ArticleBMJ public health2026
Life course adversity and risk of incident atrial fibrillation: causal mediation analysis of psychological distress in the population-based Tromsø Study.
Article in BMJ public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: This study investigated the associations between adverse childhood experiences (ACEs), adverse adulthood experiences (AAEs) and incident atrial fibrillation (AF) and examined whether psychological distress mediates these associations in the general population. Methods: In this cohort study, we analysed data from 7288 individuals free of AF at the sixth survey of the Tromsø Study (2007-2008), followed through the seventh survey (2015-2016). ACEs and AAEs were assessed using self-reported exposure to emotional abuse, violence and problematic substance use in household. Psychological distress was measured using the Hopkins Symptom Checklist. Incident AF was identified through self-reported diagnosis. Multivariable regression and causal mediation analyses were conducted, adjusting for sociodemographic, behavioural and clinical covariates. Results: A total of 389 (5.3%) participants developed incident AF. Individuals exposed to both ACE and AAE had increased AF risk (OR=1.95; 95% CI 1.30 to 2.92) compared with unexposed individuals. Adverse experiences were associated with psychological distress, which mediated the relationship between adverse experiences and AF. Mediated proportions ranged from 27% to complete mediation. Psychological distress also mediated associations between specific types of adverse experiences and AF. A further elevated risk of AF was observed in individuals exposed to adverse experiences who also had psychological distress, including individuals exposed to ACE only (OR=3.85; 95% CI 1.68 to 8.78) and both ACE and AAE (OR=4.71; 95% CI 2.24 to 9.88). Conclusions: Cumulative exposure to adverse experiences across the life course is associated with incident AF, and psychological distress plays a key mediating role. Our findings suggest that psychological distress may help identify individuals at increased risk of AF and emphasise the need for further research integrating mental health factors into risk assessment and prevention strategies.
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