Depression and Suicidality in Patients with Left Ventricular Assist Devices and Advanced Cardiac Therapies: Mechanisms, Risk Factors, and Clinical Management.

BACKGROUND

The increasing use of advanced cardiac surgical therapies, particularly left ventricular assist devices (LVADs), has improved survival in patients with end-stage heart failure. However, the psychological burden associated with these therapies-especially depression and suicidality-remains underrecognized.

OBJECTIVES

This narrative review synthesizes current evidence on the prevalence, underlying mechanisms, risk factors, screening strategies, and management of depression and suicidality in patients undergoing LVAD implantation and other advanced cardiac surgical interventions.

METHODS

A structured literature search of PubMed, Embase, and Scopus was conducted for studies published between 2020 and 2025 addressing depression, suicidal ideation, suicide attempts, and psychological distress in LVAD and advanced cardiac therapy populations.

RESULTS

Depression affects approximately 20-42% of patients with advanced heart failure, including those supported with LVADs, while suicidal ideation is reported in up to 12% of LVAD recipients, with higher rates of suicide attempts compared to other chronic disease populations. Risk factors are multifactorial and can be categorized into patient-related, disease-related, device-related, and psychosocial domains. Proposed mechanisms include neurohormonal dysregulation, systemic inflammation, and psychological processes such as loss of autonomy and existential distress. Although validated screening tools and multidisciplinary management strategies are available, their implementation in routine clinical practice remains inconsistent.

CONCLUSIONS

Depression and suicidality represent significant and complex challenges in patients undergoing advanced cardiac therapies, particularly LVAD support. Systematic mental health screening and integrated, multidisciplinary care models are essential to improve patient outcomes. Future research should focus on longitudinal assessment, standardized suicide risk monitoring, and the development of targeted, evidence-based interventions for this vulnerable population.