Examination of couples’ attachment security in relation to depression and hopelessness in maritally distressed patients facing end-stage cancer and their spouse caregivers: a buffer or facilitator of psychosocial distress?
- 618 Downloads
The purpose of this study is to determine levels of depression and hopelessness and to explore the relationship between attachment security and psychosocial distress in patients with metastatic/recurrent cancer and spouse-caregivers, experiencing marital distress.
Couple-participants were from a pilot study and a larger clinical trial prior to randomization. Participation required that one partner endorsed marital distress on the Revised Dyadic Adjustment Scale (RDAS). Outcome measures included the Beck Depression Inventory-II (BDI-II), Beck Hopelessness Scale (BHS), and Experiences in Close Relationships Inventory.
Caregivers, compared with their matched ill-partners, had significantly higher scores on the RDAS (<distress) after taking sex, avoidance, and anxiety into account. Fifty-two percent of patients and 33% of caregivers scored above the BDI-II cut-off (≥15) for depression, with patients and females reporting higher levels of depression compared to caregivers and males. Thirty-three percent of patients and 24% of caregivers scored above the BHS cut-off (≥8) for hopelessness, with males and patients displaying significantly higher mean scores compared with females and caregivers. There was a significant interaction effect of sex and avoidance for RDAS; as the male avoidance subscale score increased, the female caregiver RDAS declined (>distressed).
Marital distress may be amplified within insecure attachment bonds, especially among avoidant male patients and their female caregivers, which may influence caregiving/care-receiving. We offer unique, preliminary support for identifying couples at risk to help reduce suffering and complicated bereavement in the terminal cancer population. Further research that include larger studies, are needed to determine relationships among attachment and psychosocial outcomes.
KeywordsMetastatic/recurrent cancer Marital distress Attachment security Depression Hopelessness End-of-life
We appreciate the patients and spouse caregivers time and contribution to this study. We thank members of the psychosocial Oncology and Palliative Care Program for their assistance with the referral process. We extend appreciation to the Department of Statistics, University of Toronto, for their contribution to data analysis.
This study was funded by the Faculty of Medicine, Dean’s Fund, University of Toronto, and the University Health Network, Allied Health Grant, Toronto, Ontario, Canada.
- 10.Baider L, Kaufman B, Peretz T, Manor O, Ever-Hadani P, Kaplan De-Nour A (1996) Mutuality of fate: adaptation and psychological distress in cancer patients and their partners. In: Baider L, Cooper CL, Kaplan De-Nour A (eds) Cancer and the family. Wiley, New York, pp 173–186Google Scholar
- 16.Steinglass P (2000) Family processes and chronic illness. In: Baider L, Cooper C, De-Nour A (eds) Cancer and the family. Wiley, West Sussex, pp 3–15Google Scholar
- 17.Beck AT, Steer RA, Brown GK (1996) Manual for the beck depression inventory-II. Psychological Corporation, San AntonioGoogle Scholar
- 18.Bowlby J (1969) Attachment and loss, volume 1: attachment. Basic Books, New YorkGoogle Scholar
- 19.Bowlby J (1988) A secure base: clinical applications of attachment theory. Routledge, LondonGoogle Scholar
- 20.Goldberg S (2000) Attachment and development. Arnold Publishers, LondonGoogle Scholar
- 22.Brennan K, Clark C, Shaver P (1998) Self-report measurement of adult attachment: an integrative overview. In: Simpson JA, Rholes WS (eds) Attachment theory and close relationships. The Guilford Press, New York, pp 46–76Google Scholar
- 26.Slade A (1999) Attachment theory and research: implications for the theory and practice of individual psychotherapy with adults. In: Cassidy J, Shaver PR (eds) Handbook of attachment. Gilford Press, New York, pp 575–594Google Scholar
- 30.Kayser K (2005) Enhancing dyadic coping during a time of crisis: a theory-based intervention with breast cancer patients and their partners. In: Revnson TA, Kayser K, Bodenmann G (eds) Couples coping with stress: emerging perspectives on dyadic coping. American Psychological Association, Washington, pp 175–194CrossRefGoogle Scholar
- 33.Karnofsky DA, Burchenal JH (1949) The clinical evaluation of chemotherapeutic agents in cancer. In: Macleod CM (ed) Evaluation of chemotherapeutic agents. Columbia University Press, New York, pp 191–205Google Scholar