Skip to main content

Covert fears, anxiety and depression in congenital heart disease

  • S. Gupta (a1), R.M. Giuffre (a1), S. Crawford (a1) and J. Waters (a1)

This study compared anxiety, fears, depression and behavioural problems as occurring in children with congenital heart disease, comparing them with samples of normal children. It further considered the influence of maternal anxiety, as well as analyzing a subgroup of children with cyanotic forms of congenital heart disease to determine if they were at higher risk than acyanotic children for the problems identified.


We recruited 40 consecutive children with congenital heart disease without obvious psychoso-cial problems from the Cardiology clinic at the Alberta Children‘s Hospital. Of the 40 children, 39 families consented to have the children participate, of which 24 were cyanotic and 15 acyanotic. Children completed the revised versions of the Fear Survey Scale-Revised and the Child Manifest Anxiety Scale as well as the Child Depression Inventory. Mothers completed the Child Behaviour Checklist, and the State Trait Anxiety Scale.


Children with congenital heart diseases demonstrated more medical fears, and more physiological anxiety, than the normative samples. More specifically, children with cyanotic forms of congenital heart disease demonstrated more fears of the unknown, physiological anxiety, depression, and delinquent behaviors than the acyanotic children with congenital heart disease. Mothers of the children with cyanotic forms of congenital heart disease scored higher on both the state and trait scales, with higher maternal anxiety correlating with higher anxiety, medical fears and behavioral problems in the child.


In a clinical setting, children with congenital heart diseases who do not present with psychological adjustment problems are still at risk for covert physiological anxiety, medical fears, depression and behavioral problems. The children with cyanotic malformations represent a subgroup at higher risk for these problems, which may be further exacerbated by increased maternal anxiety.

