Psychosocial Evaluation in Adults With Congenital Heart Disease

Corresponding Author

Another important issue that needs to be addressed is the difficulty and availability of receiving mental health care for patients with ACHD.
Many ACHD programs do not include psychosocial care, and this is something that should be modified. 4ereas different guidelines outline the necessity of these patients receiving mental health care, in actual fact, in clinical practice it is very difficult that psychologist are available in the programs, mainly for financial reasons.This is a major gap that compromises the quality and continuity of care for patients with ACHD.It is extremely important to provide mental health care by professionals who know the population and have the necessary professionalism to care for them, and ideally, the mental health care professionals should be included in the ACHD program and team, not consultants.Mental health care should be integrated and coordinated with medical care, and should address not only anxiety but also other psychosocial factors that may affect the wellbeing and outcomes of patients with ACHD. 8llus Psychosocial aspects in ACHD In

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centers in the U.S. The use of a validated instrument (the State-Trait Anxiety Inventory) to measure anxiety and the inclusion of a control group of patients with acquired heart disease are important strengths of the study.The PANIC (Pre-procedural ANxiety In adults with Congenital heart disease) Study sheds light on the elevated levels of trait anxiety in patients with ACHD and emphasizes the importance of addressing anxiety disorders in this population.By recognizing the predictors of anxiety and implementing proactive strategies, health care providers can alleviate preprocedural anxiety and improve the overall well-being of patients with ACHD.Furthermore, the study highlights the significance of conducting research specifically in the preoperative phase, as very few studies have been conducted during this critical period.The PANIC Study has some limitations that the authors themselves have acknowledged.Its crosssectional design precludes causal inference regarding anxiety and clinical characteristics or outcomes.Longitudinal studies are needed to examine the temporal relationship between anxiety and disease progression or prognosis in patients with ACHD.The lack of data on clinical outcomes and quality of life limits the evaluation of anxiety's impact on these domains.The voluntary nature of participation may introduce selection bias, potentially limiting the generalizability of the findings.Additionally, the predominantly White study sample from 4 tertiary referral centers in the U.S. may not reflect the diversity or care availability in other settings or regions.Another limitation of the study is its exclusive focus on anxiety, neglecting other important factors that can affect the well-being and outcomes of ACHD during the preoperative phase, mentioned in the previous paragraphs.Health literacy, which involves obtaining and understanding health information for decision-making and self-management, is crucial for managing the complex nature of ACHD.Social and emotional support, provided by caring individuals during times of need, can help mitigate the negative effects of stress and enhance coping and resilience in patients with ACHD. 4 Depression, a prevalent mood disorder, can worsen physical symptoms and increase mortality risk in patients with ACHD, yet it is often underdiagnosed or undertreated. 1PTSD, stemming from traumatic events like surgeries, can significantly impact patients with ACHD, leading to intrusive memories, avoidance behaviors, and reduced quality of life, yet it frequently goes unrecognized or misdiagnosed.findings of this study have several implications for clinical practice.First, they suggest that patients with ACHD may benefit from routine screening and assessment of anxiety, especially during hospitalization and before undergoing invasive procedures.Standardized psychometric screening tools can be used to identify patients at risk of anxiety disorders and refer them to appropriate mental health services.Second, they indicate that patients with ACHD may require more psychological support and education to cope with their medical condition and reduce their preprocedural anxiety.Psychological interventions such as cognitive-behavioral therapy, mindfulnessbased stress reduction, or relaxation techniques can help patients manage their negative thoughts, emotions, and behaviors related to their condition and procedure. 4Education interventions such as preprocedural information sessions or booklets can help patients understand their diagnosis, treatment options, risks, benefits, and expectations of the procedure.Third, they point to some potential risk factors for anxiety in patients with ACHD, such as younger age, financial stress, and greater disease complexity, which may help identify high-risk subgroups that need more tailored interventions. 9For example, younger patients may need more guidance and support in transitioning from pediatric to adult care, coping with developmental challenges such as education, employment, or relationships, and planning for their future health care needs.Patients with financial stress may need more assistance in accessing affordable and adequate health care services or insurance coverage.Patients with complex disease may need more frequent and specialized follow-up care or interventions to prevent or treat complications.
case of the absence of mental health care pro-Despite the initial assistance of ChatGPT in the drafting process, the core ideas, critical thinking, and final articulation of the work were solely the responsibility of the author.FUNDING SUPPORT AND AUTHOR DISCLOSURESThis study was partially supported by Ricerca Corrente funding from the Italian Ministry of Health to IRCCS Policlinico San Donato.Dr Callus has reported that he has no relationships relevant to the contents of this paper to disclose.
ADDRESS FOR CORRESPONDENCE: Dr Edward Callus, IRCCS Policlinico San Donato Research and University Hospital, Piazza E. Malan, 20097 San Donato Milanese (MI), Italy.E-mail: Edward.Callus@unimi.it.R E F E R E N C E S