Joseph Nano Uncategorized

Two Quick Screens Catch More Depression and Anxiety in Adults Born with Heart Defects

Large German registry study suggests switching to PHQ‑9 and GAD‑7 in routine care to avoid missed cases—then confirming with a clinical interview.

Adults living with congenital heart disease (ACHD) face higher risks of anxiety and depression, yet symptoms are often missed in day‑to‑day care. A new analysis of 1,486 ACHD patients from Germany compared four common screening questionnaires and found that PHQ‑9 (depression) and GAD‑7 (anxiety) identify more patients with symptoms than the widely used HADS scales—though at the cost of more false alarms. The authors recommend PHQ‑9 and GAD‑7 to minimize false negatives, with positive results followed by a proper diagnostic interview.  

What the study didResearchers invited adults (average age 36.8; 60.8% women) from the National Register for Congenital Heart Defects to complete four self‑report tools: PHQ‑9 and HADS‑D (depression) plus GAD‑7 and HADS‑A (anxiety). They also collected information on prior diagnoses and psychotherapy use (one‑third had ever had therapy; 14.2% were in therapy; 9.1% reported depression diagnosis/treatment; 6.1% anxiety/panic).  

Key findings at a glance

  • More cases found: PHQ‑9 flagged about 39% more people with depressive symptoms than HADS‑D; GAD‑7 identified ≈15% more with anxiety than HADS‑A. The summary graphic on page 1 and Figures 1–2 (pages 5–6)show why: PHQ‑9/GAD‑7 had higher sensitivity (PHQ‑9 89.6%, GAD‑7 86.8%) but lower specificity (PHQ‑9 48.1%, GAD‑7 53.5%) versus HADS‑D/HADS‑A (sensitivities 56.3%/78.0%; specificities 87.8%/67.2%).  Who is most affected: Women reported higher symptom levels on every scale. Notably, symptom severity did not differ by the complexity of the heart defect—meaning mental health needs cut across ACHD severity. Table 2 (page 5) details these patterns.  Why PHQ‑9 may over‑flag: PHQ‑9 includes fatigue/low‑energy items that can be influenced by physical symptoms of heart disease, which may raise scores. The authors note this could explain some extra positives—another reason to follow up screens with clinical interviews.  

Why it mattersEven mild depression or anxiety can worsen daily functioning and quality of life in ACHD—and is linked to higher risks after heart events. The study’s bottom line: in busy clinics, PHQ‑9 and GAD‑7 are better safety nets (fewer missed cases), while HADS tools are stricter filters (fewer false positives). The safest path is to screen broadly with PHQ‑9/GAD‑7 and confirm positives in a clinician‑led assessment. None of these questionnaires replaces a standardized clinical interview.  

What patients and families can do

  • If you were born with a heart defect and notice low mood, worry, poor sleep, or loss of energy, ask your care team for PHQ‑9/GAD‑7 screening—they take just a few minutes.  Remember: a screen is not a diagnosis. It’s a first step that should lead to a conversation and, if needed, treatment (counseling, medication, or both).  

Source: Ehmann A‑L et al., European Journal of Cardio‑Thoracic Surgery (2025): “Enhancing mental health in adults with congenital heart disease: comparison of depression and anxiety screening tools.” See the summary graphic on page 1and Figures 1–2 (pages 5–6) for sensitivity/specificity comparisons.  

Editor’s note: This article is for information only and is not a substitute for professional medical advice.