{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T17:32:08Z","timestamp":1787765528817,"version":"build-2784847793"},"reference-count":48,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,11,17]],"date-time":"2023-11-17T00:00:00Z","timestamp":1700179200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Adult congenital heart disease (ACHD) is a growing disease entity, posing questions concerning psychosocial outcomes across the lifespan. Spousal relationships were shown to benefit cardiovascular and mental health in the general population. We assessed the association of relationship status with anxiety and depression in ACHD patients and determined whether patients considered disease-related concerns potential mediators of relationship problems.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p><jats:italic>N<\/jats:italic>\u2009=\u2009390 ACHD patients were included. Self-report questionnaires were used to assess relationship status, ACHD-related relationship problems, socio-demographic variables, and depression and anxiety scores. Further, clinical parameters concerning the heart condition were determined.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p><jats:italic>N<\/jats:italic>\u2009=\u2009278 (71%) patients were currently in a relationship, while <jats:italic>N<\/jats:italic>\u2009=\u2009112 (29%) were not in a relationship. Groups did not significantly differ regarding age, sex, and cardiovascular parameters. Two-way MANCOVA with relationship status and sex as independent variables, controlling for age, NYHA class, and NT-proBNP, showed an association of relationship status with depression, while sex was associated with anxiety. <jats:italic>N<\/jats:italic>\u2009=\u200997 (25%) patients reported disease-related adverse effects on a current or prior relationship. In detail, worries about body image (<jats:italic>N<\/jats:italic>\u2009=\u200957, 61%), own fears (<jats:italic>N<\/jats:italic>\u2009=\u200951, 54%), problems arising from wish to have children (<jats:italic>N<\/jats:italic>\u2009=\u200933, 35%), fears regarding a joint future (<jats:italic>N<\/jats:italic>\u2009=\u200929, 31%), partner\u2019s fears or lack of understanding (<jats:italic>N<\/jats:italic>\u2009=\u200928, 30%), and sexual problems (<jats:italic>N<\/jats:italic>\u2009=\u200921, 22%) were cited.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Relationships status was associated with depression, while sex was associated with anxiety in ACHD patients. Relationship status as well as potential relationship problems, and the importance of social support for mental and physical well-being, should be considered when treating ACHD patients.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpsyt.2023.1260664","type":"journal-article","created":{"date-parts":[[2023,11,17]],"date-time":"2023-11-17T10:50:49Z","timestamp":1700218249000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Impact of relationship status on psychological parameters in adults with congenital heart disease"],"prefix":"10.3389","volume":"14","author":[{"given":"Britta","family":"Stapel","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Scharn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim","family":"Halling","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steffen","family":"Akkermann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivo","family":"Heitland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mechthild","family":"Westhoff-Bleck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai G.","family":"Kahl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,11,17]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1093\/ije\/dyz009","article-title":"Global birth prevalence of congenital heart defects 1970-2017: updated systematic review and meta-analysis of 260 studies","volume":"48","author":"Liu","year":"2019","journal-title":"Int J Epidemiol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"2241","DOI":"10.1016\/j.jacc.2011.08.025","article-title":"Birth prevalence of congenital heart disease worldwide: a systematic review and meta-analysis","volume":"58","author":"van der Linde","year":"2011","journal-title":"J Am Coll Cardiol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"2264","DOI":"10.1161\/CIRCULATIONAHA.110.946343","article-title":"Temporal trends in survival to adulthood among patients born with congenital heart disease from 1970 to 1992 in Belgium","volume":"122","author":"Moons","year":"2010","journal-title":"Circulation"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"e017704","DOI":"10.1161\/JAHA.120.017704","article-title":"Survival in children with congenital heart disease: have we reached a peak at 97%?","volume":"9","author":"Mandalenakis","year":"2020","journal-title":"J Am Heart Assoc"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"e012030","DOI":"10.1161\/JAHA.119.012030","article-title":"Congenital heart disease and risk of cardiovascular disease: a Meta-analysis of cohort studies","volume":"8","author":"Wang","year":"2019","journal-title":"J Am Heart Assoc"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"180","DOI":"10.1016\/j.jad.2016.06.047","article-title":"Mental disorders in adults with congenital heart disease: unmet needs and impact on quality of life","volume":"204","author":"Westhoff-Bleck","year":"2016","journal-title":"J Affect Disord"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1016\/j.ijcard.2008.06.042","article-title":"Depression and anxiety in adult congenital heart disease: predictors and prevalence","volume":"137","author":"Kovacs","year":"2009","journal-title":"Int J Cardiol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1067\/mhl.2003.26","article-title":"Depression