Abstract
Background/ObjectiveChild maltreatment is associated with increased risk of psychological consequences, contributes to morbidity and has long lasting effects on mental health and quality of life. Child maltreatment has not been assessed in patients with pulmonary arterial hypertension (PAH). We examined the prevalence of child maltreatment and determined their impact on disease severity in patients with PAH.MethodsA cross-sectional observational multicenter study at two PH centers in Germany was conducted. Patients with a confirmed diagnosis of PAH were given a self-administered questionnaire. Child maltreatment using the Childhood Trauma Questionnaire (CTQ), quality of life (QoL), anxiety, depression, and lifestyle factors were assessed and enhanced by clinical parameters 6-min walk distance (6MWD), WHO functional class (WHO FC), and serum levels of N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP). Prevalence rates of child maltreatment were compared to the general population and impact of child maltreatment on disease severity was calculated by logistic regression analysis.ResultsTwo-hundred and seventeen patients, 71% female and a median age of 56 years were enrolled in this study. Patients with PAH had higher rates of emotional abuse and lower rates of physical neglect compared to the German population while rates of emotional neglect, physical abuse, and sexual abuse did not differ between patients and German population. Patients with any form of child maltreatment were more likely to be active smokers, had a worse QoL and more anxiety or depression. Moderate associations between child maltreatment, mental health, QoL, lifestyle factors and clinical parameters could be observed. Logistic regression analysis showed a significant impact of CTQ-total score on disease severity with an OR of 1.022 (95%-CI: 1.001–1.042, p = 0.035).ConclusionWe found a higher rate of child maltreatment in patients with PAH in comparison to the German population. Correlations suggest moderate associations between CTQ-scores and mental health as well as QoL. Child maltreatment had significant impact on disease severity. However, effects were moderate. We conclude that child maltreatment has effects on mental health and quality of life in patients with PAH and may have limited effect on disease severity.
Highlights
Pulmonary arterial hypertension (PAH) is progressive pulmonary vascular disease
Disease severity indicated by ERS risk status, WHO functional class (FC) and NTproBNP, hemodynamics at time of diagnosis, and PAH treatment did not differ between groups
Our findings indicate a correlation between higher Child trauma questionnaire (CTQ) scores and higher Hospital Anxiety and Depression Scale (HADS) depression and anxiety scores
Summary
Pulmonary arterial hypertension (PAH) is progressive pulmonary vascular disease. Characterized by remodeling of pulmonary vasculature it leads to increased pulmonary vascular resistance [1, 2]. Patients with PAH are experiencing symptoms such as dyspnea on exertion, fatigue and with disease progression potentially clinical signs of heart failure These debilitating symptoms impair physical activities and quality of life (QoL) [3, 4]. Child maltreatment is defined as the abuse and neglect against a child under the age of 18 by a parent or other caregivers It includes all types of physical and/or emotional ill-treatment, sexual abuse and neglect which results in actual or potential harm to the child’s health, survival, development, or dignity in the context of a relationship of responsibility, trust, or power [14]. It has been associated with poorer overall health, greater physical, and emotional functional disability and higher degree of health risk behavior.
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