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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?

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Abstract

Purpose

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.

Methods

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.

Results

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).

Conclusions

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.

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References

  1. Braun M, Mikulincer M, Rydall A, Walsh A, Rodin G (2007) Hidden morbidity in cancer: spouse caregivers. J Clin Oncol 25:4829–4834

    Article  PubMed  Google Scholar 

  2. Nijboer C, Tempelaar R, Sanderman R, Triemstra M, Spruijt RJ, van den Bos GAM (1998) Cancer and caregiving: the impact on the caregiver’s health. Psychooncology 7:3–13

    Article  PubMed  CAS  Google Scholar 

  3. Kissane DW (2003) Psychological morbidity associated with patterns of family functioning in palliative care: baseline data from the Family Grief Therapy controlled trial. Palliat Med 17:527–537

    Article  PubMed  Google Scholar 

  4. Evans DL, Staab JP, Petitto JM, Morrison MF, Szuba MP, Ward HE, Wingate B, Luber MP, O’Reardon JP (1999) Depression in the medical setting: biopsychological interactions and treatment considerations. J Clin Psychiatry 60(suppl 4):40–55

    PubMed  Google Scholar 

  5. Rodin G, Lloyd N, Katz M, Green E, Mackay JA, Wong RK (2007) The treatment of depression in cancer patients: a systematic review. Support Care Cancer 15:123–136

    Article  PubMed  Google Scholar 

  6. Pessin H, Rosenfeld B, Breitbart W (2002) Assessing psychological distress at the end-of-life. Am Behav Sci 46:357–372

    Article  Google Scholar 

  7. Hack TF, Chochinov HM, Hassard T, Kristjanson LJ, McClement S, Harlos M (2004) Defining dignity in terminally ill cancer patients: a factor-analytic approach. Psychooncology 13:700–708

    Article  PubMed  Google Scholar 

  8. Kissane DW, Bloch S, Burns WI, McKenzie D, Posterino M (1994) Psychological morbidity in the families of patients with cancer. Psychooncology 3:47–56

    Article  Google Scholar 

  9. Breitbart W, Bruera E, Chochinov H, Lynch M (1995) Neuropsychiatric syndromes and psychological symptoms in patients with advanced cancer. J Pain Symptom Manage 10:131–141

    Article  PubMed  CAS  Google Scholar 

  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 173–186

    Google Scholar 

  11. Edwards B, Clarke V (2004) The psychological impact of a cancer diagnosis on families: the influence of family functioning and patients’ illness characteristics on depression and anxiety. Psychooncology 13(8):562–576

    Article  PubMed  Google Scholar 

  12. McLean LM, Jones JM (2007) A review of distress and its management in couples facing end-of-life cancer. Psychooncology 16:603–616

    Article  PubMed  Google Scholar 

  13. McLean LM, Jones JM, Rydall AC, Walsh A, Esplen MJ, Zimmerman C, Rodin G (2009) A couples intervention for patients facing advanced cancer and their spouse caregivers: outcomes of a pilot study. Psychooncology 17:1152–1156. doi:10.10021/pon1319

    Google Scholar 

  14. Banthia R, Malcarne VL, Varni JW, Ko CM, Sadler GR, Greenbergs HL (2003) The effects of dyadic strength and coping styles on psychological distress in couples faced with prostate cancer. J Behav Med 26:31–52

    Article  PubMed  Google Scholar 

  15. Baider L, Ever-Hadani P, Goldzweig G, Wygoda MR, Peretz T (2003) Is perceived family support a relevant variable in psychological distress? A sample of prostate and breast cancer couples. J Psychosom Res 55:453–460

    Article  PubMed  Google 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 3–15

    Google Scholar 

  17. Beck AT, Steer RA, Brown GK (1996) Manual for the beck depression inventory-II. Psychological Corporation, San Antonio

    Google Scholar 

  18. Bowlby J (1969) Attachment and loss, volume 1: attachment. Basic Books, New York

    Google Scholar 

  19. Bowlby J (1988) A secure base: clinical applications of attachment theory. Routledge, London

    Google Scholar 

  20. Goldberg S (2000) Attachment and development. Arnold Publishers, London

    Google Scholar 

  21. Bartholomew K (1990) Avoidance of intimacy: an attachment perspective. J Soc Pers Relat 7:147–178

    Article  Google 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 46–76

    Google Scholar 

  23. Feeney JA, Hohaus L (2001) Attachment and spousal caregiving. Pers Relatsh 8:21–39

    Article  Google Scholar 

  24. Westmaas JL, Silver RC (2001) The role of attachment in responses to victims of life crises. J Pers Soc Psychol 80:425–438

    Article  PubMed  CAS  Google Scholar 

  25. Shields CG, Travis LA, Rousseau SL (2000) Marital attachment and adjustment in older couples coping with cancer. Aging Ment Health 4(3):223–233, Publisher Routledge, part of the Taylor & Francis Group

