Adverse childhood experience, attachment style, and quality of life in adult congenital heart disease

Abstract

Background: Adverse childhood experiences (ACEs) are associated with poorer health outcomes, including a higher risk of acquired cardiovascular disease. This was the first investigation of ACEs in adults with congenital heart disease (CHD). Methods: Adults with CHD completed the following surveys in the outpatient setting: ACE questionnaire, measure of attachment style, and linear analogue measure of quality of life. We performed Chi-square tests and t-tests to explore relationships between ACE scores with other surveys as well as demographic and clinical characteristics. Results: A total of 100 patients participated in the study (age 40 ​± ​13 years; 60% female); 90% had CHD of moderate or great complexity. The total number of reported ACEs ranged from 0 to 9 out of a possible total of 10, with a mean of 2.6 ​± ​2.5.30% of participants reported ≥ 4 ACEs, which is higher than the reported prevalence in the general population. The most frequently reported ACEs were parental divorce (46%), emotional abuse (42%), and parental substance abuse (32%). ACE scores did not differ as a function of age, sex or CHD defect complexity. Total ACE scores were significantly associated with two attachment styles (preoccupied: p ​< ​0.001; fearful: p ​= ​0.002). Quality of life scores were lower among those with ≥4 ACEs, although this did not reach statistical significance (68.6 vs. 75.7, p ​= ​0.07). Conclusion: ACEs appear to be common in adults with CHD and are associated with negative attachment styles. Further research is needed to determine the impact of ACEs on long-term outcomes.

Keywords

• Adult congenital heart disease
• Quality of life
• Adverse childhood experiences
• Attachment style