title: The impact of attachment insecurity and sleep disturbance on symptoms and sick days in hospital-based health-care workers.
abstract: OBJECTIVE
  Adult attachment insecurity is associated with many health outcomes and may be associated with sleep disturbance. The purpose of this study was to test the hypothesis that sleep disturbance mediates the relationship between attachment insecurity and three measures of health (perceived general health, physical symptoms and sick days) in a group that is at high risk of sleep disturbance: hospital based health-care workers.
  
  
  METHODS
  One hundred thirty-one nondepressed female hospital workers completed self-report measures of adult attachment, sleep disturbance, depressive symptoms (excluding sleep-related items) and health outcomes. The hypothesis of mediation was tested with sequential regression analyses.
  
  
  RESULTS
  Both attachment anxiety and attachment avoidance were significantly associated with impairment in global sleep quality (ρ=.20 and .19, respectively, P<.05) and physical symptoms (ρ=.21 and .19, P<.05). Attachment anxiety was also associated with depressive symptoms (ρ=.33, P<.001) and sick days (ρ=.21, P<.05). For both physical symptoms and sick days, mediation analyses were consistent with global sleep quality acting as a partial mediator of the relationship between attachment anxiety and physical health. Non-sleep-related depressive symptoms were a stronger mediator.
  
  
  CONCLUSIONS
  This study corroborates evidence that attachment insecurity is associated with sleep disturbance and extends this association to the occurrence of physical symptoms and time off work due to sickness among workers in a high-stress occupation.
authors.affiliation: Department of Psychiatry, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada. maunder@mtsinai.on.ca
authors.forename: Robert G
authors.initials: RG
authors.lastname: Maunder
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Hunter
authors.forename: William J
authors.initials: WJ
authors.lastname: Lancee
mesh_terms: D000328:Adult; D001007:Anxiety; D003863:Depression; D005260:Female; D006282:Health Personnel / Q000523:psychology*; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D009769:Object Attachment; D018582:Sick Leave; D012893:Sleep Wake Disorders / Q000175:diagnosis*; D011795:Surveys and Questionnaires