    Article  Google 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 575–594

    Google Scholar 

  27. Mikulincer M, Shaver PR (2005) Attachment security, compassion, and altruism. Curr Dir Psychol Sci 14:34–38

    Article  Google Scholar 

  28. Feeney JA (1996) Attachment, caregiving, and marital satisfaction. Pers Relatsh 3:401–416

    Article  Google Scholar 

  29. McLean LM, Nissim R (2007) Marital therapy for couples facing advanced cancer: case review. Palliat Support Care 5:303–313

    PubMed  Google 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 175–194

    Chapter  Google Scholar 

  31. Hunter MJ, Davis PJ, Tunstall JR (2006) The influence of attachment and emotional support in end-stage cancer. Psychooncology 15(5):431–444

    Article  PubMed  Google Scholar 

  32. Rodin G, Walsh A, Zimmermann C, Gagliese L, Jones J, Shepherd FA, Moore M, Braun M, Donner A, Mikulincer M (2007) The contribution of attachment security and social support to depressive symptoms in patients with metastatic cancer. Psychooncology 16(12):1080–1091

    Article  PubMed  Google 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 191–205

    Google Scholar 

  34. Busby DH, Crane DR, Christensen C (1995) A revision of the Dyadic Adjustment Scale for use with distressed and non-distressed couples: construct hierarchy and multidimensional scales. J Marital Fam Ther 21:289–308

    Article  Google Scholar 

  35. Kissane DW, Bloch S, Dowe D et al (1996) The Melbourne Family Grief Study I: perceptions of family functioning in bereavement. Am J Psychiatry 153:650–658

    PubMed  CAS  Google Scholar 

  36. Kissane DW, Bloch S, Onghena P, McKenzie D, Snyder R, Dowe D (1996) The Melbourne Family Grief Study II: psychosocial morbidity and grief in bereaved families. Am J Psychiatry 153:659–666

    PubMed  CAS  Google Scholar 

  37. Katzman R, Brown T, Fuld P, Peck A, Schechter R, Schimmel H (1983) Validation of a short Orientation-Memory-Concentration Test of cognitive impairment. Am J Psychiatry 140(6):734–739

    PubMed  CAS  Google Scholar 

  38. Crane DR, Middleton KC, Bean RA (2000) Establishing criterion scores for the Kansas Marital satisfaction scale and the revised Dyadic Adjustment Scale. Am J Fam Ther 28:53–60

    Article  Google Scholar 

  39. American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders: DSM-IV-TR, 4th edn, text revision. American Psychiatric Press, Washington

    Book  Google Scholar 

  40. Berard RMF, Boermeester F, Viljoen G (1998) Depressive disorders in an outpatient oncology setting: prevalence, assessment, and management. Psychooncology 7:112–120

    Article  PubMed  CAS  Google Scholar 

  41. Beck AT, Weissman A, Lester D, Trexler L (1974) The measurement of pessimism: the Hopelessness Scale. J Consult Clin Psychol 42:861–865

    Article  PubMed  CAS  Google Scholar 

  42. Breitbart W, Rosenfeld B, Pessin H, Kaim M, Funesti-Esch J, Galietta M, Nelson C, Brescia R (2000) Depression, hopelessness, and desire for hastened death in terminally ill patients with cancer. J Am Med Assoc 284:2907–2911

    Article  CAS  Google Scholar 

  43. Bartholomew K, Horowitz LM (1991) Attachment styles among young adults: a test of a four-category model. J Pers Soc Psychol 61(2):226–244

    Article  PubMed  CAS  Google Scholar 

  44. MacCormack T, Simonian J, Lim J, Remond L, Roets D, Dunn S, Butow P (2001) “Someone who cares”: a qualitative investigation of cancer patients’ experiences of psychotherapy. Psychooncology 10(1):52–65

    Article  PubMed  CAS  Google Scholar 

  45. Harding R, Higginson IJ (2003) What is the best way to help caregivers in cancer and palliative care? A systematic literature review of interventions and their effectiveness. Palliat Med 17(1):63–74

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

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.

Disclosures

None.

Funding

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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Authors and Affiliations

  1. Department of Psychosocial Oncology and Palliative Care 16-755, University Health Network, 610 University Avenue, Toronto, Ontario, M5G 2M9, Canada

    Linda M. McLean

  2. Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada

    Linda M. McLean, Andrew Matthew & Jennifer Michelle Jones

  3. Department of Psychosocial Oncology and Palliative Care, University Health Network, 200 Elizabeth Street, 9EN-233, Toronto, Ontario, M5G 2C4, Canada

    Tara Walton & Jennifer Michelle Jones

  4. Princess Margaret Hospital, The Prostate Centre, 4-922, University Health Network, 620 University Avenue, Toronto, Ontario, M5G 2M9, Canada

    Andrew Matthew

  5. Department of Surgery, University of Toronto, Toronto, Ontario, Canada

    Andrew Matthew

Authors
  1. Linda M. McLean
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  2. Tara Walton
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  4. Jennifer Michelle Jones
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Correspondence to Linda M. McLean.

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McLean, L.M., Walton, T., Matthew, A. et al. 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?. Support Care Cancer 19, 1539–1548 (2011). https://doi.org/10.1007/s00520-010-0981-z

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