Related Experiment Video
Updated: Jul 16, 2025
Measuring Cardiac Autonomic Nervous System ANS Activity in Children
Published on: April 29, 2013
Mental Health Conditions Among Children and Adolescents With Congenital Heart Disease: A Danish Population-Based
Kimberley G Miles1, Dóra Körmendiné Farkas2, Kristina Laugesen2
1Heart Institute, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, OH (K.G.M., N.A.K.).
Insights
Over one-third of children with congenital heart disease (CHD) experience mental health conditions by age 18. These conditions are more common in males and those with severe CHD, appearing early in life.
Area of Science:
- Pediatric Cardiology
- Child and Adolescent Psychiatry
- Public Health
Background:
- Children with congenital heart disease (CHD) face a significant mental health burden.
- Existing literature lacks population-based follow-up data and comparison cohorts for children with CHD.
Purpose of the Study:
- To examine the incidence of mental health conditions in children with CHD.
- To compare mental health incidence in children with CHD against general population, sibling, and major congenital anomaly cohorts.
Main Methods:
- Population-based cohort study of 16,473 children with CHD in Denmark (1996-2017).
- Utilized national registry data for complete follow-up and identified mental health conditions via hospital discharge codes, prescriptions, and community services.
- Employed Cox regression to compute adjusted hazard ratios (aHRs), accounting for sex, diagnosis year, parental mental health, and socioeconomic status.
Main Results:
- Cumulative incidence of mental health conditions by age 18 in the CHD cohort was 35.1%.
- Children with CHD had significantly higher aHRs for mental health conditions compared to the general population (1.64) and siblings (1.41), but not those with major congenital anomalies (1.02).
- Higher incidence rates were observed in males, children with severe or single-ventricle CHD, and conditions included severe stress reactions, ADHD, intellectual disability, and autism spectrum disorder.
Conclusions:
- Over one-third of children with CHD are diagnosed or treated for mental health conditions by age 18.
- Mental health issues emerge early in childhood and are more prevalent in males and those with severe CHD.
- Findings highlight the need for early and targeted mental health support for children with CHD.
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.
Related Concept Videos
01:27Psychoneuroimmunology: Cardiovascular Disease
A key area of focus in PNI is the relationship between stress and coronary...
01:29Cardiomyopathy III: Hypertrophic Cardiomyopathy
01:30Attention-Deficit/Hyperactivity Disorder
Diagnostic Criteria and Symptoms
To diagnose ADHD, symptoms must manifest before age 12 and be evident across multiple settings....
01:26Longitudinal Studies
01:27Heart Failure I: Introduction
01:28Conduct Disorder