Death-Related Fears and Attachment Style in Children with Congenital Heart Disease

Abstract

Background. Death anxiety have a significant impact on an individual's psychological well-being. The specifics of these experiences depend on age, type of attachment, health status, and other factors. At the same time, the relationship between death-related fears and the type of attachment in children with congenital heart disease and children without cardiac pathologies has not been sufficiently studied.

Objectives. To study the role of attachment style as a factor determining the severity of fears associated with death in children with congenital heart disease and without cardiac pathologies.

Study Participants. 83 children aged 7–10 years were interviewed, 32 of them were diagnosed with Congenital heart disease (CHD) and were hospitalized (Mage = 8.63; SD = 1.129), 51 children had no cardiac pathology (Mage = 8.73; SD = 0.94).

Methods. Attachment style was assessed using a questionnaire on attachment to the mother in primary school age (E. Pupyreva). Understanding of death and death-related fears were assessed by means of "Tell a Story" (G. Makhortova) — Story No. 4 ("Death") and "Fears in Houses" (A.I. Zaharov, M.A. Panfilova) methodology. The statistical analysis was performed using the Kolmogorov-Smirnov test, Pearson's chi-square test, Fisher's exact test, Student's t-test, nonparametric Mann — Whitney U test, and Spearman correlation.

Results. The correlations between death-related fears and attachment style in children with and without CHD have been identified. Both groups turned to be similar in terms of attachment styles and understanding of death. For children with heart disease, there were no correlation between attachment styles and death-related fears. In healthy children, anxiety-ambivalent attachment correlated with more pronounced death-related fears, while avoidant attachment — with less intense death-related fears.

Conclusions. The experience of death-related fears in children with CHD is determined by specific factors of the disease, and not by the type of child-parent attachment.

References

Ainsworth, M.D.S., Blehar, M.C., Waters, E., Wall, S.N. (2015). Patterns of attachment: A psychological study of the strange situation. New York: Psychology Press.

Avdeeva, N.N., Kochetova, Y.A. (2008). Influence of child-parent relationship style on fears occurrence in children. Psikhologicheskaya nauka i obrazovanie = Psychological Science and Education, 13(4), 35–47. (In Russ.)

Bakanova, A.A., Andreeva-Ko-Cen-Din, M.A. (2018). Talking about death: the relationship of children and parents. In the Psychology of the XXI Century: Psychology as a Science, Art and Vocation. In: A.V. Shaboltas, S.D. Gurieva, (eds.). International Scientific Conference of Young Scientists: in 2 vol. Vol. 1. (April 12–25, 2018). (pp. 313–319). Saint Petersburg: VVM Publ. (In Russ.)

Bates, A.T., Kearney, J.A. (2015). Understanding death with limited experience in life: dying children's and adolescents' understanding of their own terminal illness and death. Current Opinion in Supportive and Palliative Care, 9(1), 40–45. https://doi.org/10.1097/SPC.0000000000000118

El Sehmawy, A.A., Younes Abd Elaziz, S., Abdelghany Elsheikh, A., Elsawy, F.A., Abd Elsalam Amin, A., Mostafa Omran, A., Younan Abd El Malek, A. (2024). Assessment of mental health and quality of life among children with congenital heart disease. Journal of Pediatric Rehabilitation Medicine, 17(3), 307–315. https://doi.org/10.3233/PRM-220109

Elutina, M.E. (2015). Aged people: attitude to death and tanatical worries. Sociologicheskie issledovaniya = Sociological Studies, (10), 111–119. (In Russ.)

Gavrilova, T.A. (2011). The first experience of realizing automorality. Yuzhno-rossijskij zhurnal social'nyh nauk = South Russian Journal of Social Sciences, (3), 4–17. (In Russ.)

Gonzalez, V.J., Kimbro, R.T., Cutitta, K.E., Shabosky, J.C., Bilal, M.F., Penny, D.J., Lopez, K.N. (2021). Mental health disorders in children with congenital heart disease. Pediatrics, 147(2), e20201693. URL: https://publications.aap.org/pediatrics/article-abstract/147/2/e20201693/36284/Mental-Health-Disorders-in-Children-With?redirectedFrom=fulltext (accessed: 12.10.2021).

Iverach, L., Menzies, R.G., Menzies, R.E. (2014). Death anxiety and its role in psychopathology: Reviewing the status of a transdiagnostic construct. Clinical Psychology Review, 34(7), 580–593. https://doi.org/10.1016/j.cpr.2014.09.002

Jahani, M., Noury, R., Hasani, J. (2020). Lived experience of children with heart disease and cancer about death anxiety: a phenomenological study. Journal of Qualitative Research in Health Sciences, 9(3), 229–238. https://doi.org/10.22062/JQR.2020.91517

Jay, S.M., Green, V., Johnson, S., Caldwell, S., Nitschke, R. (1987). Differences in death concepts between children wither cancer and physically healthy children. Journal of Clinical Child Psychology, 16(4), 301–306. https://doi.org/10.1207/s15374424jccp1604_2

Makhortova, G.H. (2004). Tell me a story. The projective methodology of the child's personality research. Moscow: Kogito-center Publ. (In Russ.)

