Table 2. Summary of Studies Included in the Systematic Review (N=30)
First Author (Year)Study LocationDesignSampleMental Health CategoryMeasuresResultsRisk of Bias Assessment
Cantwell‐Bartl (2013)30AustraliaCross‐sectional N=29 parents
55% mothers
TraumaPTSD module of SCID83% of PCCHDs met criteria for diagnosis of ASD or PTSD at time of hospital discharge for surgery.Low
Franck (2010)32UKLongitudinal N=326 parents
56% mothers
Parenting stressParent Stressor Scale: Infant HospitalizationParenting stress was highest before surgery and decreased slightly over time until an increase at 15 days postsurgery. Parents of infants with CHDs had greater parenting stress than parents of older children with CHDs.Low
Franich‐Ray (2013)33AustraliaCross‐sectional N=132 parents
58% mothers
TraumaASDS 35% of mothers and 18% of fathers met criteria for ASD when assessed 1 month posthospital discharge from surgery.
83% of all parents reported at least one trauma symptom.
Gronning‐Dale (2013)35NorwayLongitudinalN=60 parentsStress/distressSubjective Well‐Being Index Mothers of CCHD had significantly lower subjective well‐being than controls when assessed at 6 and 36 months postpartum.
Severity of CHD was a contributing factor in overall score; Parents of children with mild to moderate CHDs did not differ from controls.
Hearps (2014)37AustraliaCross‐sectional N=39 parents
72% mothers
Anxiety/depression stress/distressPsychosocial Assessment Tool 38% of PCCHDs reported psychosocial risk at a clinical level.
51% of mothers and fathers reported excessive worry (the most commonly endorsed item) and 25.6% of mothers and fathers reported having experienced sadness or depression.
Helfricht (2008)39SwitzerlandLongitudinal N=233 parents
58% mothers
TraumaPDS 16.4% of mothers and 13.3% of fathers met diagnostic criteria for acute PTSD at hospital discharge.
14.9% of mothers and 9.5% of fathers met diagnostic criteria for PTSD when assessed again 6 months postsurgical repair.
Landolt (2011)41SwitzerlandLongitudinal N=232
58% mothers
Trauma stress/distressPDS Medical Outcomes Study Short‐Form 36 25% of mothers and 26% of fathers reported PTSD 1 month postsurgery.
PTSD was associated with higher probability of low MHRQoL.
MHQoL was significantly lower than population norms for mothers upon discharge from the hospital.
MHRQoL changed significantly over time and, by 6 months postcardiac surgery, scores were higher than population norms for both mothers and fathers.
Menahem (2008)43AustraliaLongitudinal N=39 parents
74% mothers
Anxiety/depressionSTAI Levels of anxiety and emotional distress in PCCHDs prior to surgery were significantly higher than published norms.
Levels of anxiety returned to normative values 12 months postsurgery.
Rogers (1984)44USLongitudinalN=20 mothersAnxiety/depression stress/distressProfile of mood states Psychosocial Adjustment to Illness Scale Prior to surgery, no difference between PCCHDs and controls.
PCCHDs reported significantly more symptoms of depression and distress compared with controls 1 week postsurgery.
Levels of distress remained significantly higher among PCCHDs compared with controls at 2 months postsurgery; levels of depression were not significantly different at 2 months postsurgery.
Solberg (2011a)46NorwayLongitudinalN=242 mothersAnxiety/depressionEPDS 29% of CCHD mothers reported clinically significant symptoms of depression.
CCHD mothers were 2.45 times more likely to have depression compared with mothers of children with mild or moderate CHDs at 6 months postpartum.
Solberg (2011b)47NorwayLongitudinalN=162 mothersAnxiety/depressionHopkins Symptom Checklist Depression and anxiety symptoms increased at both 6 and 18 months postpartum.
Severity of CHD has prolonged effects on symptoms and results in overall higher depression scores.
Solberg (2012c)48NorwayLongitudinalN=141 mothersAnxiety/depressionHopkins Symptom Checklist Mothers of CHD infants are at overall increased risk for symptoms of depression from pregnancy through 36 months postpartum.
Mothers of children with CCHDs reported more symptoms of anxiety and depression at 36 months postpartum compared with controls.
Spijkerboer (2007)49The NetherlandsCross‐sectional N=161 parents
62% mothers
Stress/distressGHQPCCHDs exhibited significantly lower levels of distress compared with controls.Low
Utens (2002)52The NetherlandsLongitudinal N=150 parents
50% mothers
Anxiety/depressionGHQPCCHDs reported more distress and anxiety precardiac surgery when compared with parents of children who underwent catheterization, and controls; however these symptoms tended to decrease over time and PCCHDs scored lower than the control group on anxiety and depression when assessed 18 months postsurgery.Low
Visconti (2002)55USCross‐sectionalN=143 parentsParenting stressPSIPCCHDs reported significantly less stress and more social support than a normative sample 3 years postcardiac surgery.Low
Vrijmoet‐Wiersma (2009)56The NetherlandsCross‐sectional N=196
58% mothers
Anxiety/depression stress/distress parenting stress STAI
Mothers had significantly higher anxiety scores on the STAI compared with a normative reference group; no significant differences were found for fathers.
