Empirical findings on associations between anxiety, depression, and congenital heart disease in adults - A systematic review and meta-analysis

Introduction: Research on emotional distress in adults with congenital heart disease (ACHD) has raised concerns about its effects on quality of life (QOL) and future health risks. This study aims to identify the relationship between anxiety and/or depressive symptoms and congenital heart disease (CHD) in adults. It further explores the effect of depressive symptoms on QOL in ACHD. Methods: A systematic review and meta-analysis of the available literature was performed following the preferred reporting items for systematic reviews and meta-analyses guidelines. PubMed, Google Scholar, SAGE Journals, JSTOR, and ScienceDirect databases were also explored within this study. The data extraction was executed considering the aim of the study, study population (CHD patients 18 years or above), standardized measures to diagnose anxiety and depression. The pooled correlation coefficients (with 95% confidence interval [CI]) between symptoms of anxiety or depression and CHD in adults were estimated using R software. Potential heterogeneity was analyzed using meta-regression. Publication bias was evaluated using funnel plots, Egger's and rank test. Results: A total of 21 studies were selected for the systematic review. Fifteen studies, with a total of 16,079 participants, were included into the meta-analysis. Included studies show different study designs such as cohort, cross-sectional, case-control, and experimental design. The systematic review revealed heterogeneous results on anxiety or depressive symptoms in ACHD and their effect on QOL in ACHD. The pooled correlation coefficient between anxiety symptoms and CHD was 0.22 (95% CI: 0.00-0.43). Considering depressive symptoms and CHD, the pooled correlation coefficient was 0.04 (95% CI: -0.18-0.26). The pooled correlation coefficient between depressive symptoms and QOL in ACHD was 0.20 (95% CI: -0.49-0.10). Meta-regression analysis showed that the presence of depressive and anxiety symptoms, increasing age and the application of cross-sectional study design may have an important impact on the observed correlations. Conclusion: The present study confirms that anxiety is significantly associated with negative health outcomes in ACHD. Depression was not significantly associated with negative health outcomes in ACHD. The findings emphasize the importance of a holistic approach to cardiac care in which psychosocial support is an integral component in order to effectively enhance QOL and cardiovascular health in ACHD.