ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Pediatric Cardiology
This article is part of the Research TopicAdvancements in Congenital Heart Disease: Diagnosis and Management InnovationsView all 17 articles
Psychosocial Functioning in Children with a Congenital Heart Disease (CHD): Attachment and Emotion Regulation Strategies of Children and Parents as Explanatory Factors
Provisionally accepted
- 1Ghent University Hospital, Ghent, Belgium
- 2Universiteit Gent, Ghent, Belgium
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Children born with congenital heart disease (CHD) face increased risk for psychosocial difficulties. These may stem from challenges in parent-child relationships and related emotion regulation 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 emotion regulation (ER). In a sample of 218 families, children aged 8 to 18 and their parents, participants completed questionnaires on attachment (ECR-RC), emotion regulation (FEEL-KJ/FEEL-E), and psychosocial functioning (SDQ). 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. These findings highlight the importance of fostering secure parent-child relationships and strengthening children’s ER skills through targeted interventions to better support psychological well-being in children with congenital heart disease.
Keywords: Emotion Regulation, Psychological adaptation, Child Psychology, congenital heartdefects, Parent-Child Relations, Internalizing and externalizing disorders, Family Therapy
Received: 02 Jul 2025; Accepted: 17 Nov 2025.
Copyright: © 2025 Mels, De Groote, Vandekerckhove and Goossens. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Saskia Mels, saskia.mels@uzgent.be
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