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Age and attachment style impact stress and depressive symptoms among caregivers: a prospective investigation

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Journal of Cancer Survivorship: Research and Practice Aims and scope Submit manuscript

Abstract

Introduction

Family members begin their role as caregivers to persons with cancer with little advance notice. In this situation, the caregivers’ existing psychosocial resources, including their stage in life and the nature of their relationship with the patient, can play important roles in the extent of stress caregivers experience during this unique time.

Materials and methods

Family caregivers (N = 98) of diagnosed colorectal cancer patients at community hospitals participated in the study around the time of diagnosis (T1) and at 6 months post-diagnosis (T2).

Results

Hierarchical regression analyses revealed that younger caregivers reported greater increases in caregiving stress at T2, controlling for the level of caregiving stress at T1. This was more prominent when they had an anxious attachment orientation to the care recipient (i.e., cancer survivor), which was characterized as a strong desire for closeness to the cancer survivor, hypervigilance for cues of abandonment, and emotional upset both at separation and reunion with the survivor. The same interaction effect between age and anxious attachment was found for depressive symptoms.

Conclusions

Results suggest that younger caregivers are more vulnerable to the challenges imposed by their relative’s cancer, and this vulnerability is exacerbated by the quality of their relationship.

Implications for cancer survivors

Our findings imply that younger caregivers whose relationship with the survivor can be characterized by the features above can be identified early and might benefit from intervention or additional support to reduce the caregiving stress and depressive symptoms as they carry out their new role as a cancer caregiver.

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Reference List

  1. Aiken, L. S., & West, S. G. (1991). Multiple regression: Testing and interpreting interaction. New York: Sage.

    Google Scholar 

  2. Ainsworth, M. D. S., Blehar, M. C., Waters, E., & Wall, S. (1978). Patterns of attachment: Psychological study of the strange situation. Hillsdale, NJ: Lawrence Erlbaum.

    Google Scholar 

  3. American Cancer Society (2007). Cancer facts and figures, 2007. Atlanta, GA: American Cancer Society.

    Google Scholar 

  4. Aneshensel, C. S., Pearlin, L. I., & Schuler, R. H. (1993). Stress, role captivity, and the cessation of caregiving. Journal of Health and Social Behavior, 34(1), 54–70.

    Article  PubMed  CAS  Google Scholar 

  5. Avis, N. E., Crawford, S., & Manuel J. (2005). Quality of life among younger women with breast cancer. Journal of Clinical Oncology, 23(15), 3322–3330.

    Article  PubMed  Google Scholar 

  6. Bakas, T., Pressler, S. J., Johnson, E. A., Nauser, J. A., & Shaneyfelt T. (2006). Family caregiving in heart failure. Nursing Research, 55(3), 180–188.

    Article  PubMed  Google Scholar 

  7. Baltes, M. M., & Carstensen, L. L. (2003). The process of successful aging: Selection, optimization and compensation. In U. M. Staudinger & U. Lindenberger (Eds.), Understanding human development: Dialogues with lifespan psychology. Dordrecht, The Netherlands: Kluwer.

    Google Scholar 

  8. Besser, A., & Priel, B. (2005). The apple does not fall far from the tree: Attachment styles and personality vulnerabilities to depression in three generations of women. Personality & Social Psychology Bulletin, 31(8), 1052–1073.

    Article  Google Scholar 

  9. Carnelley, K. B., Pietromonaco, P. R., & Jaffe, K. (1996). Attachment, caregiving, and relationship functioning in couples: Effects of self and partner. Personal Relationships, 3(3), 257–278.

    Article  Google Scholar 

  10. Carpenter, B. D. (2001). Attachment bonds between adult daughters and their older mothers: Associations with contemporary caregiving. Journal of Gerontology B: Psychological Science and Social Science, 56(5), 257–266.

    Google Scholar 

  11. Carver, C. S. (1997). Adult attachment and personality: Converging evidence and a new measure. Personality & Social Psychology Bulletin, 23(8), 865–883.

    Article  Google Scholar 

  12. Carver, C. S., & Antoni, M. H. (2004). Finding benefit in breast cancer during the year after diagnosis predicts better adjustment 5 to 8 years after diagnosis. Health Psychology, 23(6), 595–598.

    Article  PubMed  Google Scholar 

  13. 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.

    Article  PubMed  Google Scholar 

  14. Covinsky, K. E., Newcomer, R., Fox, P., Wood, J., Sands, L., Dane, K., et al. (2003). Patient and caregiver characteristics associated with depression in caregivers of patients with dementia. Journal of General Internal Medicine, 18(12), 1006–1014.

    Article  PubMed  Google Scholar 

  15. Diamond, E. L., & Aspinwall, L. G. (2003). Emotion regulation across the life span: An integrative perspective emphasizing self-regulation, positive affect, and dyadic processes. Motivation and Emotion, 27, 125–156.

