Cross-sectional study on the impact of adverse childhood experiences on psychological distress in patients with an implantable cardioverter-defibrillator

Objective: Previous studies implied detrimental effects of adverse childhood experiences (ACE) on cardiovascular disease and mental health. Still, data on the influence of ACE on psychological distress in patients with an implantable cardioverter-defibrillator (ICD) are lacking. Methods: We prospectively recruited 423 patients with an ICD. To determine associations between ACE (ACE questionnaire, cut-off >= 4), depression (Patient Health Questionnaire-8), anxiety (Generalized Anxiety Disorder-7 scale), and post-traumatic stress disorder (PTSD) symptoms (Post-Traumatic Stress Diagnostic Scale), we conducted a binary logistic regression analysis. Regression models were adjusted for conventional risk factors of psychological distress in ICD patients. To identify indirect mediating effects of resilience (Resilience Scale) on ACE and psychological distress, we applied the PROCESS regression path analysis modeling tool. Results: 49.1 % of all patients reported at least one ACE, and 9.7 % experienced even four or more ACE. A high-risk ACE profile (>= 4) was associated with higher levels of anxiety (OR 3.68, 95 % CI 1.37-9.84, p = 0.009), depression (OR 4.08, 95 % CI 1.67-9.97, p = 0.002), and PTSD symptoms (OR 2.20, 95 % CI 1.03-5.21, p = 0.041). Greater resilience partially mediated the relationship between ACE and depression (indirect effect 0.11, 95 % CI 0.01-0.26) as well as anxiety (indirect effect 0.08, 95 % CI 0.008-0.19). Conclusions: The current study suggests an association between ACE and psychological distress in patients with an ICD. However, resilience could mitigate the adverse effects of ACE. Future studies should strive to unravel the complex mechanisms of ACE and its effects on cardiovascular and mental health in ICD patients.