Psychiatric morbidity and work participation in patients with congenital ventricular septal defects: a case-controlled study

Author:

Eckerström Filip1234ORCID,Hjortdal Vibeke Elisabeth12ORCID,Rask Charlotte Ulrikka56ORCID,Nyboe Camilla67ORCID

Affiliation:

1. Department of Cardiothoracic Surgery, Copenhagen University Hospital , Blegdamsvej 9, DK-2100 Copenhagen , Denmark

2. Department of Clinical Medicine, Copenhagen University , Blegdamsvej 9, DK-2100 Copenhagen , Denmark

3. Adult Congenital Heart Disease Unit, Department of Medicine, Sahlgrenska University Hospital , Diagnosvägen 11, SE-416 85 Gothenburg , Sweden

4. Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg , Medicinaregatan 3, SE-405 30 Gothenburg , Sweden

5. Centre for Child and Adolescent Psychiatry, Aarhus University Hospital Psychiatry , Palle Juul-Jensen Boulevard 99, DK-8200 Aarhus , Denmark

6. Department of Clinical Medicine, Aarhus University , Palle Juul-Jensen Boulevard 99, DK-8200 Aarhus , Denmark

7. Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital , Palle Juul-Jensen Boulevard 99, DK-8200 Aarhus , Denmark

Abstract

Abstract Background The burden of psychiatric morbidity, level of education, and work participation are currently unknown in patients with congenital ventricular septal defects (VSD). Methods and results In a Danish population-based cohort study using nationwide medical registries, the burden of psychiatric disorders, use of psychotropic agents, level of education, and work participation were examined in patients with isolated congenital VSD and controls from the general population matched by age and sex. Subjects with known chromosomal abnormalities were excluded. To compute estimates, Cox proportional regression model, Fine and Gray's competing risk regression, and Kaplan–Meier failure function were used. We included 8006 patients and 79 568 controls born before 2018. Median follow-up was 23 years. Compared with controls, patients with VSD displayed a hazard ratio (HR) of 1.24 [95% confidence interval (CI): 1.17–1.32] for any psychiatric disorder where the hazard for intellectual disabilities was most pronounced [HR of 3.66 (95% CI: 2.98–4.50)]. The use of psychotropic agents was higher in patients compared with controls [HR 1.14 (95% CI: 1.09–1.20)]. The work participation was lower in patients with VSD compared with controls (P < 0.001) and was lower in patients with VSD with a psychiatric disorder compared with those without (P < 0.001). The 40-year cumulative incidence of permanent social security benefits was 29% in patients with psychiatric disorders (vs. 21% in controls with psychiatric disorders) and 8% in patients without psychiatric disorders (vs. 4% in controls). Conclusion Patients with isolated VSD suffer from a higher burden of psychiatric disorders and display lower work participation compared with matched controls from the general Danish population. It is important to consider longer-term impacts on mental health, education, and subsequent employment in patients with VSD, in addition to cardiovascular effects, as these factors severely affect quality of life and have direct socioeconomic implications on an individual and societal level.

Funder

Novo Nordisk Fonden

Publisher

Oxford University Press (OUP)

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