What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Cardiovascular disease (n=194). Primary outcome: Self-reported non-adherence (Adjusted R2 0.149, p=<0.01).

June 23, 2022Open Access

Associations Between Personality Functioning, Childhood Trauma and Non-adherence in Cardiovascular Disease: A Psychodynamically-Informed Cross-Sectional Study

Q: What are the key findings of this study?

Higher deficits in personality functioning, higher levels of childhood trauma, and male gender were significantly associated with self-reported non-adherence in cardiovascular disease patients.

KHKarl HallerCharité - Universitätsmedizin Berlin SFStefan FritzscheAgaplesion Bethanien Krankenhaus IKIrina KrusePeoples' Friendship University of Russia

Key Result

Higher deficits in personality functioning, higher levels of childhood trauma, and male gender were significantly associated with self-reported non-adherence in cardiovascular disease patients.

Study Design

Type

Cross-Sectional (n=194)

Multicenter

Structured PICO

Are personality functioning and childhood trauma associated with non-adherence in cardiovascular disease patients?

Population

194 cardiology inpatients with a history of cardiological disease (secondary prevention), mean age 70.6 years, 59.3% male, recruited from a general hospital in northeast Germany.

Intervention

Assessment of personality functioning (OPD-SQS), childhood trauma (CTS), depression (PHQ-9), and anxiety (GAD-7)

Outcome

Self-reported non-adherence measured by a novel 3-item scale assessing tendency not to start treatments, implement lifestyle changes, or discontinue treatmentpatient reported

In cardiovascular disease patients, deficits in personality functioning and childhood trauma are significantly associated with non-adherence, suggesting that basic psychological impairments may be more important than symptoms of depression or anxiety for treatment compliance.

Main Result

Effect estimate: Adjusted R2 0.149

p-value: p=<0.01

Limitations

All variables were measured using self-report, which may be subject to recall bias or social desirability.
The cross-sectional design prevents clear statements about the causality of the associations.
The measurement of childhood trauma may have been influenced by recall bias due to the advanced age of the sample.
The sample reported good overall personality functioning, with low personality functioning presenting rarely.

Abstract

Objective Although treatment adherence and lifestyle changes significantly improve the prognosis of cardiovascular disease, many patients do not comply with clinician recommendations. Personality functioning appears to be of importance and is hypothesized to be superior to symptom-based measures in explaining individual differences in non-adherence. Methods 194 cardiology inpatients (mean age = 70.6 years, 60% male) were assessed using self-report measures in a cross-sectional design. Patients were assessed using the short version of the Operationalized Psychodynamic Diagnosis Structure Questionnaire (OPD-SQS) to measure personality functioning, as well as the Childhood Trauma Screener (CTS), the Patient Health Questionnaire (PHQ-9) for symptoms of depression, and the Generalized Anxiety Disorder Scale-7 (GAD-7). To assess non-adherence we introduced a brief, novel scale. Results Non-adherence correlated significant with personality functioning ( r = 0.325), childhood trauma ( r = 0.204) and depressiveness ( r = 0.225). In a stepwise multiple regression analysis with socio-demographic variables inputted into the model, higher deficits in personality functioning, higher levels of childhood trauma, and male gender were associated with non-adherence (adjusted R 2 = 0.149, F (3,190) = 12.225, p 0.01). Level of depressive symptoms, anxiety, age, education, and income showed no significant additional predictive value and were excluded from the model. Conclusion In cardiovascular disease, personality functioning, childhood trauma and male gender are associated with non-adherence and appear to be more important than symptom reports of depression and anxiety. This highlights the relevance of basic impairments in intra- and interpersonal functioning in chronic disease, where the patient’s adherence is central.

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