Mental health burden and health-related quality of life in adults with congenital heart disease: a cross-sectional study

Background

Adults with congenital heart disease (ACHD) frequently experience psychological comorbidities—including depression, anxiety, and risk-related alcohol consumption—that may affect quality of life and clinical outcomes. Although guidelines increasingly recommend routine mental health screening in ACHD care pathways, real-world data from specialized clinics remain limited.

Purpose

To quantify the burden of anxiety, depressive symptoms, and risk-related alcohol use in adults with congenital heart disease (ACHD), and to evaluate their associations with health-related quality of life in a specialized ACHD clinic.

Methods

We conducted an observational, descriptive, cross-sectional study using an anonymous self-administered survey in adults (≥18 years) attending an ACHD clinic. Standardized instruments included EQ-5D-5L (five dimensions and 0–100 VAS), PHQ-9 (0–27), GAD-7 (0–21), and AUDIT-C (0–12). PHQ-9 and GAD-7 totals were imputed using item-mean substitution when ≥7 (PHQ-9) or ≥6 (GAD-7) items were completed; otherwise scores were coded as missing. AUDIT-C positivity used sex-specific cut-offs (≥3 women, ≥4 men). Prevalences were summarized with Wilson 95% CIs, and associations explored using Spearman correlations and logistic models adjusted for age, sex, and region.

Results

A total of 95 adults were included (mean age 44.4 ± 17.3 years; 46.3% male). Mean EQ-5D VAS was 80.6 (SD ~17). Moderate or worse symptom levels were observed in 15.8% for PHQ-9 ≥10 and 14.7% for GAD-7 ≥10. Risk-positive AUDIT-C screening was present in 44.0% of participants with complete data. Across EQ-5D-5L dimensions, ≥1 problem was reported by 16.8% (mobility), 9.5% (self-care), 18.9% (usual activities), 33.7% (pain/discomfort), and 44.2% (anxiety/depression). Strong correlations were observed between PHQ-9 and GAD-7 (ρ≈0.75), and both scales correlated inversely with EQ-VAS (PHQ-9 ρ≈–0.45; GAD-7 ρ≈–0.33). Associations involving AUDIT-C were weaker and inconsistent, partly due to smaller denominators. Logistic regression did not identify significant independent predictors for PHQ-9 ≥10, GAD-7 ≥10, or AUDIT-C positivity (wide confidence intervals).

Conclusions

Adults with congenital heart disease attending a specialized clinic exhibited substantial levels of anxiety and depressive symptoms, together with a notable prevalence of risk-related alcohol use, despite generally preserved quality-of-life scores. These findings reinforce the need for systematic mental health screening and integrated psychosocial care within ACHD services, in alignment with current international recommendations.

Figure 1.AUDIT-C positivity by sex (A); EQ-5D problems by dimension (B); GAD-7 severity distribution (C); PHQ-9 severity distribution (D).

Table A. Baseline characteristics and EQ-5D.

Table B. Psychological screening outcomes and correlations.