Quality of Life Research

, Volume 25, Issue 2, pp 423–433 | Cite as

Associations between adult attachment and: oral health-related quality of life, oral health behaviour, and self-rated oral health

  • Pamela MeredithEmail author
  • Jenny Strong
  • Pauline Ford
  • Grace Branjerdporn



Although adult attachment theory has been revealed as a useful theoretical framework for understanding a range of health parameters, the associations between adult attachment patterns and a range of oral health parameters have not yet been examined. The aim of this study was to examine potential associations between attachment insecurity and: (1) oral health-related quality of life (OHRQoL), (2) oral health behaviours, and (3) self-rated oral health. In association with this aim, sample characteristics were compared with normative data.


The sample in this cross-sectional study was comprised of 265 healthy adults, recruited via convenience sampling. Data were collected on attachment patterns (Experiences in Close Relationships Scale-Short Form, ECR-S), OHRQoL (Oral Health Impact Profile-14, OHIP-14), oral health behaviours (modified Dental Neglect Scale, m-DNS), and self-rated oral health (one-item global rating of oral health). Multivariate regression models were performed.


Both dimensions of attachment insecurity were associated with lowered use of favourable dental visiting behaviours, as well as decreased OHRQoL for both overall well-being and specific aspects of OHRQoL. Attachment avoidance was linked with diminished self-rated oral health.


This study supports the potential value of an adult attachment framework for understanding a range of oral health parameters. The assessment of a client’s attachment pattern may assist in the identification of people who are at risk of diminished OHRQoL, less adaptive dental visiting behaviours, or poorer oral health. Further research in this field may inform ways in which attachment approaches can enhance oral health-related interventions.


Adult attachment Oral health-related quality of life Oral health behaviours Self-rated oral health Psychosocial factors 




Compliance with ethical standards

Conflict of interest

The authors declare no conflicts of interest.


