O1007: Evaluating the Mental Health of Adolescent Patients with Cardiac Implantable Electronic Devices

Background: Adolescents with chronic illness are at higher risk for psychological distress. Research suggests that children with cardiac implantable electronic devices (CIEDs) have higher rates of depression and anxiety compared to their peers. However, little is known about factors that may mitigate these risks.

Methods: We sought to determine anxiety and depression symptom burden among adolescents with CIEDs, evaluate their effects on health-related quality of life (HRQoL) and executive functioning (ExF), and identify risk and protective factors for reducing mental health distress. In a single center, prospective study from 1/2023 – 12/2023, 34 patients with CIEDs, median 17 (range 12-21) years of age participated. Patients completed validated measures of anxiety, depression, resiliency, post-traumatic stress, HRQoL, cardiac HRQoL, and ExF. Primary outcomes were anxiety and depression symptom burden; secondary outcomes were HRQoL and ExF scores. Impairment was defined by HRQoL < 70 and ExF ≥65, respectively. Univariable linear regression model assessed association between HRQoL score and select variables. Additional variables of interest included sex, presence of congenital heart disease or cardiomyopathy, age at CIED implant, time from first CIED implant, CIED type, number of implantable cardioverter defibrillator (ICD) shocks.

Results: Mild or moderate anxiety or depression symptoms were reported in 45% and 41% of patients, respectively (table). Mean anxiety and depression scores were higher than adolescent normative values; 41% of patients reported HRQoL impairment, and 6% reported ExF impairment. Higher anxiety and depression scores were associated with lower HRQoL (coefficient -1.34 p=0.038 and -1.98 p=0.006, respectively) and cardiac HRQoL scores (coefficient -1.88 p< 0.001 and -1.94 p=0.001, respectively). Likewise, higher PTSD score was associated with lower HRQoL (coefficient -0.60 p=0.044) and cardiac HRQoL (-0.61 p=0.016). However, higher resilience score was associated with higher HRQoL score (coefficient 0.96, p=0.016). No other associations between anxiety or depression and aforementioned variables of interest were identified.

Conclusion: Over 40% of adolescents with CIEDs report mild or moderate symptoms of anxiety and depression. Higher anxiety, depression, and PTSD scores are associated with lower perceived quality of life. Higher resilience is associated with higher perceived quality of life. Identifying modifiable protective and risk factors are essential to improve the mental health of adolescents with CIEDs.