{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T22:43:15Z","timestamp":1789512195128,"version":"build-2803163510"},"reference-count":106,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T00:00:00Z","timestamp":1778112000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medical Sciences"],"abstract":"<jats:p>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\u2014especially depression and suicidality\u2014remains 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\u201342% 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.<\/jats:p>","DOI":"10.3390\/medsci14020244","type":"journal-article","created":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T12:15:07Z","timestamp":1778156107000},"page":"244","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Depression and Suicidality in Patients with Left Ventricular Assist Devices and Advanced Cardiac Therapies: Mechanisms, Risk Factors, and Clinical Management"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8692-0059","authenticated-orcid":false,"given":"Vasileios","family":"Leivaditis","sequence":"first","affiliation":[{"name":"Department of Cardiothoracic and Vascular Surgery, Westpfalz Klinikum, 67655 Kaiserslautern, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7198-2628","authenticated-orcid":false,"given":"Francesk","family":"Mulita","sequence":"additional","affiliation":[{"name":"Department of General Surgery, General Hospital of Eastern Achaia\u2013Unit of Aigio, 25100 Aigio, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4672-6396","authenticated-orcid":false,"given":"Chrysa","family":"Andrikopoulou","sequence":"additional","affiliation":[{"name":"Department of General Surgery, General Hospital of Eastern Achaia\u2013Unit of Aigio, 25100 Aigio, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ejona","family":"Shaska","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, \u201cAli Mihali\u201d Psychiatric Hospital, 9401 Vlora, Albania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elias","family":"Liolis","sequence":"additional","affiliation":[{"name":"Department of Oncology, General University Hospital of Patras, 26504 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0606-7287","authenticated-orcid":false,"given":"Sofoklis","family":"Mitsos","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Attikon General Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos","family":"Grapatsas","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery and Thoracic Endoscopy, Ruhrlandklinik, West German Lung Center, University Hospital Essen, University Duisburg-Essen, 45141 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Periklis","family":"Tomos","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Attikon General Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5645-662X","authenticated-orcid":false,"given":"Nikolaos G.","family":"Baikoussis","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Ippokrateio General Hospital of Athens, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1412","DOI":"10.1016\/j.cardfail.2023.07.006","article-title":"Heart Failure Epidemiology and Outcomes Statistics: A Report of the Heart Failure Society of America","volume":"29","author":"Bozkurt","year":"2023","journal-title":"J. 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