  1. 1.
    Fagundes, C. P., Jaremka, L. M., Malarkey, W. B., & Kiecolt-Glaser, J. K. (2014). Attachment style and respiratory sinus arrhythmia predict post-treatment quality of life in breast cancer survivors. Psycho-Oncology, 23(7), 820–826.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Ciechanowski, P., Russo, J., Katon, W., Von Korff, M., Ludman, E., Lin, E., et al. (2004). Influence of patient attachment style on self-care and outcomes in diabetes. Psychosomatic Medicine, 66(5), 720–728.CrossRefPubMedGoogle Scholar
  3. 3.
    Ciechanowski, P., Russo, J., Katon, W., Simon, G., Ludman, E., Von Korff, M., et al. (2006). Where is the patient? The association of psychosocial factors and missed primary care appointments in patients with diabetes. General Hospital Psychiatry, 28(1), 9–17.CrossRefPubMedGoogle Scholar
  4. 4.
    McWilliams, L. A., & Bailey, S. J. (2010). Associations between adult attachment ratings and health conditions: Evidence from the National Comorbidity Survey Replication. Health Psychology, 29(4), 446–453.CrossRefPubMedGoogle Scholar
  5. 5.
    Ahrens, K. R., Ciechanowski, P., & Katon, W. (2012). Associations between adult attachment style and health risk behaviors in an adult female primary care population. Journal Psychosomatic Research, 72(5), 364–370.CrossRefGoogle Scholar
  6. 6.
    Sockalingam, S., Wnuk, S., Strimas, R., Hawa, R., & Okrainec, A. (2011). The association between attachment avoidance and quality of life in bariatric surgery candidates. Obesity Facts, 4(6), 456–460.CrossRefPubMedGoogle Scholar
  7. 7.
    Meredith, P., Strong, J., & Feeney, J. A. (2006). Adult attachment, anxiety, and pain self-efficacy as predictors of pain intensity and disability. Pain, 123(1–2), 146–154.CrossRefPubMedGoogle Scholar
  8. 8.
    Bowlby, J. (1979). The Bowlby–Ainsworth attachment theory. Behavioral and Brain Sciences, 2(4), 637–638.CrossRefGoogle Scholar
  9. 9.
    Ravitz, P., Maunder, R., Hunter, J., Sthankiya, B., & Lancee, W. (2010). Adult attachment measures: A 25-year review. Journal Psychosomatic Research, 69(4), 419–432.CrossRefGoogle Scholar
  10. 10.
    Bartholomew, K. (1990). Avoidance of intimacy: An attachment perspective. Journal of Social and Personal Relationships, 7(2), 147–178.CrossRefGoogle Scholar
  11. 11.
    Mikulincer, M., & Shaver, P. R. (2012). An attachment perspective on psychopathology. World Psychiatry, 11(1), 11–15.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Bartholomew, K., & Horowitz, L. M. (1991). Attachment styles among young adults: A test of a four-category model. Journal of Personality and Social Psychology, 61, 226–244.CrossRefPubMedGoogle Scholar
  13. 13.
    Brennan, K. A., Clark, C. L., & Shaver, P. R. (1998). Self-report measurement of adult attachment: An integrative overview. In J. A. Simpson & W. S. Rholes (Eds.), Attachment theory and close relationships (pp. 46–76). New York: The Guildford Press.Google Scholar
  14. 14.
    Hazan, C., & Shaver, P. (1987). Romantic love conceptualized as an attachment process. Journal of Personality and Social Psychology, 52(3), 511.CrossRefPubMedGoogle Scholar
  15. 15.
    Ainsworth, M. D. S., Blehar, M. C., Waters, E., & Wall, R. (1978). Patterns of attachment: Assessed in the strange situation and at home. Hillsdale: Erlbaum.Google Scholar
  16. 16.
    Maunder, R. G., & Hunter, J. J. (2009). Assessing patterns of adult attachment in medical patients. General Hospital Psychiatry, 31(2), 123–130.CrossRefPubMedGoogle Scholar
  17. 17.
    Bennett, J. K., Fuertes, J. N., Keitel, M., & Phillips, R. (2011). The role of patient attachment and working alliance on patient adherence, satisfaction, and health-related quality of life in lupus treatment. Patient Education and Counseling, 85(1), 53–59.CrossRefPubMedGoogle Scholar
  18. 18.
    Ciechanowski, P. S., Walker, E. A., Katon, W. J., & Russo, J. E. (2002). Attachment theory: A model for health care utilization and somatization. Psychosomatic Medicine, 64(4), 660–667.PubMedGoogle Scholar
  19. 19.
    Locker, D., & Allen, F. (2007). What do measures of ‘oral health-related quality of life’ measure? Community Dental Oral Epidemiology, 35(6), 401–411.CrossRefGoogle Scholar
