Electronic Mental Health Screening in a Pediatric Heart Failure and Transplant Clinic

Abstract

Mental health disorders have deleterious effects on outcomes in adult heart failure. Mental health is not systematically investigated or screened in pediatric heart failure and transplantation patients. Our institution implemented universal mental health screening for all patients age 11 or older in our pediatric heart failure and transplant clinic. 17 items are answered on a tablet while the patient awaits cardiac testing. Validated mental health screening tools are utilized: the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder scale (GAD-7). Scores for both scales range from 0-4 = no symptoms, 5-9 = mild symptoms, 10-14 = moderate symptoms, >15 = severe symptoms. Scores are immediately available in the electronic health record. The presence of suicidal ideation, severe depression and/or anxiety leads to notification of the psychologist for further intervention. 94 patients have been screened to date. Median age was 16.25 years (IQR 14.7-18.4). Median PHQ-9 score was 2 (IQR 0-6) and 2 (IQR 0-5.3) for GAD-7. Four patients (4.3%) reported severe depression, 8 (8.5%) moderate depression, 15 (16%) mild, 67 (71.3%) reported no depressive symptoms. Seven patients reported suicidal ideation (7.5%). Six patients (6.4%) reported severe anxiety, 8 (8.5%) moderate anxiety, 14 (14.9%) mild anxiety and 66 (70.2%) reported no anxiety. There were no differences in mental health scores between heart failure and transplant patients (Table 1). Eighteen new behavioral health interventions were implemented due to screening. Electronic mental health screening can successfully be employed in pediatric heart failure and transplant clinics. A significant portion have moderate to severe anxiety (14.9%) or moderate to severe depression (12.8%). Mental health screening has led to many behavioral health interventions in this population. Our initial experience supports the use of mental health screening in a pediatric heart failure and transplant clinic.