February is American Heart Month, drawing attention to one of the strongest and most important organs of the human body. While media, researchers, and healthcare providers often discuss heart diseases as an adult issue, children, adolescents, and teenagers are equally susceptible to heart-related challenges. In fact, according to the Centers for Disease Control and Prevention (2023), congenital heart disease (CHD) is considered one of the most common birth defects, affecting about 1 percent (~40,000) of all live births per year within the United States.

The Heart and Mental Health

As if the possibility of a heart condition is not scary enough for parents, the association between heart-related issues and mental health is very high. More specifically, pediatric patients are at an increased risk for a range of mental health challenges, including anxiety, depression, disruptive behavior, attention-deficit/hyperactivity disorder (ADHD), substance use, and trauma (Gonzalez et al., 2001). These issues can extend from the doctor’s office to the home, and even affect school performance and peer relationships. Unfortunately, the mental health issues combined with heart issues can create a perfect storm of difficulties for both the youth and their family.

Why the Association?

Why are youth with heart issues at a higher risk for mental health conditions? That answer is complicated with no singular reason. In brief, healthcare providers and researchers have suggested that the stress around heart-related issues, sociocultural impacts (e.g., parenting style), learned helplessness and sadness coming from diagnoses, and underlying genetic predispositions are among the common theories for why children can develop mental health issues. Combine this with confusion over what is happening to them, as well as a lack of awareness of how to cope with high-level stress, and the issues can grow.

Interventions for Mental Health

Given all possible issues, the question becomes – what can families do to help the kiddos? Good news! There is a lot that can be done to help youth feel better. Pediatric mental healthcare providers, such as psychologists, social workers, and counselors are specially trained in ways to help children, adolescents, and teenagers not only cope with current issues, but prevent the development of future issues. Even better news: these specialists can help treat both the body and the mind!

On the physical health side of things, cardiac behavioral therapy targets lifestyle choices. Treatments can include, but aren’t necessarily limited to:

• Teaching alternatives to stress eating
• Improving sleep quality
• Increasing physical activity
• Improving diet and lowering weight (e.g., more fruits and vegetables, lower fatty foods)
• Controlling cholesterol
• Controlling any associated health risks (e.g., diabetes)
• Reducing any tobacco or alcohol use

On the mental health side of things, psychotherapy treatments, including cardiac behavioral therapy and cognitive behavioral therapy, can help youth:

• Identify symptoms and signs of stress
• Understand habits and association to heart issues and overall physical and mental health
• Set goals
• Understand physical and cognitive roadblocks to achieving success
• Apply scientifically tested techniques designed to address the primary medically focused issues, as well as any other mental health challenges (e.g., anxiety, depression, substance use, adjustment issues to the diagnosis, ADHD, trauma)

While often involving the youth working one-on-one with a mental healthcare professional, families are also included so they can understand what the child is going through, what therapeutic techniques can be helpful, and how they can help as the youth grows into an adult and must take care of themselves both physically and psychologically. Ultimately, while many consider heart-related issues a medical issue, don’t underestimate the power of psychotherapy in helping children, adolescents, and teen success, as psychotherapy cannot only help with general mental health conditions, but has been found to lower cardiovascular disease risk and related issues throughout the lifespan.

Finally, mental health-focused medications can also be prescribed by psychiatrists and other physicians to augment benefits from therapies.

Having a child, adolescent, or teenager with a heart condition can be stressful and scary, but parents are not in it alone. In addition to the cardiac team of physicians, nurses, and staff, mental health professionals can provide psychological care that can have a monumental and lifelong positive impact for the patient and their family. For questions or concerns regarding a child, adolescent, or teenager with signs of mental health issues, please reach out to the WVU Medicine Children’s Behavioral Medicine and Psychiatry Department at 304-598-4214.

Additional Resources & References

NIH Fact Sheets: https://www.nhlbi.nih.gov/education/heart-month/fact-sheets

Centers for Disease Control and Prevention. (2023). Data and statistics on congenital heart defects. https://www.cdc.gov/ncbddd/heartdefects/data.html

Gonzalez, V. J., Kimbro, R. T., Cutitta, K. E., Shabosky, J. C., Bilal, M. F., Penny, D. J., & Lopez, K. N. (2021). Mental health disorders in children with congenital heart disease. Pediatrics, 147(2), e20201693. https://doi.org/10.1542/peds.2020-1693

Art: https://www.vecteezy.com/free-vector/mental”>Mental Vectors by Vecteezy