    Article  Google Scholar 

  16. Feeney, J. A. (1996). Attachment, caregiving, and marital satisfaction. Personal Relationships, 3(4), 401–416.

    Article  Google Scholar 

  17. Fraley, R. C., & Shaver, P. R. (1998). Airport separations: A naturalistic study of adult attachment dynamics in separating couples. Journal of Personality and Social Psychology, 75, 1198–1212.

    Article  Google Scholar 

  18. Given, B. A., Given, C. W., & Kozachik S. (2001). Family support in advanced cancer. CA: A Cancer Journal for Clinicians, 51(4), 213–231.

    Article  CAS  Google Scholar 

  19. Goode, W. J. (1960). A theory of role strain. American Sociological Review, 25(4), 483–496.

    Article  Google Scholar 

  20. Gore, S., & Mangione, T. W. (1983). Social roles, sex roles, and psychological distress: Additive and interactive models of sex differences. Journal of Health and Social Behavior, 24, 300–312.

    Article  PubMed  CAS  Google Scholar 

  21. Grinyer, A., & Thomas, C. (2001). Young adults with cancer: The effect of the illness on parents and families. International Journal of Palliative Nursing, 7(4), 162–170.

    PubMed  CAS  Google Scholar 

  22. Hankin, B. L., Kassel, J. D., & Abela, J. R. (2005). Adult attachment dimensions and specificity of emotional distress symptoms: Prospective investigations of cognitive risk and interpersonal stress generation as mediating mechanisms. Personality & Social Psychology Bulletin, 31(1), 136–151.

    Article  Google Scholar 

  23. Hazan, C., & Shaver, P. (1987). Romantic love conceptualized as an attachment process. Journal of Personality and Social Psychology, 52(3), 511–524.

    Article  PubMed  CAS  Google Scholar 

  24. Hull, M. M. (1992). Coping strategies of family caregivers in hospice homecare. Oncology Nursing Forum, 19(8), 1179–1187.

    PubMed  CAS  Google Scholar 

  25. Kessler, R. C. (1979). Stress, social status, and psychological distress. Journal of Health and Social Behavior, 20(3), 259–272.

    Article  PubMed  CAS  Google Scholar 

  26. Kim, Y., Baker, F., & Spillers, R. L. (2007). Cancer caregivers’ quality of life: Effects of gender, relationship, and appraisal. Journal of Pain and Symptom Management (in press).

  27. Kim, Y., & Carver, C. S. (2006). Frequency and difficulty in caregiving among spouses of individuals with cancer: Effects of adult attachment and gender [Electronic version]. Psycho-Oncology.

  28. Kim, Y., Duberstein, P. R., Sörensen, S., & Larson, M. R. (2005). Levels of depressive symptoms in spouses of people with lung cancer: Effects of personality, social support, and caregiving burden. Psychosomatics, 46(2), 123–130.

    Article  PubMed  Google Scholar 

  29. Langer, S., Abrams, J., & Syrjala, K. (2003). Caregiver and patient marital satisfaction and affect following hematopoietic stem cell transplantation: A prospective, longitudinal investigation. Psycho-Oncology, 12(3), 239–253.

    Article  PubMed  Google Scholar 

  30. Levine, C. (2003). Depression in caregivers of patients with dementia: A greater role for physicians. Journal of General Internal Medicine, 18(12), 1058–1059.

    Article  PubMed  Google Scholar 

  31. Mikulincer, M., & Shaver, P. R. (2003). The attachment behavioral system in adulthood: Activation, psychodynamics, and interpersonal processes. In M. P. Zanna (Ed.), Advances in experimental social psychology, Vol. 35. (pp. 53–152). San Diego, CA: Academic.

    Chapter  Google Scholar 

  32. Mor, V., Allen, S., & Malin M. (1994). The psychosocial impact of cancer on older versus younger patients and their families. Cancer, 74(7 Suppl):2118–2127.

    Article  PubMed  CAS  Google Scholar 

  33. Pearlin, L. I., Mullan, J. T., Semple, S. J., & Skaff, M. M. (1990). Caregiving and the stress process: An overview of concepts and their measures. Gerontologist, 30(5), 583–594.

    PubMed  CAS  Google Scholar 

  34. Pinquart, M., & Silbereisen, R. K. (2006). Socioemotional selectivity in cancer patients. Psychology and Aging, 21(2), 419–423.

    Article  PubMed  Google Scholar 

  35. Pinquart, M., & Sörensen, S. (2003). Associations of stressors and uplifts of caregiving with caregiver burden and depressive mood: A meta-analysis. Journal of Gerontology B: Psychological Science and Social Science, 58(2), 112–128.