Both mothers and fathers scored comparable to instrument reference groups on the generic stress questionnaire of the GHQ.
Parenting stress levels on the PSI were comparable to normative reference groups.
Wray (2004)57UKLongitudinal N=102 parents
53% mothers
Stress/distressGHQ 65% of mothers and 48% of fathers reported being distressed immediately prior to surgery.
PCCHDs had significantly higher rates of distress than parents of healthy children.
PCCHDs experienced significant decreases in distress over time compared with no changes in parents of healthy children.
Bevilacqua (2013)28ItalyCross‐sectionalN=38 couplesAnxiety/depression stress/distressGHQ 46% of mothers and 20% of fathers were reported to be depressed.
82% of mothers and 61% of fathers reported psychological distress.
PCCHDs had significantly lower mental health component scores compared with controls.
Brosig (2007)29USCross‐sectionalN=26 parentsParenting stressPSIParenting stress was significantly lower for PCCHDs compared with controls.Medium
DeMaso (1991)31USCross‐sectionalN=99 mothersParenting stressPSI Mean score on PSI was significantly different from the comparative mean for “normal healthy children.
PSI scores were positively and significantly correlated with child behavior problems.
Guan (2014)36ChinaCross‐sectionalN=29 parents 66% mothersAnxiety/depressionGHQ Mothers of CCHDs reported higher levels of anxiety and depression compared with controls up to 5 years postsurgical repair.
Maternal anxiety was 4 times more likely if behavioral problems in the child were reported.
No significant differences were noted in fathers.
Helfricht (2009)38SwitzerlandLongitudinal N=61 parents
57% mothers
TraumaASDS 25% of PCCHDs were diagnosed with ASD when assessed at 3 weeks postsurgical repair.
ASDS scores were significantly correlated with measures of anxiety and depression.
ASDS scores were significantly predictive of PTSD 6 months posttrauma.
Jordan (2014)40AustraliaCross‐sectionalN=97 mothersAnxiety/depressionEPDSMaternal depression was significantly associated with boding difficulties and feelings of attachment towards the CHD infant.Medium
Majnemer (2006)42CanadaLongitudinal N=49 parents
82% mothers
Parenting stressPSI 27% of PCCHDs were classified as having high parenting stress.
If the child was cyanotic prior to first surgery, the odds of high parenting stress 5 years postsurgery increased by a factor of 4.5 (95% CI, 1.05–19.02).
Sarajuuri (2012)45FinlandCross‐sectional N=54 parents
56% mothers
Parenting stressPSIPCCHDs reported significantly more parenting stress than healthy controls.Medium
Tallon (2015)50AustraliaCross‐sectionalN=91 mothersAnxiety/depression stress/distressDepression Anxiety Stress Scale 30% of mothers reported some level of stress, 25% reported “abnormal” levels of anxiety, and 20% reported symptoms of depression.
Severity of CHD corresponded to higher levels of depression in mothers.
Torowicz (2010)51USCross‐sectionalN=129 mothersParenting stressPSIParenting demands of infants with critical CHD, regardless of single‐ventricle and biventricular physiology, were a source of increased parenting stress when compared with healthy controls (P<0.05).Medium
Uzark (2003)53USCross‐sectional N=80 parents
86% mothers
Parenting stressPSI PCCHDs experience greater levels of parenting stress than population norms.
25% of PCCHDs experience clinically significant levels of parenting stress.
Van Horn (2001)54USLongitudinalN=38 mothersAnxiety/depressionHow “depressed” and “anxious” on 7‐point scale At initial interviews, maternal anxiety was classified in high range; depressed mood determined in moderate‐high range.
At follow‐up, symptoms of anxiety and depression significantly decreased.
Gardner (1996)34UKLongitudinalN=20 mothersStress/distressGHQCHD mothers were significantly more distressed than controls 2 days before surgery, but were indistinguishable from controls 6 months postsurgery.High
  • Risk of bias based on 5‐item, 4‐domain, risk of bias assessment. Low risk=score=1 in domains I–IV; medium risk=study was insufficient in 1 domain (score=0 in domains I–III or score=1 in domain IV); high risk=study was insufficient in >1 domain (score of 0 or 1 in domain IV) in >1 domain. ASD indicates acute stress disorder; ASDS, Acute Stress Disorder Scale; CHDs, congenital heart defects; EPDS, Edinburgh Postnatal Depression Scale; GHQ, General Health Questionnaire; MHRQoL, mental health–related quality of life; PCCHDs, parents of children with critical congenital heart defects; PDS, Posttraumatic Stress Diagnostic Scale; PSI, Parenting Stress Index; PTSD, posttraumatic stress disorder; SCID, Structured Clinical Interview for DSM‐IV; STAI, State Trait Anxiety Inventory.