Emotional and behavioral problems in children with dilated cardiomyopathy

Background: Dilated cardiomyopathy (DCM) in children is an important cause of severe heart failure and carries a poor prognosis. Adults with heart failure are at increased risk of anxiety and depression and such symptoms predict adverse clinical outcomes such as mortality. In children with DCM, studies examining these associations are scarce. 

Aims: We studied whether in children with DCM: (1) the level of emotional and behavioral problems was increased as compared to normative data, and (2) depressive and anxiety problems were associated with the combined risk of death or cardiac transplantation. 

Methods: To assess emotional and behavioral problems in children with DCM, parents of 68 children, aged 1.5–18 years (6.9±5.7 years), completed the Child Behavior Checklist. 

Results: Compared to normative data, more young children (1.5–5 years) with DCM had somatic complaints (24.3% vs. 8.0%; p <.001), but fewer had externalizing problems (5.4% vs. 17.0%; p =.049). Overall internalizing problems did not reach significance. Compared to normative data, more older children (6–18 years) showed internalizing problems (38.7% vs. 17.0%; p =.001), including depressive (29.0% vs. 8.0%; p <.001) and anxiety problems (19.4% vs. 8.0%; p =.023), and somatic complaints (29.0% vs. 8.0%; p <.001). Anxiety and depressive problems, corrected for heart failure severity, did not predict the risk of death or cardiac transplantation. 

Conclusion: Children of 6 years and older showed more depressive and anxiety problems than the normative population. Moreover, in both age groups, somatic problems were common. No association with outcome could be demonstrated.