Background: Congenital heart diseases (CHD) pose a major global concern due to its increasing survival trend in the adult stage; but data in our country is lacking. Despite improvement in management, formal assessment for anxiety and depression in patients with adult CHD is not routinely done. The Hospital Anxiety and Depression Scale (HADS) is a popular and simple self-administered instrument highly reliable for detecting states of anxiety and depression for use in medical practice. Identifying the prevalence of anxiety and depression through a simple screening tool that may lead to a proper psychiatric referral may help health-care providers consider the contribution of these components of the disease and identify additional points of holistic care for our patients.

Objectives: We aim to determine the prevalence of anxiety and depression in adult CHD Filipino patients using the HADS-P questionnaire (validated Tagalog version of the HADS). We also aim to determine association between depression & anxiety and disease characteristics.

Methods: This is a cross-sectional study using non-probability sampling of adult Filipinos with CHD in the Philippine General Hospital (UP-PGH). The HADS-P is a 14-item, self-administered rating scale with independent subscales for anxiety and depression (seven items each) was administered to both the study and control groups after securing consent.

A cut–off score of > 8.0 points on either of the depression and anxiety subscale of the HADS was used to determine their respective prevalence. Logistic regression analysis was used to determine the association of clinical variables with anxiety or depression.

Results: A total of 92 patients with CHD with a mean age of 33 years old were recruited. The prevalence of anxiety and depression was higher among those with CHD compared to local literature (61% and 34% respectively). Majority had an atrial septal defect, ventricular septal defect, and patent ductus arteriosus. On the basis of a HADS-P score of >8.0 per category, 56 patients had anxiety and 31 patients had depression. Simple logistic regression identified employment status, a higher NYFC, low distance six-minute walk test, uncorrected defects, and heart failure as predictors of anxiety; whereas lower educational achievement, higher functional class, right-to-left shunt or Eisenmenger physiology, low distance six-minute walk test, and heart failure were predictors of depression. Multiple logistic regression identified only employment status (ie. being unemployed) as a significant predictor of anxiety [OR 4.54, 95% CI 1.38 – 14.28, p 0.012]; while having a right-to-left shunt or Eisenmenger physiology was a significant predictor of depression [OR 6.44, 95% CI 1.82-22.76, p 0.004].

Conclusion: This cohort of adult Filipinos with CHD has higher HADS-P scores, suggestive of a higher prevalence of anxiety and depression compared to available data. Factors associated with anxiety and/or depression were related to their underlying CHD and sociodemographic profile. Screening for emotional disorders is of paramount importance to provide holistic care for this vulnerable population. Health care professionals should be alert for the possible need for psychological intervention for adult survivors of CHD, even among those that are seemingly emotionally well-adjusted.

Keywords: Congenital heart disease, HADS, depression, anxiety  

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