  20. 20.
    Agostini, A., Moretti, M., Calabrese, C., Rizzello, F., Gionchetti, P., Ercolani, M., et al. (2014). Attachment and quality of life in patients with inflammatory bowel disease. International Journal of Colorectal Disease, 29(10), 1291–1296.CrossRefPubMedGoogle Scholar
  21. 21.
    Caplan, R. A., Maunder, R. G., Stempak, J. M., Silverberg, M. S., & Hart, T. L. (2014). Attachment, childhood abuse, and IBD-related quality of life and disease activity outcomes. Inflammatory Bowel Diseases, 20(5), 909–915.CrossRefPubMedGoogle Scholar
  22. 22.
    Hill, E. M., & Gick, M. L. (2013). Attachment and barriers to cervical screening. Journal of Health Psychology, 18(5), 648–657.CrossRefPubMedGoogle Scholar
  23. 23.
    Maunder, R. G., & Hunter, J. J. (2001). Attachment and psychosomatic medicine: Developmental contributions to stress and disease. Psychosomatic Medicine, 63(4), 556–567.CrossRefPubMedGoogle Scholar
  24. 24.
    Graetz, C., Ehrenthal, J. C., Senf, D., Semar, K., Herzog, W., & Dörfer, C. E. (2013). Influence of psychological attachment patterns on periodontal disease—A pilot study with 310 compliant patients. Journal of Clinical Periodontology, 40(12), 1087–1094.CrossRefPubMedGoogle Scholar
  25. 25.
    Sambunjak, D., Nickerson, J. W., Poklepovic, T., Johnson, T. M., Imai, P., Tugwell, P., et al. (2011). Flossing for the management of periodontal diseases and dental caries in adults. Cochrane Database of Systematic Reviews, 12(12), 17–20. doi: 10.1002/14651858.CD008829.pub2.
  26. 26.
    Zimmermann, H., Zimmermann, N., Hagenfeld, D., Veile, A., Kim, T. S., & Becher, H. (2014). Is frequency of tooth brushing a risk factor for periodontitis? A systematic review and meta‐analysis. Community Dentistry and Oral Epidemiology, 43(2), 116–127.Google Scholar
  27. 27.
    Davenport, C. F., Elley, K. M., Fry-Smith, A., Taylor-Weetman, C. L., & Taylor, R. S. (2003). The effectiveness of routine dental checks: A systematic review of the evidence base. British Dental Journal, 195(2), 87–98.CrossRefPubMedGoogle Scholar
  28. 28.
    Kranz, A. M., Rozier, R. G., Preisser, J. S., Stearns, S. C., Weinberger, M., & Lee, J. Y. (2014). Preventive services by medical and dental providers and treatment outcomes. Journal of Dental Research, 93(7), 633–638.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Sanders, A. E., & Slade, G. D. (2006). Deficits in perceptions of oral health relative to general health in populations. Journal of Public Health Dentistry, 66(4), 255–262.CrossRefPubMedGoogle Scholar
  30. 30.
    Thomson, W. M., Mejia, G. C., Broadbent, J. M., & Poulton, R. (2012). Construct validity of Locker’s global oral health item. Journal of Dental Research, 91(11), 1038–1042.CrossRefPubMedGoogle Scholar
  31. 31.
    Mavaddat, N., Parker, R. A., Sanderson, S., Mant, J., & Kinmonth, A. L. (2014). Relationship of self-rated health with fatal and non-fatal outcomes in cardiovascular disease: A systematic review and meta-analysis. PLoS One, 9(7), e103509.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Kidd, T., & Sheffield, D. (2005). Attachment style and symptom reporting: Examining the mediating effects of anger and social support. British Journal of Health Psychology, 10(4), 531–541.CrossRefPubMedGoogle Scholar
  33. 33.
    Wearden, A. J., Lamberton, N., Crook, N., & Walsh, V. (2005). Adult attachment, alexithymia, and symptom reporting: An extension to the four category model of attachment. Journal of Psychosomatic Research, 58(3), 279–288.CrossRefPubMedGoogle Scholar
  34. 34.
    Waldinger, R. J., Schulz, M. S., Barsky, A. J., & Ahern, D. K. (2006). Mapping the road from childhood trauma to adult somatization: The role of attachment. Psychosomatic Medicine, 68(1), 129–135.CrossRefPubMedGoogle Scholar
  35. 35.
    SurveyMonkey, L. L. C. (2012). SurveyMonkey ®. Palo Alto: SurveyMonkey, LLC.Google Scholar
  36. 36.
    Wright, K. B. (2005). Researching internet-based populations: Advantages and disadvantages of online survey research, online questionnaire authoring software packages, and web survey services. Journal of Computer-Mediated Communication, 10(3).Google Scholar
