The burden of psychological trauma and post-traumatic stress disorder among adults with congenital heart disease: PTSD in ACHD

Psychological trauma, symptoms of post-traumatic stress disorder (PTSD), and mental health conditions are common in adult congenital heart disease (ACHD). There is a gap in research examining PTSD in ACHD using the current Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5)...

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Bibliographic Details
Published in:The American journal of cardiology 2024-05, Vol.219, p.9-16
Main Authors: Harrison, David J., Kay, Joseph, Jacobsen, Roni M., Londono-Obregon, Camila, Yeung, Elizabeth, Kelly, Sarah L., Poteet, Ann, Levek, Claire, Landzberg, Michael J., Wallrich, Molly, Khanna, Amber
Format: Article
Language:English
Subjects:
ACHD
Adult
adult congenital heart disease
Adults
Adverse childhood experiences
Anxiety
Cardiovascular disease
Cardiovascular diseases
Check lists
Children
Complexity
Congenital diseases
Congestive heart failure
Cost of Illness
Criteria
depression
Diagnosis
Emergency medical care
Emergency medical services
Female
Health services
Heart
Heart Defects, Congenital - complications
Heart Defects, Congenital - epidemiology
Heart Defects, Congenital - psychology
Heart diseases
Humans
Longitudinal studies
Male
Medical instruments
Mental depression
Mental disorders
Mental health
Mental health care
Middle Aged
Morbidity
Patients
Pediatrics
Post traumatic stress disorder
Prevalence
Psychological stress
PTSD
Quality of Life
Signs and symptoms
Social interactions
Social Support
Stress Disorders, Post-Traumatic - epidemiology
Surveys
Trauma
Young Adult
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Summary:Psychological trauma, symptoms of post-traumatic stress disorder (PTSD), and mental health conditions are common in adult congenital heart disease (ACHD). There is a gap in research examining PTSD in ACHD using the current Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) criteria in assessing patient characteristics and experiences with trauma-focused treatment. Surveys were offered to outpatients over a 6-month enrollment period to be completed by way of a QR code on their personal smart phone. Patient-reported items include a detailed medical and psychosocial history, the Oslo social support scale, adverse childhood experiences survey, and the PTSD checklist for DSM-5. Of 158 patients (77% moderate or complex heart disease) who provided complete data, a provisional diagnosis of PTSD was found in 48 patients (30%) using a PTSD checklist for DSM-5 cut-off score of ≥31. A positive PTSD screen was associated with younger age, nonwhite race, presence of heart failure, lower New York Heart Association functional class, lower linear quality of life score, lower Oslo social support scale score, an insecure caregiver relation, period of unemployment, emergency department visits, medication nonadherence, and coexisting mental health disorders. Complexity of heart disease and number of surgical and/or catheter-based interventions were not associated with PTSD, although having undergone no cardiac surgeries until adulthood (aged ≥18 years) was associated with a lower prevalence of PTSD. Those who screened positive for PTSD were more likely to report multiple traumatic events, including noncardiac traumatic events. Only 14 of 48 patients (29%) reported a known diagnosis of PTSD, although 44 patients (92%) reported having ever seen a mental health provider. A total of 18 patients (38%) reported currently having a mental health provider. A total of 30 patients (62%) had heard of at least 1 evidence-based trauma-informed therapy, and 14 (29%) had tried at least 1. In conclusion, using the DSM-5 criteria, we observed a high prevalence of potential PTSD in ACHD associated with several novel cardiac and psychosocial patient factors. Future longitudinal studies will be necessary to establish causality. Few patients with ACHD have been formally diagnosed with PTSD or have experience with evidence-based trauma-informed therapies.
ISSN:0002-9149
1879-1913
1879-1913
DOI:10.1016/j.amjcard.2024.03.007