title: Mental disorders in adults with congenital heart disease: Unmet needs and impact on quality of life.
abstract: In adult congenital heart disease (ACHD), mental health status and quality of life become important issues due to improved life expectancy. Current literature provides conflicting data regarding mental health status in ACHD. Furthermore, none of the studies so far compared prevalence rates with a matched control group.
  
  
  
  The prevalence of mental disorders was assessed in 150 ACHD using a structured interview, and compared to 12-months estimates of the general German population. Quality of life (QoL) was measured with World Health Organization Quality of Life instrument. Furthermore, we related the diagnostic results of widely used screening instruments for depression (Beck Depression Inventory-2; BDI-2; Hospital Anxiety and Depression Scale; HADS) with clinical diagnoses, to receive optimal sensitivity and specificity values.
  
  
  
  The prevalence of psychiatric disorders was significantly higher in ACHD than in the general population (48.0%; CI: 44.7-60.0 vs. 35.7%; CI: 33.5-37.9). Mood (30.7%; CI: 24.0-38.0 vs. 10.7%;CI:9.4-12.0) and anxiety disorders (28.0%; CI:22.0-36.7 vs. 16.8%; CI: 15.0-18.6) were the leading causes of psychiatric illness. Sixteen of 150 ACHD patients (10.7%) received specific treatment for psychiatric disorders before entering the study. Overall quality of life was independently and negatively associated with a diagnosis of major depression (p<0.001), alcohol dependency (p=0.004), nicotine dependency (p=0.036), and NYHA class (p=0.007). Accuracy of the HADS-D and BDI-2 as screening instruments was moderate (AUC 0.60-0.81), depending on the cut-off score used.
  
  
  
  Psychiatric disorders, particularly mood and anxiety disorders are significantly more frequent in ACHD compared to the general population. However, these disorders are rarely diagnosed resulting in under treatment and loss of quality of life. Quality of life is independently associated with the existence of mood, anxiety and substance use disorders. When self-rating instruments (BDI-2, HADS) are used as screening instruments in ACHD care, lower cut-off values are recommended.
authors.affiliation: Department of Cardiology and Angiology, Hannover Medical School, Germany.
authors.forename: Mechthild
authors.initials: M
authors.lastname: Westhoff-Bleck
authors.affiliation: Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Germany.
authors.forename: Juliane
authors.initials: J
authors.lastname: Briest
authors.affiliation: Department of Cardiology and Angiology, Hannover Medical School, Germany.
authors.forename: Daniela
authors.initials: D
authors.lastname: Fraccarollo
authors.affiliation: Department of Cardiology and Angiology, Hannover Medical School, Germany.
authors.forename: Denise
authors.initials: D
authors.lastname: Hilfiker-Kleiner
authors.affiliation: Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Germany.
authors.forename: Lotta
authors.initials: L
authors.lastname: Winter
authors.affiliation: Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Maske
authors.affiliation: Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany.
authors.forename: Markus A
authors.initials: MA
authors.lastname: Busch
authors.affiliation: Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Bleich
authors.affiliation: Department of Cardiology and Angiology, Hannover Medical School, Germany.
authors.forename: Johann
authors.initials: J
authors.lastname: Bauersachs
authors.affiliation: Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Germany. Electronic address: kahl.kai@mh-hannover.de.
authors.forename: Kai G
authors.initials: KG
authors.lastname: Kahl
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000209:etiology / Q000523:psychology*; D016022:Case-Control Studies; D003865:Major Depressive Disorder / Q000209:etiology / Q000523:psychology*; D005260:Female; D006301:Health Services Needs and Demand; D006330:Heart Defects, Congenital / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D055815:Young Adult
keywords: Congenital heart disease; Depression; General anxiety disorder; Quality of life