Corresponding author
Dr. S. Gupta, Alberta Children‘s Hospital, 1820 Richmond Road SW, Calgary, Alberta T2T 5C7, Canada. Tel: (403)229-7970; Fax: (403)229-7086
Hide All
1.Leek I. Structural birth defects. In: Pless IB (ed). The epidemiology of childhood disorders. Oxford University Press, New York, 1994.
2.Nolan T, Pless B.Emotional correlates and consequences of birth defects. J Pediatrics 1986; 109: 201–216.
3.Eksi A, Molzan J, Savasir I, Guler N.Psychological adjustment of children with mild and moderately severe asthma. Eur Child Adoles Psychiatry 1995; 4: 77–84.
4.Inhelder B, Sinclair H, Bovet M.Learning and the development of cognition. Harvard University Press, Cambridge, MA., 1974. p.3.
5.Lerner RH.Concepts and theories of human development: The nature and nurture of intelligence. Addison Welsey, Reading, MA., 1976.
6.Myers-Vando R, Steward MS, Folkins CH, Hines P.The effects of congenital heart disease on cognitive development, illness causality concepts and vulnerability. Am J Orthopsychiat 1979; 49: 617–625.
7.Kramer HH, Awiszus D, Sterzel U, van Halteren A, Claben R.Development of personality and intelligence in children with congenital heart disease. J Child Psychol Psychiat 1989; 30: 299–308.
8.Bjornstad PThe impact of severe congenital heart disease on physical and psychosocial functioning in adolescents. Cardiol Young 1995; 5: 56–62.
9.Utens EMWJ, Verhulst FC, Meijboom FJ et al. Behavioural and emotional problems in children and adolescents with congenital heart disease. Psycho Med 1993; 23: 415–424.
10.Gustafsson PA, Kjellman N-IM, Ludvigsson J, Cederblad M.Asthma and family interaction. Arch Dis Child 1987; 62: 258–263.
11.Wallander JL, Varni JW, Babani L, Banis HT, Wilcox KT.Family resources as resistance factors for psychological malad-justment in chronically ill and handicapped children. J Pediatr Psychol 1989; 14: 157–173.
12.Linde LM.Psychiatric aspects of congenital heart disease. Psychiatric Clinics of North America 1982; 5: 399–405.
13.Warnes CA, Sommerville JS.Tricuspid atresia in adolescents and adults; current states and late complication. British Heart Journal 1986; 56: 535–543.
14.Ollendick TH.The Fear Survey Schedule for Children — Revised. Unpublished manuscript, Indiana State University, Terre Haute, Indiana, 1978.
15.Last CG, Francis G, Strauss CC.Assessing fears in anxiety-disordered children with the Revised Fear Survey Schedule for Children (FSSC-R). J Clin Child Psychol 1989; 18: 137–141.
16.Ollendick TH.Reliability and validity of the Revised Fear Survey Schedule for Children (FSSC-R). Behav Res Therapy 1983; 21: 685–692.
17.Reynolds CR, Richmond BO.Revised Children‘s Manifest Anxiety Scale. Western Psychological Services, Los Angeles, 1978.
18.Reynolds CR, Paget KD.National normative and reliability data for the revised Children‘s Manifest Anxiety Scale. School Psychol Rev 1983; 12: 324–336.
19.King N, Gullone E, Ollendick T.Fears in children and adolescents with chronic medical conditions. J Clin Child Psychol 1990; 19: 173–177.
20.Kovacks M.Children‘s Depression Inventory. Multi-Health Systems, Inc., Toronto, 1992.
21.Curry JF, Craighead WE.Attributional style and self-reported depression among adolescent inpatients. Child and Family Behavioural Therapy 1990; 12: 89–93.
22.Eason LJ, Finch AJ Jr, Brasted W, Saylor CF.The assessment of depression and anxiety in hospitalized pediattic patients. Child Psychiatry and Human Development 1985; 16: 57–64.
23.Achenbach TM.Manual for the Child Behaviour Checklist/4–18 and 1991 profile. University of Vermont, Burlington, VT., 1991.
24.Achenbach TM, Edelbrock C.Manual for the Child Behaviour Checklist and Revised Child Behaviour Profile. University of Vermont, Burlington, VT., 1983.
25.Spielberger CD, Gorsuch RL, Lushen R, Vagg PR, Jacobs GA.State-Trait Anxiety Inventory (Form Y). Consulting Psychologists Press, Inc., Palo Alto, CA., 1983.
26.Butz A, Alexander C.Anxiety in children with asthma. J Asthma 1993; 30: 199–209.
27.Blishen BR, Carroll WK, Moore C.The 1981 socioeconomic index for occupations in Canada. Can Rev Sociol Anthropol 1987; 24: 465–488.
28.Hambley J, Brazil K, Furrow D, Chaa YY.Demographic and psychosocial characteristics of asthmatic children in a Canadian rehabilitation setting. J Asthma 1989; 26: 167–175.
29.DeMaso DR, Campis LJ et al. The Impact of Maternal Perceptions and Medical Severity on the Adjustment of Childten with Congenital Heart Disease. J Pediatt Psychol 1991; 16: 137–149.
30.Linde LM, Rasof B, Dunn OJ, Rabb E.Attitudinal factors in congenital heart disease. Pediatrics 1966; 38: 92–101.
31.Linde LM.Physical and emotional aspects of congenital heart disease in children. Am J Cardiol 1971; 27: 712713.
32.Garson SL, Baer P. Psychological aspects of heart disease in Childhood. In: Garson A, Bricker jj, McNarmara DG (eds). Science and Practice of Pediatric Cardiology. Lea & Febiger, Philadelphia, 1990.
33.Spuckland I. Mental health and psychosocial functioning in adolescents with congenital heart disease. A comparison between adolescents born with severe heart defect and atrial septal defect. Acta Paediatr 1993; 82: 71–76.
34.Garson A, Williams RB, Reckless L: Long-term follow-up with patients with tetralogy of Fallot. Physical health and psy- chopathology. J Pediatr 1974; 85: 429–433.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Cardiology in the Young
  • ISSN: 1047-9511
  • EISSN: 1467-1107
  • URL: /core/journals/cardiology-in-the-young
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Full text views

Total number of HTML views: 0
Total number of PDF views: 6 *
Loading metrics...

Abstract views

Total abstract views: 165 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 19th November 2017. This data will be updated every 24 hours.