and anxiety in adults with congenital heart disease: a pilot study","volume":"32","author":"Bromberg","year":"2003","journal-title":"Heart Lung"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"398","DOI":"10.1007\/s11897-018-0414-8","article-title":"Depression, anxiety, and cognitive impairment: comorbid mental health disorders in heart failure","volume":"15","author":"Angermann","year":"2018","journal-title":"Curr Heart Fail Rep"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1145","DOI":"10.1016\/j.amjmed.2016.05.018","article-title":"Mental health and cardiovascular disease","volume":"129","author":"Chaddha","year":"2016","journal-title":"Am J Med"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1136\/heartjnl-2019-315629","article-title":"Marital status, telomere length and cardiovascular disease risk in a Swedish prospective cohort","volume":"106","author":"Chen","year":"2020","journal-title":"Heart"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1016\/j.tcm.2019.05.012","article-title":"Marital status and outcomes in patients with cardiovascular disease","volume":"30","author":"Dhindsa","year":"2020","journal-title":"Trends Cardiovasc Med"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1937","DOI":"10.1136\/heartjnl-2018-313005","article-title":"Marital status and risk of cardiovascular diseases: a systematic review and meta-analysis","volume":"104","author":"Wong","year":"2018","journal-title":"Heart"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"5890","DOI":"10.1161\/JAHA.117.005890","article-title":"Marital status and outcomes in patients with cardiovascular disease","volume":"6","author":"Schultz","year":"2017","journal-title":"J Am Heart Assoc"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"246","DOI":"10.1136\/heartjnl-2019-316042","article-title":"Living alone makes the heart more vulnerable","volume":"106","author":"O'Keefe","year":"2020","journal-title":"Heart"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1016\/j.jad.2017.06.007","article-title":"The depression and marital status relationship is modified by both age and gender","volume":"223","author":"Bulloch","year":"2017","journal-title":"J Affect Disord"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"404","DOI":"10.1111\/j.1741-3729.2009.00562.x","article-title":"Marital status and depressive symptoms over time: age and gender variations","volume":"58","author":"LaPierre","year":"2009","journal-title":"Fam Relat"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"2237","DOI":"10.1016\/j.jacc.2016.03.477","article-title":"Quality of life of adults with congenital heart disease in 15 countries: evaluating country-specific characteristics","volume":"67","author":"Apers","year":"2016","journal-title":"J Am Coll Cardiol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"686169","DOI":"10.3389\/fpsyt.2021.686169","article-title":"Prevalence of Child maltreatment in adults with congenital heart disease and its relationship with psychological well-being, health behavior, and current cardiac function","volume":"12","author":"Proskynitopoulos","year":"2021","journal-title":"Front Psych"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"788013","DOI":"10.3389\/fpsyt.2021.788013","article-title":"Factors that influence adherence to medication in adults with congenital heart disease (ACHD)","volume":"12","author":"Halling","year":"2021","journal-title":"Front Psych"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"812611","DOI":"10.3389\/fpsyt.2022.812611","article-title":"Impact of COVID-19 on medical supply in adults with congenital heart disease","volume":"13","author":"Akkermann","year":"2022","journal-title":"Front Psych"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1554","DOI":"10.3390\/jcm10081554","article-title":"Depression associated with reduced heart rate variability predicts outcome in adult congenital heart disease","volume":"10","author":"Westhoff-Bleck","year":"2021","journal-title":"J Clin Med"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1192\/bjp.bp.115.169094","article-title":"Social support and protection from depression: systematic review of current findings in Western countries","volume":"209","author":"Gariepy","year":"2016","journal-title":"Br J Psychiatry"},{"key":"ref24","year":"2022"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1170","DOI":"10.1016\/S0735-1097(01)01272-4","article-title":"Task force 1: the changing profile of congenital heart disease in adult life","volume":"37","author":"Warnes","year":"2001","journal-title":"J Am Coll Cardiol"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1186\/1477-7525-1-29","article-title":"The hospital anxiety and depression scale","volume":"1","author":"Snaith","year":"2003","journal-title":"Health Qual Life Outcomes"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"906385","DOI":"10.3389\/fped.2022.906385","article-title":"Anxiety and depression in adults with congenital heart disease","volume":"10","author":"Lebherz","year":"2022","journal-title":"Front Pediatr"},{"key":"ref28","first-page":"12","article-title":"Prevalence of cardiac dysfunction among adult patients with congenital heart disease: a single-center investigation","volume":"20","author":"Khajali","year":"2019","journal-title":"Iran Heart J"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1161\/CIRCULATIONAHA.108.190690","article-title":"ACC\/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology\/American Heart Association task force on practice guidelines (writing committee to develop guidelines on the Management of Adults with Congenital Heart Disease). Developed in collaboration with the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons","volume":"118","author":"Warnes","year":"2008","journal-title":"J