Psychiatric Disorders in Adolescents With Single Ventricle Congenital Heart Disease.
OBJECTIVE
Mental health outcomes for survivors of critical congenital heart disease (CHD) remain under-investigated. We sought to examine psychiatric disorders and psychosocial functioning in adolescents with single ventricle CHD and to explore whether patient-related risk factors predict dysfunction.


METHODS
This cohort study recruited 156 adolescents with single ventricle CHD who underwent the Fontan procedure and 111 healthy referents. Participants underwent comprehensive psychiatric evaluation including a clinician-rated psychiatric interview and parent- and self-report ratings of anxiety, disruptive behavior, including attention-deficit/hyperactivity disorder (ADHD), and depressive symptoms. Risk factors for dysfunction included IQ, medical characteristics, and concurrent brain abnormalities.


RESULTS
Adolescents with single ventricle CHD had higher rates of lifetime psychiatric diagnosis compared with referents (CHD: 65%, referent: 22%;P< .001). Specifically, they had higher rates of lifetime anxiety disorder and ADHD (P< .001 each). The CHD group scored lower on the primary psychosocial functioning measure, the Children's Global Assessment Scale, than referents (CHD median [interquartile range]: 62 [54-66], referent: 85 [73-90];P< .001). The CHD group scored worse on measures of anxiety, disruptive behavior, and depressive symptoms. Genetic comorbidity did not impact most psychiatric outcomes. Risk factors for anxiety disorder, ADHD, and lower psychosocial functioning included lower birth weight, longer duration of deep hypothermic circulatory arrest, lower intellectual functioning, and male gender.


CONCLUSIONS
Adolescents with single ventricle CHD display a high risk of psychiatric morbidity, particularly anxiety disorders and ADHD. Early identification of psychiatric symptoms is critical to the management of patients with CHD.
Departments of Psychiatry, david.demaso@childrens.harvard.edu.|Cardiology, and.|Departments of Psychiatry.
David R
DR
DeMaso
Departments of Psychiatry.|Departments of Psychiatry.
Johanna
J
Calderon
Departments of Psychiatry.
George A
GA
Taylor
Departments of Psychiatry.
Jennifer E
JE
Holland
Cardiology, and.
Christian
C
Stopp
Departments of Psychiatry.|Departments of Psychiatry.
Matthew T
MT
White
Departments of Psychiatry.|Departments of Psychiatry.|Neurology, Boston Children's Hospital, Boston, Massachusetts.|Neurology, and.
David C
DC
Bellinger
Departments of Psychiatry.|Neurology, Boston Children's Hospital, Boston, Massachusetts.|Neurology, and.
Michael J
MJ
Rivkin
Cardiology, and.|Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
David
D
Wypij
Cardiology, and.|Pediatrics, Harvard Medical School, Boston, Massachusetts; and.
Jane W
JW
Newburger
D000293:Adolescent; D001008:Anxiety Disorders / Q000150:complications* / Q000175:diagnosis; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000150:complications* / Q000175:diagnosis; D001724:Birth Weight; D016022:Case-Control Studies; D050792:Circulatory Arrest, Deep Hypothermia Induced; D015331:Cohort Studies; D003863:Depression / Q000150:complications* / Q000175:diagnosis; D005260:Female; D018729:Fontan Procedure; D006330:Heart Defects, Congenital / Q000150:complications / Q000523:psychology* / Q000601:surgery; D006801:Humans; D008607:Intellectual Disability; D008297:Male; D012307:Risk Factors; D012737:Sex Factors; D018754:Ventricular Dysfunction / Q000150:complications / Q000523:psychology* / Q000601:surgery