Miles Kimberley G, Farkas Dóra Körmendiné, Laugesen Kristina, Sørensen Henrik Toft, Kasparian Nadine A, Madsen Nicolas
Heart Institute, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, OH (K.G.M., N.A.K.).
Department of Clinical Epidemiology, Aarhus University Hospital and Department of Clinical Medicine Aarhus University, Denmark (D.K.F., K.L., H.T.S.).
Circulation. 2023 Oct 31;148(18):1381-1394. doi: 10.1161/CIRCULATIONAHA.123.064705. Epub 2023 Sep 18.
BACKGROUND: Despite the known mental health burden among children with congenital heart disease (CHD), the literature is constrained by a lack of comparison cohorts and population-based follow-up data. We examined the incidence of mental health conditions among children with CHD, relative to 3 comparison cohorts. METHODS: This population-based cohort study identified all children with CHD (<18 years of age; n=16 473) in Denmark from 1996 to 2017, through linkage of individual-level data across national registries. This allowed for complete follow-up of the population. Comparison cohorts included children from the general population (n=162 204), siblings of children with CHD (n=20 079), and children with non-CHD major congenital anomalies (n=47 799). Mental health conditions were identified using inpatient and outpatient hospital discharge codes, prescription data, and data on use of community-based psychology, psychiatry, and psychotherapy services. We computed cumulative incidence by 18 years of age, incidence rates, and adjusted hazard ratios (aHRs) using Cox regression. aHRs accounted for sex, year of CHD diagnosis, parental mental health, and socioeconomic status. All estimates were stratified by age, sex, and CHD complexity. RESULTS: The cumulative incidence of mental health conditions by 18 years of age in the CHD cohort was 35.1% (95% CI, 34.0%-36.1%), corresponding to aHRs of 1.64 (95% CI, 1.58-1.71), 1.41 (95% CI, 1.30-1.52), and 1.02 (95% CI, 0.98-1.07) compared with the general population, sibling, and major congenital anomaly cohorts, respectively. Mental health incidence rates showed prominent peaks in early childhood and adolescence. Males and children with severe or single-ventricle CHD demonstrated higher incidence rates of mental health conditions relative to females and children with mild or moderate CHD, respectively. Compared with the general population and sibling cohorts, incidence rates and aHRs in the CHD cohort were highest for severe stress reactions, attention deficit/hyperactivity disorder, intellectual disability, and autism spectrum disorder. Compared with children in the major congenital anomaly cohort, the aHRs were close to 1. CONCLUSIONS: More than one-third of children with CHD were diagnosed or treated for a mental health condition by 18 years of age. Mental health conditions began early in life and were most prominent among males and children with severe or single-ventricle heart disease.
背景：尽管已知先天性心脏病（CHD）患儿存在心理健康负担，但相关文献因缺乏对照队列和基于人群的随访数据而受到限制。我们研究了CHD患儿心理健康状况的发生率，并与3个对照队列进行了比较。 方法：这项基于人群的队列研究通过链接国家登记处的个体水平数据，确定了1996年至2017年丹麦所有CHD患儿（<18岁；n = 16473）。这使得对该人群能够进行完整的随访。对照队列包括普通人群中的儿童（n = 162204）、CHD患儿的兄弟姐妹（n = 20079）以及患有非CHD重大先天性异常的儿童（n = 47799）。使用住院和门诊出院代码、处方数据以及基于社区的心理学、精神病学和心理治疗服务使用数据来确定心理健康状况。我们使用Cox回归计算了18岁时的累积发病率、发病率和调整后的风险比（aHRs）。aHRs考虑了性别、CHD诊断年份、父母心理健康和社会经济地位。所有估计值均按年龄、性别和CHD复杂性进行分层。 结果：CHD队列中18岁时心理健康状况的累积发病率为35.1%（95%CI，34.0%-36.1%），与普通人群、兄弟姐妹和重大先天性异常队列相比，对应的aHRs分别为1.64（95%CI，1.58-1.71）、1.41（95%CI，1.30-1.52）和1.02（95%CI，0.98-1.07）。心理健康发病率在幼儿期和青春期出现显著峰值。与女性和轻度或中度CHD患儿相比，男性和重度或单心室CHD患儿的心理健康状况发病率更高。与普通人群和兄弟姐妹队列相比，CHD队列中严重应激反应、注意力缺陷/多动障碍、智力残疾和自闭症谱系障碍的发病率和aHRs最高。与患有重大先天性异常队列中的儿童相比，aHRs接近1。 结论：超过三分之一的CHD患儿在18岁时被诊断出患有心理健康疾病或接受了相关治疗。心理健康状况在生命早期就开始出现，在男性以及患有严重或单心室心脏病的儿童中最为突出。
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