Am Coll Cardiol"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"1220","DOI":"10.1093\/eurheartj\/ehq032","article-title":"Mortality in adult congenital heart disease","volume":"31","author":"Verheugt","year":"2010","journal-title":"Eur Heart J"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"540","DOI":"10.1016\/j.annepidem.2006.12.006","article-title":"The protective effect of marriage on mortality in a dynamic society","volume":"17","author":"Jaffe","year":"2007","journal-title":"Ann Epidemiol"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1016\/j.socscimed.2006.08.031","article-title":"Marital status and mortality in the elderly: a systematic review and meta-analysis","volume":"64","author":"Manzoli","year":"2007","journal-title":"Soc Sci Med"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"148","DOI":"10.2307\/2137169","article-title":"Effects of social support from various sources on depression in elderly persons","volume":"31","author":"Dean","year":"1990","journal-title":"J Health Soc Behav"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"413","DOI":"10.1007\/BF00922627","article-title":"Distinctions between social support concepts, measures, and models","volume":"14","author":"Barrera","year":"1986","journal-title":"Am J Community Psychol"},{"key":"ref35","first-page":"385","volume-title":"Low social support and major depression: Research, theory and methodological issues. Risk factors in depression","author":"Lakey","year":"2008"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"511","DOI":"10.1037\/0882-7974.16.3.511","article-title":"Social exchange and well-being: is giving better than receiving?","volume":"16","author":"Liang","year":"2001","journal-title":"Psychol Aging"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"1765","DOI":"10.1111\/apa.14876","article-title":"Quality-of-life research in adult patients with congenital heart disease: current status and the way forward","volume":"108","author":"Moons","year":"2019","journal-title":"Acta Paediatr"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1186\/s12872-021-02026-1","article-title":"Quality of life and health status of hospitalized adults with congenital heart disease in Vietnam: a cross-sectional study","volume":"21","author":"Truong","year":"2021","journal-title":"BMC Cardiovasc Disord"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"1062386","DOI":"10.3389\/fpsyt.2022.1062386","article-title":"Quality of life in adult patients with congenital heart disease: results of a double-center study","volume":"13","author":"Khajali","year":"2022","journal-title":"Front Psych"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1136\/hrt.2010.200709","article-title":"Quality of life in adults with congenital heart disease: biopsychosocial determinants and sex-related differences","volume":"97","author":"Chen","year":"2011","journal-title":"Heart"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"S15","DOI":"10.1097\/01.psy.0000164013.55453.05","article-title":"Gender differences in the link between depression and cardiovascular disease","volume":"67","author":"Naqvi","year":"2005","journal-title":"Psychosom Med"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1177\/002214650704800204","article-title":"Depression and the psychological benefits of entering marriage","volume":"48","author":"Frech","year":"2007","journal-title":"J Health Soc Behav"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"1657","DOI":"10.1016\/j.amjcard.2012.01.397","article-title":"Social burden and lifestyle in adults with congenital heart disease","volume":"109","author":"Zomer","year":"2012","journal-title":"Am J Cardiol"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"505","DOI":"10.1007\/s10865-007-9124-5","article-title":"Cardiovascular reactivity during positive and negative marital interactions","volume":"30","author":"Nealey-Moore","year":"2007","journal-title":"J Behav Med"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1016\/j.amjcard.2018.09.033","article-title":"Marriage dissatisfaction and the risk of sudden cardiac death among men","volume":"123","author":"Isiozor","year":"2019","journal-title":"Am J Cardiol"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"369","DOI":"10.1037\/0893-3200.20.3.369","article-title":"Impairment and distress associated with relationship discord in a national sample of married or cohabiting adults","volume":"20","author":"Whisman","year":"2006","journal-title":"J Fam Psychol"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"737","DOI":"10.1080\/01494929.2019.1610136","article-title":"Marital quality and depression: a review","volume":"55","author":"Goldfarb","year":"2019","journal-title":"Marriage Fam Rev"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"417","DOI":"10.1007\/s00127-012-0559-9","article-title":"Relationship quality and levels of depression and anxiety in a large population-based survey","volume":"48","author":"Leach","year":"2013","journal-title":"Soc Psychiatry Psychiatr Epidemiol"}],"container-title":["Frontiers in Psychiatry"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2023.1260664\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,17]],"date-time":"2023-11-17T10:50:54Z","timestamp":1700218254000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2023.1260664\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,17]]},"references-count":48,"alternative-id":["10.3389\/fpsyt.2023.1260664"],"URL":"https:\/\/doi.org\/10.3389\/fpsyt.2023.1260664","relation":{},"ISSN":["1664-0640"],"issn-type":[{"value":"1664-0640","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,17]]},"article-number":"1260664"}}