Washington: Resilience and high quality of life they are demonstrated by many people born with heart defects; however, they may face a variety of health-related psychological and social challenges throughout their lives.
A new scientific statement reviews the potential psychological and social challenges that occur from childhood to adulthood among people born with heart defects and the types of mental health care that can be beneficial. The declaration advocates that mental health professionals be integrated into interdisciplinary teams that provide medical care to children and adults with congenital heart defectswhich is more common in cancer care than cardiac care.
Congenital heart defects (coronary cardiopathy) occur when people are born with structural abnormalities of the heart or blood vessels that affect the heart. Surgeries and catheter interventions are often required to address these problems. Most people with CHD survive into adulthood, and adults now outnumber children among the more than 2.4 million living with CHD in the United States. However, surgical intervention does not cure CHD. People may need multiple operations and require specialized heart care throughout their lives, especially if they were born with complex heart problems.
“Decades of research describe the psychological and social stressors and challenges that can occur throughout the lives of people with CHD,” said Adrienne H. Kovacs, Ph.D., chair of the scientific statement writing committee. and a clinical psychologist who specializes in working with people who have CHD. “It is long overdue to move from awareness to action and provide more resources and expert mental health care for people living with CHD.”
A American Heart Association scientific statement is an expert analysis of current research and may inform future guidelines. The Association’s 2011 scientific statement on a related topic addressed developmental delays and other neurodevelopmental outcomes in children with CHD. However, this is the first statement to summarize psychological and social challenges from childhood to adulthood and to review age-appropriate mental health interventions to improve quality of life.
According to the new statement, children with more complex CHD have a 5 times higher rate of receiving an anxiety diagnosis in their lifetime compared to children without CHD. Despite evidence of emotional, social, and behavioral difficulties, only a small fraction of children with CHD receive or participate in mental health evaluation or treatment. For adults with CHD, the rate of experiencing a mood or anxiety disorder in their lifetime is about 50%, compared to about 30% for adults in the general population.
The statement summarizes psychosocial impact of CHD during various stages of life:
Infancy: Babies may be exposed to frightening or painful procedures, and may be separated from caregivers and family members for long periods of time for surgery or other hospitalization. In response, babies with CHD may be hypersensitive to light and sound, have difficulty feeding and sleeping, or show intense fear and distress, and may have developmental delays.
Childhood: There may be additional hospitalizations and surgeries, therefore fewer opportunities to play or attend school, and they may also have developmental delays. In response, children with CHD may become socially withdrawn, experience symptoms of anxiety or depression, have difficulty in school, or display aggression or hyperactivity.
Adolescence: Health problems can arise at the same time that adolescents strive to be independent, expand their social networks, and take on greater responsibility for managing their health care as they move from pediatric to adult care. In response, teens with CHD may struggle socially, become angry, challenged, or frustrated, or have body image issues. They may also display risk behaviors or fail to follow health recommendations.
Adulthood: There may be new or worsening heart symptoms, repeat surgeries or other heart interventions during adulthood, and CHD can negatively impact financial, employment, insurance, and family planning options. In response, adults with CHD may have difficulty with interpersonal relationships, higher education, or employment. They may also have trouble taking care of their health needs and worry about death and dying.
“It’s completely understandable to have a psychological reaction to living with a congenital heart defect. The condition presents numerous challenges throughout life and can include unexpected news, such as a person realizing they can no longer physically handle the demands of their job, or learning that there are significant risks to pregnancy,” Kovacs said. “Many people with CHD are highly resilient in the face of these challenges. At the same time, we want to normalize psychological reactions and increase the prevalence of psychological wellness care to help people with CHD experience a full and healthy life.” “.
According to the statement, approaches to mental health care can include self-care strategies, such as relaxation techniques and support groups online or in hospitals; psychotherapy such as talk therapy for individuals, couples, families, or groups; and drug therapy where a medical team can determine the appropriate and safe heart medications for depression or anxiety.
The statement strongly advocates for the integration of mental health professionals within CHD specialty care teams. Integrated mental health care normalizes emotional reactions to health problems, reduces stigma, improves timely access as soon as health problems arise, and provides coordinated care across the multidisciplinary health care team.
“The goal of this statement is to encourage psychologically informed care that empowers people with CHD and their families and provides emotional support,” Kovacs said. “We would like mental health assessment and support to be part of comprehensive care for all people with CHD rather than a special service offered only in a few special places or circumstances.”
.
