title: 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?
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Psychosocial Oncology and Palliative Care 16-755, University Health Network, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada. lmmclean@rogers.com
authors.forename: Linda M
authors.initials: LM
authors.lastname: McLean
authors.forename: Tara
authors.initials: T
authors.lastname: Walton
authors.forename: Andrew
authors.initials: A
authors.lastname: Matthew
authors.forename: Jennifer Michelle
authors.initials: JM
authors.lastname: Jones
mesh_terms: D000328:Adult; D000368:Aged; D017028:Caregivers / Q000523:psychology*; D003863:Depression / Q000209:etiology*; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008393:Marriage / Q000523:psychology; D008875:Middle Aged; D009369:Neoplasms / Q000451:nursing / Q000523:psychology*; D009769:Object Attachment; D010865:Pilot Projects; D012737:Sex Factors; D018454:Spouses / Q000523:psychology*; D013315:Stress, Psychological / Q000209:etiology; D013727:Terminal Care / Q000523:psychology
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