title: Depressive Symptoms in Patients with Congenital Heart Disease: Incidence and Prognostic Value of Self-Rating Depression Scales.
abstract: OBJECTIVE
  To determine the presence of depressive symptoms in adolescent and adult patients with CHD and their impact on prognosis, using self-rating depression scales.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Outpatient clinic of a tertiary center.
  
  
  METHODS
  Sixty ambulatory adolescent and adult patients admitted at the outpatient clinic for regular evaluation.
  
  
  METHODS
  Self-rating depression questionnaires (Beck Depression Inventory [BDI] and Zung Self-Rating Depression Scale [Zung SDS]) were administered on admission. Patients were characterized as having depressive symptoms when scores on both questionnaires were above cutoff levels and were subsequently followed for 5.1 ± 1.1 years for major adverse cardiovascular events (MACEs; death or hospitalization for cardiac reasons).
  
  
  RESULTS
  Seventeen patients (mean age 28.9 ± 11.4 years) were characterized as having depressive symptoms. According to univariate Cox regression analysis, the presence of depressive symptoms was independently associated with adverse clinical outcome. During the follow-up period, patients with depressive symptoms had a shorter event-free survival (1559 ± 92 days vs. 1077 ± 188 days, P = .00215) and a twofold higher risk of getting a MACE, compared with patients without (95% CI 1.630 to 3.616, P < .05). Based on receiver operator characteristics, the BDI had a better prognostic value for future MACEs (area under curve = 0.662, 95% CI 0.5442 to 0.7792; P < .05) compared with the Zung SDS. Mean event-free survival for patients with BDI ≥ 10 was 986 ± 179 days vs. 1624 ± 83 days for patients with BDI < 10.
  
  
  CONCLUSIONS
  The incidence of depressive symptomatology in patients with CHD is rather high and is associated with poorer prognosis. The BDI seems to independently predict adverse clinical outcome. Standardized screening tools and psychosocial interventions to improve the well being of these patients should be a priority in the overall care of this population.
authors: Department of Pediatric Cardiology and Adult Congenital Heart Disease, Onassis Cardiac Surgery Center, Athens, Greece.
authors: Panagiota
authors: P
authors: Kourkoveli
authors: Department of Pediatric Cardiology and Adult Congenital Heart Disease, Onassis Cardiac Surgery Center, Athens, Greece.
authors: Spyros
authors: S
authors: Rammos
authors: Department of Cardiology, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece.
authors: John
authors: J
authors: Parissis
authors: Department of Pediatric Cardiology and Adult Congenital Heart Disease, Onassis Cardiac Surgery Center, Athens, Greece.|Department of Psychiatry, Aeginitio Hospital, National and Kapodistrian University of Athens, Athens, Greece.
authors: Antonis
authors: A
authors: Maillis
authors: Department of Cardiology, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece.
authors: Dimitrios
authors: D
authors: Kremastinos
authors: Department of Cardiology, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece.
authors: Ioannis
authors: I
authors: Paraskevaidis
mesh_terms: D000328:Adult; D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology* / Q000209:etiology; D059026:Diagnostic Self Evaluation; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications*; D006801:Humans; D015994:Incidence; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D055815:Young Adult
keywords: Congenital Heart Disease; Depression; Prognosis; Questionnaires