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Insecure attachment predicts depression and death anxiety in advanced cancer patients

Published online by Cambridge University Press:  15 May 2017

Katharina Scheffold ,
Rebecca Philipp ,
Susan Koranyi ,
Dorit Engelmann ,
Frank Schulz-Kindermann ,
Martin Härter  and
Anja Mehnert
Katharina Scheffold
Affiliation:
Department of Medical Psychology, University Medical Center Hamburg–Eppendorf, Hamburg, Germany
Rebecca Philipp
Affiliation:
Department of Medical Psychology, University Medical Center Hamburg–Eppendorf, Hamburg, Germany
Susan Koranyi
Affiliation:
Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
Dorit Engelmann
Affiliation:
Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
Frank Schulz-Kindermann
Affiliation:
Department of Medical Psychology, University Medical Center Hamburg–Eppendorf, Hamburg, Germany
Martin Härter
Affiliation:
Department of Medical Psychology, University Medical Center Hamburg–Eppendorf, Hamburg, Germany
Anja Mehnert*
Affiliation:
Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
*
Address correspondence and reprint requests to: Anja Mehnert, Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Philipp-Rosenthal Strasse 55, 04103 Leipzig, Germany. E-mail: anja.mehnert@medizin.uni-leipzig.de.
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Abstract

Objective:

The prevalence of depression as well as adjustment and anxiety disorders is high in advanced cancer patients, and research exploring intraindividual factors leading to high psychological distress is underrepresented. Cancer patients' feelings about security and trust in their healthcare providers have a significant influence on how they deal with their disease. The perception of social support is affected by patients' attachment styles and influences their reactions to feelings of dependency and loss of control. We therefore aimed to explore attachment and its association with psychological distress in patients with advanced cancer.

Method:

We obtained data from the baseline measurements of a randomized controlled trial in advanced cancer patients. Patients were sampled from the university medical centers of Hamburg and Leipzig, Germany. The main outcome measures included the Patient Health Questionnaire, the Death and Dying Distress Scale, the Memorial Symptom Assessment Scale, and the Experience in Close Relationships Scale for assessing attachment insecurity.

Results:

A total of 162 patients were included. We found that 64% of patients were insecurely attached (fearful-avoidant 31%, dismissing 17%, and preoccupied 16%). A dismissing attachment style was associated with more physical symptoms but did not predict psychological distress. A fearful-avoidant attachment style significantly predicted higher death anxiety and depression, whereas preoccupied attachment predicted higher death anxiety only. Overall, insecure attachment contributed to the prediction of depression (10%) and death anxiety (14%).

Significance of results:

The concept of attachment plays a relevant role in advanced cancer patients' mental health. Healthcare providers can benefit from knowledge of advanced cancer patients' attachment styles and how they relate to specific mental distress. Developing a better understanding of patients' reactions to feelings of dependency and distressing emotions can help us to develop individually tailored advanced cancer care programs and psychotherapeutic interventions.

Keywords

Advanced cancerAttachmentDepressionDeath anxiety
Type
Original Article
Information
Palliative & Supportive Care , Volume 16 , Issue 3 , June 2018 , pp. 308 - 316
Copyright
Copyright © Cambridge University Press 2017 

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