Medvedeva, V.A., Kadirov, R.V. (2019). Attitude to life and death in adolescents with oncological disease. Klinicheskaya i special'naya psihologiya = Clinical Psychology and Special Education, 8(4), 39–57. (In Russ.). https://doi.org/10.17759/cpse.2019080403

Mikulincer, M. (2019). An attachment perspective on managing death concerns. In: C. Routledge, M. Vess, (eds.). Handbook of terror management theory. (pp. 243–257). London: Academic Press.

O'Halloran, C.M., Altmaier, E.M. (1996). Awareness of death among children: does a life-threatening illness alter the process of discovery? Journal of Counseling and Development, 74(3), 259–262. https://doi.org/10.1002/j.1556-6676.1996.tb01862.x

Panfilova M.A. (2000). Game therapy of communication. Tests and remedial games. A practical guide for psychologists, educators, and parents. Moscow: "Izdatel'stvo GNOM i D" Publ. (In Russ.)

Procaccia, R., Neimeyer, R.A., Veronese, G., Castiglioni, M. (2018). Children's representations of death: The role of age and attachment style. TPM-Testing, Psychometrics, Methodology in Applied Psychology, 25(4), 549–569.

Pupyreva, E.V. (2007). Emotsional'naya privyazannost' k materi kak faktor stanovleniya avtonomii lichnosti v mladshem shkol'nom vozraste: dissertatsiya kandidata psikhologicheskikh nauk. (Emotional attachment to mother as a factor of individual autonomy in the early school years). Cand. Sci. (Psychology), Moscow. (In Russ.)

Rostovtseva, M.E. (2023). The influence of thanatopsychological education on the mental and psychological health of children and adolescents. In the Current Issues of Psychiatry, Narcology and Clinical Psychology. In: A.M. Seledtsov, G.V. Akimenko, Yu.Yu. Kirina, L.V. Gukina, (eds.). Forth International Scientific and Practical Conference (October 20, 2023). (pp. 329–343). Kemerovo: Kemerovo State Medical University Publ. (In Russ.)

Rostovtseva, M.E. (2024). Children's understanding of death: formation of the concept of death and its main characteristics. Rossijskij psihologicheskij zhurnal = Russian Psychological Journal, 21(1), 87–107. (In Russ.). https://doi.org/10.21702/rpj.2024.1.5

Scheffold, K., Philipp, R., Koranyi, S., Engelmann, D., Schulz-Kindermann, F., Härter, M., Mehnert, A. (2018). Insecure attachment predicts depression and death anxiety in advanced cancer patients. Palliative and Supportive Care, 16(3), 308–316. https://doi.org/10.1017/S1478951517000281

Sivrikova, N.V., Lukicheva, E.A. (2022). Perception of death: dynamics and factors in childhood. Gumanitarnye issledovaniya. Pedagogika i psihologiya = Humanitarian Studies. Pedagogy and Psychology, (11), 72–80. (In Russ.). https://doi.org/10.24412/2712-827X-2022-11-72-80

Tesson, S., Butow, P.N., Marshall, K., Fonagy, P., Kasparian, N.A. (2022). Parent-child bonding and attachment during pregnancy and early childhood following congenital heart disease diagnosis. Health Psychology Review, 16(3), 378–411. https://doi.org/10.1080/17437199.2021.1927136

Vakhrushev, D.S., Zhukova, M.A. (2021). Current view on the dyadic synchrony mechanism. Sovremennaya zarubezhnaya psikhologiya = Journal of Modern Foreign Psychology, 10(2), 86–95. (In Russ.). https://doi.org/10.17759/jmfp.2021100209

Valikhani, A., Yarmohammadi-Vasel, M. (2014). The relationship between attachment styles and death anxiety among cardiovascular patients. Journal of Kerman University of Medical Sciences, 21(2), 355–367.

Yalom, I. (2000). Existential psychotherapy. Moscow: Klass Publ. (In Russ.)

Yurevich, A.V. (2017). Psychological factors of attitudes towards death. Nauka. Kul'tura. Obshchestvo = Science. Culture. Society, (3–4), 35–48. (In Russ.)

Zakharov, A.I. (2007). Day and night fears in children. Saint Petersburg: Rech' Publ. (In Russ.)