 (2.0)
High risk	9 (18.0)	0 (0.0)
Columbia Suicide Severity Rating Scale (categorized)
Risk	14 (28.0)	4 (8.0)	6.7751	0.009
No risk	36 (72.0)	46 (92.0)

¹χ² test.

²Likelihood ratio.

Table 6 Factors associated with suicidal ideation severity risk among parents with heart defects, n (%)

Variable	Suicidal ideation severity risk (n = 50)		P value1	aOR (95%CI)
	Yes	No
Age of child in years
< 5 years	10 (32.3)	21 (67.7)	0.392	N/A
≥ 5 years	4 (21.1)	15 (78.9)
Age of father in years
< 45 years	8 (24.2)	25 (75.8)	0.410	N/A
≥ 45 years	6 (35.3)	11 (64.7)
Age of mother in years
< 35 years	10 (37.0)	17 (63.0)	0.123	0.9 (0.8-1.1)
≥ 35 years	4 (17.4)	19 (82.6)
Educational attainment of father
Primary education and less	9 (31.0)	20 (69.0)	0.574	N/A
Secondary education and more	5 (23.8)	16 (76.2)
Educational attainment of mother
Primary education and less	8 (28.6)	20 (71.4)	0.919	N/A
Secondary education and more	6 (27.3)	16 (72.7)
Socioeconomic status
Low socioeconomic class	7 (30.4)	16 (69.6)	0.723	N/A
High socioeconomic class	7 (25.9)	20 (74.1)
Anxiety symptoms
Yes	12 (48.0)	13 (52.0)	0.002	7.5 (1.4-41.6)
No	2 (8.0)	23 (92.0)
Depressive symptoms
Yes	11 (42.3)	15 (57.7)	0.019	2.7 (0.6-13.5)
No	3 (12.5)	21 (87.5)

¹P value from bivariate analysis.

N/A: Not applicable; aOR: Adjusted odds ratio; CI: Confidence interval.

Table 7 Correlation matrix of variables for parents with heart defects

Variable	Correlation coefficient (r), P value (n = 50)
	Age of child	Total anxiety score	Total depression score	Total suicidal ideation score
Age of child	1
Total anxiety score	r = -0.062, P = 0.667	1
Total depression score	r = 0.008, P = 0.957	r = 0.754, P < 0.001	1
Total suicidal ideation score	r = -0.105, P = 0.466	r = 0.748, P < 0.001	r = 0.617, P < 0.001	1