Kids With Congenital Heart Disease Face Higher Odds of Mental Health Issues
Kids born with heart defects may be more likely to develop anxiety, depression and/or attention-deficit/hyperactivity disorder (ADHD), regardless of the severity of their heart condition.
Congenital heart defects are the most common type of birth defect in the United States, affecting about 40,000 babies a year, according to the U.S. Centers for Disease Control and Prevention. The defects range from mild to severe and sometimes require immediate or multiple surgeries. These children often miss school and social activities due to doctors' visits or health restrictions.
For the study, the researchers reviewed medical records of close to 119,000 kids, aged 4 to 17, who were treated at Texas Children's Hospital in Houston more than once between 2011 and 2016.
Of those, 1,164 had congenital heart disease. All of those youngsters, including the youngest, were more likely than their peers to have anxiety, depression or ADHD, the records revealed.
Slightly more than 18% of those who had been born with heart disease had a diagnosis or medication for anxiety and/or depression, compared to just over 5% of others, the researchers found.
The findings were published online Jan. 4 in the journal Pediatrics.
Exactly why these children are at higher risk for mental health issues is not fully understood. But the study's lead author described these kids as "uniquely vulnerable."
"They are frequently hospitalized and often undergo multiple invasive procedures or surgeries early in childhood and throughout their lifetime," said Dr. Vincent Gonzalez, a pediatric cardiology fellow at Baylor College of Medicine/Texas Children's Hospital in Houston.
"These factors, along with a higher prevalence of underlying genetic disorders, learning disabilities, increased parental anxiety and social stressors all likely contribute to this increase in mental health disorders," he added.
Nonetheless, kids who are born with heart defects are living longer and fuller lives today than ever before, said Dr. David Meyer, a heart surgeon at Cohen's Children's Hospital in New Hyde Park, N.Y., who reviewed the findings.
"We used to focus solely on survival, but now that these kids are doing so well, we need to take a more holistic approach and monitor them for secondary issues that may arise down the road, such as anxiety, depression and or ADHD," Meyer said.
Looking out for signs -- such as extreme sadness, constant worry, irritability or trouble sleeping -- can help kids get the treatments they need to feel better, the experts agreed.
Gonzalez said that the study findings "indicate that providers caring for all patients with any type of [congenital heart disease] should consider screening for symptoms of these disorders earlier in childhood, as opposed to waiting until the typical adolescent time period."
The study also found that uninsured children and those from minority groups are diagnosed with anxiety, depression or ADHD at a strikingly lower rate than their white peers.
"This suggests that these populations are at increased risk for being underdiagnosed and treated for these conditions, and providers should have a higher index of suspicion when seeing these patients," Gonzalez said.
Rebecca Berry is a clinical associate professor of child and adolescent psychiatry at Hassenfeld Children's Hospital at NYU Langone Health in New York City. She reviewed the findings and pointed out that a certain degree of fear or worry is to be expected when a child has a serious medical condition.
"The question is: Are these symptoms distressing and disruptive to a child's quality of life and disproportionate to what we would expect for a child with this condition?" she said.
Many pediatric heart surgery teams include a psychologist to help children and their families cope with the heart defect, its treatment and its effect on day-to-day life.
Parents can do their part, too, Berry said.
"Listen to your child and validate what they are saying and feeling," she suggested. "Don't make everything about the illness. Try and treat them as a child and include them in normal activities whenever you can."
The U.S. Centers for Disease Control and Prevention has more about congenital heart defects.
SOURCES: Vincent Gonzalez, MD, MS, pediatric cardiology fellow, Baylor College of Medicine/Texas Children's Hospital, Houston; David Meyer, MD, pediatric cardiothoracic surgeon, Cohen Children's Hospital, New Hyde Park, N.Y., and associate professor, cardiothoracic surgery and pediatrics, Zucker-Hofstra School of Medicine, Hempstead, N.Y.; Rebecca Berry, PhD, clinical associate professor, child and adolescent psychiatry, Child Study Center, Hassenfeld Children's Hospital at NYU Langone Health, New York City; Pediatrics, Jan. 4, 2021, online