Ehmann Anna-Lena, Schütte Emily, Semmler Janina, Berger Felix, Bauer Ulrike M M, Schmitt Katharina, Pfitzer Constanze, Helm Paul C
Department of Congenital Heart Disease-Pediatric Cardiology, Deutsches Herzzentrum der Charité, Berlin, Germany.
Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
Eur J Cardiothorac Surg. 2025 May 6;67(5). doi: 10.1093/ejcts/ezaf145.
Individuals with congenital heart disease (CHD) face daily life limitations, increasing the risk of anxiety and depression. Diagnosing these disorders in adults with CHD (ACHD) remains challenging in the clinical routine, because physical symptoms can be misattributed to a patient's physical condition. Several screening instruments are available, and studies revealed that they can be used to diagnose varying numbers of people with clinically relevant symptoms. Therefore, we compared frequently used screening tools for depression and anxiety in ACHD in Germany.
Participants were recruited from the German National Register for Congenital Heart Defects. A total of 1486 patients aged 18 to 85 (Mage = 36.84; 60.8% female) were classified as simple, moderate or complex CHD. Self-reported measures of depression [Hospital Anxiety and Depression Scale (HADS-D); Patient Health Questionnaire-9 (PHQ-9)], anxiety [Hospital Anxiety and Depression Scale (HADS-A); Generalized Anxiety Disorder-7 (GAD-7)], psychotherapy utilization, secondary illnesses and sociodemographic characteristics, were recorded.
The PHQ-9 recorded about 39% more patients with depressive symptoms compared to the HADS-D. The GAD-7 detected approximately 15% more patients with anxiety symptoms in comparison to the HADS-A. PHQ-9 and GAD-7 demonstrated higher sensitivity (89.6%/86.8%) but lower specificity (48.1%/53.5%) compared to the HADS-D/HADS-A (sensitivity: 56.3%/78.0%; specificity: 87.8%/67.2%). No significant differences were found between the CHD severity levels.
The screening tools we compared were used to diagnose a significantly different number of patients with depression or anxiety in ACHD. Because even mild symptoms have a significant impact on quality of life, using PHQ-9 and GAD-7 in clinical practice is recommended to minimize false negatives and ensure mental health in ACHD.
先天性心脏病（CHD）患者面临日常生活限制，焦虑和抑郁风险增加。在临床常规中，诊断成年先天性心脏病患者（ACHD）的这些疾病仍然具有挑战性，因为身体症状可能被误诊为患者的身体状况。有几种筛查工具可用，研究表明它们可用于诊断不同数量有临床相关症状的人。因此，我们比较了德国ACHD中常用的抑郁和焦虑筛查工具。
参与者从德国先天性心脏病国家登记处招募。共有1486名年龄在18至85岁之间（平均年龄 = 36.84岁；60.8%为女性）的患者被分类为简单、中度或复杂CHD。记录了自我报告的抑郁测量指标[医院焦虑抑郁量表（HADS-D）；患者健康问卷-9（PHQ-9）]、焦虑测量指标[医院焦虑抑郁量表（HADS-A）；广泛性焦虑障碍-7（GAD-7）]、心理治疗利用率、继发性疾病和社会人口学特征。
与HADS-D相比，PHQ-9记录的有抑郁症状的患者多约39%。与HADS-A相比，GAD-7检测出的有焦虑症状的患者多约15%。与HADS-D/HADS-A（敏感性：56.3%/78.0%；特异性：87.8%/67.2%）相比，PHQ-9和GAD-7表现出更高的敏感性（89.6%/86.8%）但更低的特异性（48.1%/53.5%）。在CHD严重程度级别之间未发现显著差异。
我们比较的筛查工具用于诊断ACHD中抑郁或焦虑患者的数量有显著差异。由于即使是轻微症状也会对生活质量产生重大影响，建议在临床实践中使用PHQ-9和GAD-7以尽量减少假阴性并确保ACHD患者的心理健康。
