Psychosocial functioning in children with a congenital heart disease: attachment and emotion regulation strategies of children and parents as explanatory factors

Introduction: Children born with congenital heart disease (CHD) face increased risk of psychosocial difficulties. These may stem from challenges in parent-child relationships and related emotion regulation (ER) processes. This study examined whether insecure attachment and maladaptive parental emotion regulation strategies (ERS) are associated with psychological functioning in children with CHD. We also investigated whether these effects are associated through pathways involving children's own ER. Methods: In a sample of 218 families, with children between the ages 8 and 18 and their parents, participants completed questionnaires on attachment [Experiences in Close Relationships Scale-Revised Child (ECR-RC)], emotion regulation [Fragebogen zur erhebung der emotions regulation bei kindern und jugendlichen (FEEL-KJ/FEEL-E)], and psychosocial functioning [Strengths and Difficulties Questionnaire (SDQ)]. Results: Results showed that insecure attachment to mothers, but not fathers, had direct effects on children's self-reported psychological difficulties, particularly internalizing symptoms. These effects were partially associated through pathways involving children's maladaptive ER. Mother-reported outcomes mirrored these findings, while father-reported outcomes primarily revealed associations via associative pathways. Parental maladaptive ER showed no significant effects based on child or mother reports but did show both direct effects and associations via associative pathways based on father reports. Discussion: These findings highlight the importance of fostering secure parent-child relationships and strengthening children's ER skills through targeted interventions to better support psychological wellbeing in children with congenital heart disease.