The effect of psychosocial interventions on anxiety and depression in congenital heart disease population: a systematic review and explorative meta-analysis
Authors: Arianna Magon A M , Syria Invernizzi S I , Cristina Arrigoni C A , Serena Flocco S F , Simona Devecchi S D V , Raluca Bianca Nedesca R B N , Laura Schianchi L S , Massimo Chessa M C , Rosario Caruso R C 
Published: July 2024

Abstract

Introduction
Patients with congenital heart disease (CHD) face various psychological challenges throughout their clinical journey, mainly attributed to symptoms of anxiety and depression. Approximately 19-43% of adults with CHD experience symptoms of depression and/or anxiety. In this scenario, addressing anxiety and depression through psychological interventions (PIs) becomes crucial. However, no available syntheses of the efficacy of PIs on anxiety and depression in the population with CHD have been performed thus far.

Purpose
To explore the efficacy of PIs on anxiety and depression within the CHD population.

Methods
We have conducted a systematic review up to January 2024 in these databases: PubMed, CINAHL, SCOPUS, and EMBASE. The study selection process adhered to specific inclusion criteria: (a) patients of all ages with CHD, (b) randomized controlled trial studies (RCTs), (c) published in English between 2000 and 2023, (d) focusing on PIs targeting anxiety and depression as outcomes. Cohen’s d was calculated to quantify and standardize the effect sizes between groups (treatment group vs. control group, considering an intention-to-treat approach) and within groups (from baseline to the last follow-up) to compute a cumulative effect size (Cohen’s d) per each study that controls potential differences of the outcome scores at the baseline in each study. Random-effect models were applied to pool each primary study's effect size (Stata 18 with the "metan.ado" add-on).

Results
Out of 558 records identified, only 3 RCTs met the inclusion criteria. These studies, published between 2017 and 2021, predominantly involved adults with CHD. None was conducted in Europe. Three main PIs were tested: Rational Emotive Behaviour Therapy, Mindfulness-based Stress Reduction, and Cognitive-Behaviour Therapy. Instead, the Hamilton Depression Rating Scale and Beck Depression Inventory were utilized, while the Hospital Anxiety and Depression Scale was employed to assess both depression and anxiety. For depression (N_intervention group = 93, N_control group = 85), the overall Cohen’s d was -1.04 [95% CI: -2.00, -0.07; p ≤ 0.001] with a moderate level of heterogeneity among studies (I² = 31.53%; Q(2) = 2.79; p = 0.25) as illustrated in Figure 1. Therefore, the findings indicate a moderate statistically significant effect of PIs in reducing depression up to three months post-intervention. Conversely, for anxiety (N_intervention group = 51, N_control group = 43), the overall Cohen’s d was 0 [95% CI: -0.96 +0.97; p ≤ 0.001] as illustrated in Figure 2.

Conclusions
This study summarizes the current evidence and brings the need for more attention in performing research employing PIs in adults with CHD. In fact, the paucity of available included RCTs sustains the need for more research. The results of this study highlight that PIs appear to be effective in reducing depression, while the studies performed in this population do not support evidence about anxiety.Figure 1.Figure 2.