The Role of the Psychologist in Adult Congenital Heart Disease Adrienne H. Kovacs, PhD a, * , Candice Silversides, MD b , Arwa Saidi, MB, BCh c , Samuel F. Sears, PhD d a Cardiac Psychology, Division of Cardiology, University Health Network, 399 Bathurst Street, 1-West-414, Toronto, ON M5T 2N2, Canada b Division of Cardiology, University Health Network, University of Toronto, Toronto General Hospital, 585 University Avenue, 5N-521, Toronto, ON M5G 2N2, Canada c Departments of Pediatrics and Internal Medicine, University of Florida, PO Box 100296, 1600 SW Archer Road, Gainesville, FL 32610, USA d Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Box 100165 UFHSC, 1600 SW Archer Road, Gainesville, FL 32610, USA Due to diagnostic, surgical, interventional, and pharmacologic advances, it is estimated that up to 95% of infants born with congenital heart defects will reach adulthood [1]. There are now more adults than children living with congenital heart disease [2], but there exists a less than ideal capac- ity to manage adults in pediatric or adult cardiol- ogy clinics. Adult congenital heart disease (ACHD) patients are at an increased risk of late cardiac complications including arrhythmias, en- docarditis, congestive heart failure, and pulmo- nary vascular disease. The effects of chronic illness, multiple surgical admissions, and hospital- ization in childhood, adolescence, and adulthood can have a significant impact on the psychological well-being of these patients. The evidence for psy- chological distress in impacting health outcomes and quality of life (QOL) across cardiac patient populations is now considered by some as ‘‘clear and convincing’’ [3]. Psychological distress is com- mon following cardiac diagnosis, with approxi- mately 20% to 50% of patients reporting adjustment difficulties [4]. Therefore, in addition to monitoring and treating the medical sequelae, it is important to recognize and manage the potential psychosocial consequences of growing up with congenital heart disease [5,6]. Interna- tional working groups have emphasized the inclu- sion of specialized mental health care for ACHD [7–9]. The summary document of the 32nd Be- thesda Conference (‘‘Care of the Adult with Con- genital Heart Disease’’) included the following statement: ‘‘The emotional health of adults with [congenital heart disease] should be a priority in the overall care of this patient population’’ [7]. Similarly, the Task Force on the Management of Grown Up Congenital Heart Disease of the Euro- pean Society of Cardiology stated, ‘‘The specialist service for grown-ups with congenital heart dis- ease must provide support for the many psychoso- cial problems in this population’’ [9]. In this article, the authors review the evidence that patients who have ACHD have special and unique psychosocial needs and discuss ways in which psychologists can be integrated into multi- disciplinary ACHD care teams. The psychosocial adjustment and QOL issues observed in adults who have grown up with congenital heart defects are reviewed. Three professional domains in which clinical health psychologists can contribute to an ACHD teamdprovision of clinical services, multidisciplinary research, and professional edu- cationdare discussed in detail. Finally, consider- ations for introducing or increasing the presence of psychology in ACHD teams are presented. * Corresponding author. E-mail address: adrienne.kovacs@uhn.on.ca (A.H. Kovacs). 0733-8651/06/$ - see front matter Ó 2006 Elsevier Inc. All rights reserved. doi:10.1016/j.ccl.2006.08.003 cardiology.theclinics.com Cardiol Clin 24 (2006) 607–618