Impact of congenital heart disease on personality disorders in adulthood

• Published in: European journal of preventive cardiology 2024-08, Vol.31 (11), p.1324-1332
• Main Authors: Stapel, Britta, Winter, Lotta, Heitland, Ivo, Löffler, Friederike, Bauersachs, Johann, Westhoff-Bleck, Mechthild, Kahl, Kai G
• Format: Article
• Language: English
• Subjects: Adult; Anxiety - diagnosis; Anxiety - epidemiology; Anxiety - psychology; Depression - diagnosis; Depression - epidemiology; Depression - psychology; Female; Heart Defects, Congenital - epidemiology; Heart Defects, Congenital - psychology; Humans; Male; Mental Health; Middle Aged; Personality Disorders - diagnosis; Personality Disorders - epidemiology; Personality Disorders - psychology; Prevalence; Psychiatric Status Rating Scales; Quality of Life; Risk Factors; Young Adult
• ISSN: 2047-4873; 2047-4881; 2047-4881
• DOI: 10.1093/eurjpc/zwae030

Abstract Aims Adults with congenital heart disease (ACHD) constitute an ever-growing patient population characterized by high risks for cardiovascular- and mental disorders. Personality disorders (PDs) are associated with adverse physical and mental health. Studies assessing PD prevalence in ACHD are lacking. Methods and results Personality disorder point prevalence was assessed in 210 ACHD by Structured Clinical Interview for Axis-II Personality Disorders (SCID-II) and compared to meta-analytical data from the general population (GP). Depression and anxiety were measured by self-report (Hospital Anxiety and Depression Scale, HADS) and clinician rating (Montgomery–Åsberg depression rating scale, MADRS). Childhood maltreatment was assessed with the Childhood Trauma Questionnaire and quality-of-life (QOL) with the World Health Organization QOL Scale. PD prevalence was markedly higher in ACHD compared to GP (28.1 vs. 7.7%). Particularly borderline (4.8 vs. 0.9%) and cluster C (i.e. anxious or fearful; 17.1 vs. 3.0%) PDs were overrepresented. PD diagnosis was associated with a surgery age ≤12 years (χ²(1) = 7.861, ϕ = 0.195, P = 0.005) and higher childhood trauma levels (U = 2583.5, Z = −3.585, P < 0.001). ACHD with PD reported higher anxiety (HADS-A: U = 2116.0, Z = −5.723, P < 0.001) and depression (HADS-D: U = 2254.5, Z = −5.392, P < 0.001; MADRS: U = 2645.0, Z = −4.554, P < 0.001) levels and lower QOL (U = 2538.5, Z = −4.723, P < 0.001). Conclusion Personality disorders, particularly borderline- and cluster C, are significantly more frequent in ACHD compared to GP and associated with depression, anxiety, and decreased QOL. Data from the GP suggest an association with adverse cardiometabolic and mental health. To ensure guideline-based treatment, clinicians should be aware of the increased PD risk in ACHD. Lay Summary Adults with congenital heart disease (ACHD) constitute an ever-growing patient population characterized by an increased cardiovascular disease risk. Personality disorders (PDs) are associated with adverse mental and physical, in particular cardiovascular, health in the general population (GP). Studies assessing PD prevalence in ACHD have been lacking to date.Personality disorders, particularly borderline PD and cluster C (anxious or fearful) PDs, are highly prevalent in ACHD.Personality disorders are associated with heightened levels of anxiety and depression and decreased quality of life in ACHD.Heart surgery before puberty and increased leve