How Emotion Regulation and Illness Identity Shape Mental Health in Adults with Congenital Heart Disease.

Rumination showed the strongest positive correlations with both depression and anxiety among ACHD.

• Sample consisted of 1136 adults with congenital heart disease (ACHD), aged 18-85 years, with 59.7% female participants
• Participants were drawn from the National Register for Congenital Heart Defects, Berlin, and completed an online survey
• Rumination had the highest positive correlation with depressive symptoms compared to other emotion regulation strategies and illness identity variables
• Rumination also had the highest positive correlation with anxiety symptoms

Acceptance was most negatively correlated with both depression and anxiety symptoms.

• Acceptance showed the strongest negative correlation among all psychological variables assessed
• This pattern held for both depressive and anxiety symptom outcomes
• Variables assessed included emotion regulation strategies, illness perceptions, and illness identity

Rumination was the strongest unique predictor of both depressive and anxiety symptoms in multiple regression analyses.

• Rumination explained the highest unique variance for depression with semi-partial R² = 0.068
• Rumination explained the highest unique variance for anxiety with semi-partial R² = 0.072
• Significance level was set at p < 0.025 due to Bonferroni correction across the two regression models
• Models controlled for sociodemographic characteristics, CHD severity, and secondary diseases

Illness engulfment emerged as the second most strongly associated predictor of both depressive and anxiety symptoms.

• Illness engulfment refers to a pattern in which illness dominates one's identity
• It was a significant predictor alongside rumination in multiple regression analyses for both outcomes
• This finding suggests that identity-level variables contribute independently to emotional distress beyond emotion regulation strategies alone

Illness-related concerns were not significant predictors of depressive or anxiety symptoms in the regression models.

• Despite illness perceptions including concerns being assessed, they did not reach significance as predictors
• The Bonferroni-corrected significance threshold of p < 0.025 was applied
• This contrasts with the significant role of illness identity (engulfment) and emotion regulation (rumination)

ACHD are at increased risk for mental health problems, particularly depression and anxiety, and psychological factors may play a decisive role in explaining individual differences in emotional adjustment.

• The study aimed to identify psychological variables most strongly associated with depressive and anxiety symptoms when considered simultaneously
• Comprehensive models integrating multiple cognitive and emotional domains in ACHD were described as scarce prior to this study
• The study assessed emotion regulation, illness perceptions, and illness identity as potential psychological predictors