title: Anxiety, depressive and somatic symptoms in adults with congenital heart disease.
abstract: OBJECTIVE
  Despite the improvement in life-expectancy of adults with congenital heart disease, they may experience unique medical and social challenges that could impact on their psychological functioning. The aims of this study were to address the experience of anxiety, depressive and somatic symptoms among adults with congenital heart disease in comparison with that of non-heart diseased persons considering the role of various factors (e.g. socio-economic).
  
  
  METHODS
  In cross-sectional case-control study, the participants consisted of 347 patients with congenital heart disease (18-64 years, 52.2% female) and 353 matched (by sex/age) non-heart diseased persons. The participants completed a questionnaire. The data were analyzed with bivariate and multivariate methods.
  
  
  RESULTS
  In bivariate analyses, scores in anxiety and somatic symptoms were higher among patients than the healthy controls (both at p≤0.001), whereas the groups did not differ in depressive symptoms. Following multiple-linear-regression-analyses, only the association between congenital heart disease and somatic symptoms was confirmed. Among the patients, perceived financial strain was significantly related to anxiety, depressive and somatic symptoms; lower perceived social support to anxiety and depression; and low annual income to somatic symptoms. Additionally, somatic symptoms were associated with anxiety and depressive symptoms, and vice versa. And no medical variables were related to anxiety, depressive and somatic symptoms.
  
  
  CONCLUSIONS
  Congenital heart disease was only independently associated with somatic symptoms. Financial strain, social support and co-existence of emotional distress with somatic symptoms should be considered in developing appropriate interventions to improve the well-being of patients with congenital heart disease. However, longitudinal research is warranted to clarify causality.
authors.affiliation: Institution of Health Sciences, Department of Public Health Sciences, Mid Sweden University, Sundsvall, Sweden. Bahareh.eslami@miun.se
authors.forename: Bahareh
authors.initials: B
authors.lastname: Eslami
authors.forename: Orjan
authors.initials: O
authors.lastname: Sundin
authors.forename: Gloria
authors.initials: G
authors.lastname: Macassa
authors.forename: Hamid Reza
authors.initials: HR
authors.lastname: Khankeh
authors.forename: Joaquim J F
authors.initials: JJ
authors.lastname: Soares
mesh_terms: D000293:Adolescent; D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D016022:Case-Control Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D004522:Educational Status; D005191:Family Characteristics; D005260:Female; D015438:Health Behavior; D006330:Heart Defects, Congenital / Q000453:epidemiology* / Q000523:psychology*; D006801:Humans; D007492:Iran; D008297:Male; D008875:Middle Aged; D018582:Sick Leave; D012959:Socioeconomic Factors; D013001:Somatoform Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D011795:Surveys and Questionnaires; D055815:Young Adult