    Google Scholar 

  36. Pitceathly, C., & Maguire, P. (2003). The psychological impact of cancer on patients’ partners and other key relatives: A review. European Journal of Cancer, 39(11), 1517–1524.

    Article  PubMed  CAS  Google Scholar 

  37. Shaver, P. R., Collins, N., & Clark, C. L. (1996). Attachment styles and internal working models of self and relationship partners. In G. J. O. Fletcher & J. Fitness (Eds.), Knowledge structures in close relationships: A social psychological approach (pp. 25–61). Hillsdale, NJ: Lawrence Erlbaum.

    Google Scholar 

  38. Shaver, P. R., Schachner, D. A., & Mikulincer, M. (2005). Attachment style, excessive reassurance seeking, relationship processes, and depression. Personality & Social Psychology Bulletin, 31(3), 343–359.

    Article  Google Scholar 

  39. Spencer, S. M., Lehman, J. M., Wynings, C., Arena, P., Carver, C. S., Antoni, M. H., et al. (1999). Concerns about breast cancer and relations to psychosocial well-being in a multiethnic sample of early-stage patients. Health Psychology, 18(2), 159–168.

    Article  PubMed  CAS  Google Scholar 

  40. Vanderwerker, L. C., Laff, R. E., Kadan-Lottick, N. S., McColl, S., & Prigerson, H. G. (2005). Psychiatric disorders and mental health service use among caregivers of advanced cancer patients. Journal of Clinical Oncology, 23(28), 6899–6907.

    Article  PubMed  Google Scholar 

  41. Ware, J. E., Jr., Snow, K. K., Kosinski, M., & Gandek, B. (1994). SF-36 health survey manual and interpretation guide. Boston, MA: The Health Institute Medical Center.

    Google Scholar 

  42. Wei, M., Shaffer, P. A., Young, S. K., & Zakalik, R. A. (2005). Adult attachment, shame, depression, and loneliness: The mediation role of basic psychological needs satisfaction. Journal of Counseling Psychology, 52, 591–601.

    Article  Google Scholar 

  43. Zebrack, B. J., Gurney, J. G., Oeffinger, K., Whitton, J., Packer, R. J., Mertens, A., et al. (2004). Psychological outcomes in long-term survivors of childhood brain cancer: A report from the childhood cancer survivor study. Journal of Clinical Oncology, 22(6), 999–1006.

    Article  PubMed  Google Scholar 

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Acknowledgments

This study was funded by the American Cancer Society National Home Office, intramural research. The authors wish to extend their appreciation to Dr. Charles S. Carver for thoughtful comments, to Dr. Corinne Crammer for editorial assistance, to Di He, Marra Katz, Linda Nguyen, Kunal Sharma, and Adriane Vega for assistance in data collection, to Chiewkwei Kaw for assistance in data management, and all the families who participated in this investigation. The first author dedicates this research to the memory of Heekyoung Kim.

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Authors and Affiliations

  1. Behavioral Research Center, American Cancer Society, 250 Williams St., NW, Atlanta, GA, 30303, USA

    Youngmee Kim & Tekla V. Evans

  2. Department of Psychology, Michigan State University, East Lansing, MI, USA

    Deborah A. Kashy

Authors
  1. Youngmee Kim
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  2. Deborah A. Kashy
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  3. Tekla V. Evans
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Corresponding author

Correspondence to Youngmee Kim.

Appendix

Appendix

MAQ-Caregiver Items

Attachment Security

It feels relaxing and good to be close to him/her.

I am very comfortable being close to him/her.

When I’m close to him/her, it gives me a sense of comfort about life in general.

Being close to him/her gives me a source of strength for other activities.

Attachment Anxiety

I have trouble getting this person to be as close as I want him/her to be.

I find he/she is reluctant to get as close as I would like.

I often worry that he/she doesn’t really love me.

My desire to become one with this person scares him/her away.

I often worry he/she will not want to stay with me.

I don’t worry about him/her abandoning me. (R)

Attachment Avoidance

He/She wants me to be more close than I feel comfortable being.

I get uncomfortable when he/she wants to be very close.

I prefer not to be too close to him/her.

Note. He/She refers to the cancer survivor.

(R) indicates reverse coding.

Copyright John Wiley & Sons Limited. Reproduced with permission. Kim Y., & Carver C.S. (2006). Frequency and difficulty in caregiving among spouses of individuals with cancer: Effects of adult attachment and gender [Electronic version].

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Kim, Y., Kashy, D.A. & Evans, T.V. Age and attachment style impact stress and depressive symptoms among caregivers: a prospective investigation. J Cancer Surviv 1, 35–43 (2007). https://doi.org/10.1007/s11764-007-0011-4

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