Supportive Care in Cancer

, Volume 19, Issue 10, pp 1539–1548 | Cite as

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?

  • Linda M. McLeanEmail author
  • Tara Walton
  • Andrew Matthew
  • Jennifer Michelle Jones
Original Article



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.


Metastatic/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.


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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Linda M. McLean
    • 1
    • 2
    Email author
  • Tara Walton
    • 3
  • Andrew Matthew
    • 2
    • 4
    • 5
  • Jennifer Michelle Jones
    • 2
    • 3
  1. 1.Department of Psychosocial Oncology and Palliative Care 16-755University Health NetworkTorontoCanada
  2. 2.Department of PsychiatryUniversity of TorontoTorontoCanada
  3. 3.Department of Psychosocial Oncology and Palliative CareUniversity Health NetworkTorontoCanada
  4. 4.Princess Margaret Hospital, The Prostate Centre, 4-922University Health NetworkTorontoCanada
  5. 5.Department of SurgeryUniversity of TorontoTorontoCanada

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