Copyright © 2003 by the European Society of Cardiology.
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Psychopathology in adults with congenital heart disease: the attribution of longitudinal cohort studies
Sophia Children's Hospital, Rotterdam, The Netherlands
* Correspondence to: Dr E. H .M. van Rijen, The Department of Child and Adolescent Psychiatry, Sophia Children's Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands. Tel: +31-10-463-6671, Fax: +31-10-463-6803
E-mail address: e.vanrijen{at}erasmusmc.nl
In accordance with the comment of Tayebjee and Lip on our article concerning psychosocial functioning in a cohort of adults with congenital heart disease,1we agree with the importance of assessing psychopathological symptoms and development of optimal psychological treatment.
About a decade ago, our research group investigated a broad range of psychiatric problems in children, adolescents and young adults in the first follow-up of this same cohort.2–4A broad range of psychiatric problems was investigated. Besides symptoms of depression and anxiety, somatic complaints (without medical cause), withdrawn behaviour, delinquent behaviour, aggressive behaviour, social problems, thought problems and attention problems were examined. Results of psychiatric problems in children were unfavourable,2whereas, in contrast, those of the young adults were favourable overall.3
We agree with Tayebjee and Lip about the scarcity of information regarding depression. In literature, the prevalence of depression might be overrated since many studies consisted of relative small samples of patients with severe congenital heart disease. Often, response rates were low, thereby enlarging the chance ofselection bias. To get a clear view of prevalence of psychopathology, cohort studies with consecutive series of patients provide an important contribution. The strength of both our present and previous cohort studies are the large sample size and high response rate. Moreover, patients with severe as well as less severe cardiac diagnoses are represented.
In our present patient sample (second follow-up), the same broad range of psychiatric problems was assessed again, with internationally well-known, psychometrically sound questionnaires. Moreover, we have now studied the longitudinal development of psychiatric problems in our sample. Also, the predictive value of a broad range of medical variables, derived from the complete medical course from birth until the present, on long-term psychopathological symptoms, was examined. Because the concerning manuscripts, in which the results are described, are presently submitted, we cannot give further details.
The purpose of the present study was to give a description of the overall psychosocial functioning of the present sample (covering education, occupation, marital status, leisure-time activities).1We would like to point out that in our manuscript emotional functioning (including neuroticism) was not neglected. Our present results and those of the previous study5indicated more favourable data regarding neuroticism, self-esteem and hostility for adults with congenital heart disease, compared to a reference group.
We agree that studies regarding development of psychological interventions are lacking. We recommend such interventions should be attuned to individual needs of patients. Depression should not be the only focus of attention. Adults with congenital heart disease might suffer from a wide range of psychiatric problems (e.g. anxiety, psychosomatic complaints, defiant behaviour). We recommend assessment and treatment of psychopathology at an early stage. In this respect, cardiologists should have the opportunity to refer patients with psychosocial problems to psychologists who specialise in this field. With our manuscripts, hopefully soon to be published, we intend to attribute to a better understanding of these problems.
References
- van Rijen EHM, Utens EMWJ, Roos-Hesselink JW et al. Psychosocial functioning of the adult with congenital heart disease:a 20-33 years follow-up. Eur Heart J. 2003;24(7):673–683.
[Abstract/Free Full Text] - Utens EMWJ, Verhulst FC, Meijboom FJ et al. Behavioural and emotional problems in children and adolescents with congenital heart disease. Psychol Med. 1993;23(2):415–424.[ISI][Medline]
- Utens EM, Versluis-Den Bieman HJ, Verhulst FC et al. Psychopathology in young adults with congenital heart disease. Follow-up results. Eur Heart J. 1998;19(4):647–651.
[Abstract/Free Full Text] - Utens EM, Verhulst FC, Duivenvoorden HJ et al. Prediction of behavioural and emotional problems in children and adolescents with operated congenital heart disease. Eur Heart J. 1998;19(5):801–807.
[Abstract/Free Full Text] - Utens EMWJ, Verhulst FC, Erdman RAM et al. Psychosocial functioning of young adults after surgical correction for congenital heart disease in childhood: a follow-up study. Psychosom Res. 1994;38(7):745–758.
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