Worsening Mental Health in Adolescent Heart Failure and Transplant Patients During the COVID-19 Pandemic

PURPOSE: Center for Disease Control data shows a significant increase in percentage of adults with symptoms of anxiety or depressive disorder during the COVID-19 pandemic. Adolescent heart failure (HF) and heart transplant (HT) recipients report higher prevalence of mood symptoms compared to general adolescent population. The effects of the COVID-19 pandemic on mental health outcomes in Adolescent HF and HT recipients remains unknown. METHODS: Electronic Mental Health Screens, Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7), were administered at quarterly intervals to patients aged 11 years and older presenting for ambulatory HF and HT care at our center. Screening results from August 2020- February 2021 (COVID Screen) were compared to results from August 2019- March 2020 (Pre-COVID Screen). When multiple Pre-COVID screens were available, the one closest to pandemic start date (April 2020) was used and in case of multiple COVID screens, the one completed during the peak of COVID wave (November-January 2021) was used. RESULTS: Demographic data for 37 patients with paired screens is summarized in Table 1. There was a significant increase in mean GAD-7 score, 2.51 (±2.98) Pre-COVID to 3.76 (±4.99) during COVID (p=0.04) and no significant change in mean PHQ-9 score, 2.73 (±3.71) Pre-COVID to 4.05 (±4.83) during COVID (p=0.06). Although there was no significant difference in Pre-COVID screen scores by age or race, the COVID Screen scores were significantly higher for younger adolescents and Black patients for both PHQ-9 and GAD-7 (Table 1). Nine patients (24.3%) were receiving treatment for mood disorders pre-COVID and 11 (29.7%) during COVID (p=0.50). CONCLUSION: Adolescents with HF and HT reported worsening anxiety symptoms during COVID similar to the worsening mental health trends for young adults noted nationwide. Younger and Black adolescents with HF or HT reported worse anxiety and depression symptoms during the pandemic compared to other demographics.