  37. 37.
    Wei, M., Russell, D. W., Mallinckrodt, B., & Vogel, D. L. (2007). The Experiences in Close Relationship Scale (ECR)-short form: Reliability, validity, and factor structure. Journal of Personality Assessment, 88(2), 187–204.CrossRefPubMedGoogle Scholar
  38. 38.
    Brennan, K. A., Clark, C. L., & Shaver, P. R. (1998). Self-report measurement of adult romantic attachment: An integrative overview. In J. A. Simpson & W. S. Rholes (Eds.), Attachment theory and close relationships. New York: Guilford Press.Google Scholar
  39. 39.
    Slade, G. D. (1997). Derivation and validation of a short-form Oral Health Impact Profile. Community Dentistry and Oral Epidemiology, 25(4), 284–290.CrossRefPubMedGoogle Scholar
  40. 40.
    Slade, G. D., & Spencer, A. J. (1994). Development and evaluation of the Oral Health Impact Profile. Community Dental Health, 11(1), 3–11.PubMedGoogle Scholar
  41. 41.
    Sanders, A. E., Spencer, A. J., & Slade, G. D. (2006). Evaluating the role of dental behaviour in oral health inequalities. Community Dentistry and Oral Epidemiology, 34(1), 71–79.CrossRefPubMedGoogle Scholar
  42. 42.
    Thomson, W. M., Spencer, A. J., & Gaughwin, A. (1996). Testing a child Dental Neglect Scale in South Australia. Community Dentistry and Oral Epidemiology, 24(5), 351–356.CrossRefPubMedGoogle Scholar
  43. 43.
    Harford, J. E., & Islam, S. (2013). Adult oral health and dental visiting in Australia: Results from the national dental telephone interview survey 2010. Canberra: Australian Institute of Health and Welfare.Google Scholar
  44. 44.
    Carter, K. D., & Stewart, J. F. (2002). National dental telephone interview survey 1999. Adelaide: Australian Institute of Health and Welfare Dental Statistics and Research Unit.Google Scholar
  45. 45.
    IBM Corp. (2013). IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp.Google Scholar
  46. 46.
    Finlayson, T. L., Williams, D. R., Siefert, K., Jackson, J. S., & Nowjack-Raymer, R. (2010). Oral health disparities and psychosocial correlates of self-rated oral health in the National Survey of American Life. American Journal of Public Health, 100(Suppl 1), S246–S255.CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Australian Bureau of Statistics. (2011). 2011 Census QuickStats: Australia.
  48. 48.
    Australian Bureau of Statistics. (2013). Education and work 2013. Canberra: Australian Bureau of Statistics.Google Scholar
  49. 49.
    Chrisopoulos, S., & Harford, J. E. (2013). Oral health and dental care in Australia: Key facts and figures 2012. Canberra: Australian Institute of Health and Welfare.Google Scholar
  50. 50.
    Sanders, A. E. (2007). Social determinants of oral health: Conditions linked to socioeconomic inequalities in oral health in the Australian population. Canberra: Australian Institute of Health and Welfare and the Australian Research Centre for Population Oral Health.Google Scholar
  51. 51.
    Slade, G. D., Nuttall, N., Sanders, A. E., Steele, J. G., Allen, P. F., Lahti, S., et al. (2005). Impacts of oral disorders in the United Kingdom and Australia. British Dental Journal, 198(8), 489–493.CrossRefPubMedGoogle Scholar
  52. 52.
    Wei, M., Russell, D. W., Mallinckrodt, B., & Zakalik, R. A. (2004). Cultural equivalence of adult attachment across four ethnic groups: Factor structure, structured means, and associations with negative mood. Journal of Counseling Psychology, 51(4), 408.CrossRefGoogle Scholar
  53. 53.
    Celenk, O., van de Vijver, F. J., & Goodwin, R. (2011). Relationship satisfaction among Turkish and British adults. International Journal of Intercultural Relations, 35(5), 628–640.CrossRefGoogle Scholar
  54. 54.
    Özhayat, E. B. (2013). Influence of negative affectivity and self-esteem on the oral health related quality of life in patients receiving oral rehabilitation. Health and Quality of Life Outcomes, 11(1), 178.CrossRefPubMedPubMedCentralGoogle Scholar
  55. 55.
    Sanders, A. E., & Spencer, A. J. (2005). Childhood circumstances, psychosocial factors and the social impact of adult oral health. Community Dentistry and Oral Epidemiology, 33(5), 370–377.CrossRefPubMedGoogle Scholar
