A single-centre study, published in the American Journal of Cardiology, from The Children’s Hospital of Philadelphia (CHOP) indicates that as many as one in five adult patients with congenital heart disease have symptoms of post-traumatic stress disorder (PTSD), with about one in 10 patients having symptoms that are directly related to their heart condition. The study researchers suggest that clinicians and carers need to be aware of possible PTSD symptoms, such as anxiety and depression, in their patients.
Yuli Kim (CHOP, Philadelphia, USA) and others enrolled 134 patients with congenital heart defects and used two validated mental health scales, with questions related to anxiety, depression and PTSD, to assess the incidence of PTSD among these patients. Of the 134 patients who completed one scale, 27 (21%) met criteria for global PTSD symptoms and of the 127 patients who completed another scale, 14 patients (11%) had PTSD symptoms specifically related to their congenital heart disease or treatment. According to a CHOP press release, the high prevalence of PTSD in this patient cohort (11–21%) is several times higher than the rate of 3.5% observed in the general population. Kim et al note in the American Journal of Cardiology that the prevalence is comparable to that found in children with CHD and in adults with acquired heart disease.
The authors also found two factors that were most strongly linked to PTSD in their patients: elevated depressive symptoms and the patient’s most recent cardiac surgery. Patients who had undergone cardiac surgery at an earlier year were more likely to have PTSD. This finding, according to Kim et al, may reflect recent medical and surgical advances that lessen traumatic impacts, or alternatively, a “residual stress” explanation—ie. that traumatic stress produces chronic, lasting effects.
Furthermore, the study indicates that non-medical traumatic events may have contributed to PTSD in some patients. Additionally, the authors explain, the self-report measurements used in the study may not be as accurate as a clinical interview.
The press release reports that, overall, the new study may reveal important unmet needs in a growing population of patients. Corresponding author Lisa Deng (also at CHOP), says: “The high prevalence of PTSD detected in these adult congenital heart disease patients has important clinical implications. We need to conduct more research to identify measures along the lifespan to support our patients and ensure that they have a good quality of life.”
Kim comments: “Although the life expectancy of adults living with congenital heart disease has improved, ongoing care may include multiple surgeries and procedures. These patients remain at risk for both cardiac and non-cardiac effects of their chronic condition, and face unique life stressors that may place them at elevated risk for psychological stress.”