  56. 56.
    Brennan, D. S., & Spencer, A. J. (2012). Social support and optimism in relation to the oral health of young adults. International Journal of Behavioral Medicine, 19(1), 56–64.CrossRefPubMedGoogle Scholar
  57. 57.
    Boman, U. W., Wennstrom, A., Stenman, U., & Hakeberg, M. (2012). Oral health-related quality of life, sense of coherence and dental anxiety: An epidemiological cross-sectional study of middle-aged women. BMC Oral Health, 12, 14.CrossRefPubMedPubMedCentralGoogle Scholar
  58. 58.
    Adam, E. K., Gunnar, M. R., & Tanaka, A. (2004). Adult attachment, parent emotion, and observed parenting behavior: Mediator and moderator models. Child Development, 75(1), 110–122.CrossRefPubMedGoogle Scholar
  59. 59.
    Brennan, D. S., Singh, K. A., Spencer, A. J., & Roberts-Thomson, K. F. (2006). Positive and negative affect and oral health-related quality of life. Health and Quality of Life Outcomes, 4, 83.CrossRefPubMedPubMedCentralGoogle Scholar
  60. 60.
    Kressin, N. R., Reisine, S., Spiro, A, 3rd, & Jones, J. A. (2001). Is negative affectivity associated with oral quality of life? Community Dentistry and Oral Epidemiology, 29(6), 412–423.CrossRefPubMedGoogle Scholar
  61. 61.
    Meredith, P. J., Strong, J., & Feeney, J. A. (2006). The relationship of adult attachment to emotion, catastrophizing, control, threshold and tolerance, in experimentally-induced pain. Pain, 120(1–2), 44–52.CrossRefPubMedGoogle Scholar
  62. 62.
    Beltrán-Aguilar, E. D., Barker, L. K., Canto, M. T., Dye, B. A., Gooch, B. F., Griffin, S. O., et al. (2005). Surveillance for dental caries, dental sealants, tooth retention, edentulism, and enamel fluorosis—United States, 1988–1994 and 1999–2002. Morbidity and Mortality Weekly Report Surveillance Summaries, 54(3), 1–43.PubMedGoogle Scholar
  63. 63.
    Ciechanowski, P., & Katon, W. J. (2006). The interpersonal experience of health care through the eyes of patients with diabetes. Social Science and Medicine, 63(12), 3067–3079.CrossRefPubMedGoogle Scholar
  64. 64.
    Consedine, N. S., Tuck, N. L., & Fiori, K. L. (2013). Attachment and health care utilization among middle-aged and older african-descent men: Dismissiveness predicts less frequent digital rectal examination and prostate-specific antigen screening. American Journal of Men’s Health, 7(5), 382–393.CrossRefPubMedGoogle Scholar
  65. 65.
    Ciechanowski, P., Sullivan, M., Jensen, M., Romano, J., & Summers, H. (2003). The relationship of attachment style to depression, catastrophizing and health care utilization in patients with chronic pain. Pain, 104(3), 627–637.CrossRefPubMedGoogle Scholar
  66. 66.
    Taylor, R. E., Marshall, T., Mann, A., & Goldberg, D. P. (2012). Insecure attachment and frequent attendance in primary care: A longitudinal cohort study of medically unexplained symptom presentations in ten UK general practices. Psychological Medicine, 42(4), 855–864.CrossRefPubMedGoogle Scholar
  67. 67.
    Dumitrescu, A. L., Zetu, L., Zetu, M., & Păcurar, M. (2013). The relationship between narcissism, oral health status and oral health-related behaviors. Procedia-Social and Behavioral Sciences, 78, 496–500.CrossRefGoogle Scholar
  68. 68.
    Mansyur, C., Amick, B. C., Harrist, R. B., & Franzini, L. (2008). Social capital, income inequality, and self-rated health in 45 countries. Social Science and Medicine, 66(1), 43–56.CrossRefPubMedGoogle Scholar
  69. 69.
    Aida, J., Kondo, K., Kondo, N., Watt, R. G., Sheiham, A., & Tsakos, G. (2011). Income inequality, social capital and self-rated health and dental status in older Japanese. Social Science and Medicine, 73(10), 1561–1568.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  • Pamela Meredith
    • 1
    Email author
  • Jenny Strong
    • 1
  • Pauline Ford
    • 2
  • Grace Branjerdporn
    • 1
  1. 1.Occupational Therapy, School of Health and Rehabilitation SciencesThe University of QueenslandBrisbaneAustralia
  2. 2.School of DentistryThe University of QueenslandBrisbaneAustralia

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