title: Attachment style is associated with perceived spouse responses and pain-related outcomes.
abstract: OBJECTIVE
  Attachment theory can provide a heuristic model for examining factors that may influence the relationship of social context to adjustment in chronic pain. This study examined the associations of attachment style with self-reported pain behavior, pain intensity, disability, depression, and perceived spouse responses to pain behavior. We also examined whether attachment style moderates associations between perceived spouse responses and self-reported pain behavior and depressive symptoms, as well as perceived spouse responses as a mediator of these associations.
  
  
  METHODS
  Individuals with chronic pain (N = 182) completed measures of self-reported attachment style, perceived spouse responses, and pain-related criterion variables.
  
  
  RESULTS
  Secure attachment was inversely associated with self-reported pain behaviors, pain intensity, disability, depressive symptoms, and perceived negative spouse responses; preoccupied and fearful attachment scores were positively associated with these variables. In multivariable regression models, both attachment style and perceived spouse responses were uniquely associated with self-reported pain behavior and depressive symptoms. Attachment style did not moderate associations between perceived spouse responses to self-reported pain behavior and pain criterion variables, but negative spouse responses partially mediated some relationships between attachment styles and pain outcomes.
  
  
  CONCLUSIONS
  Findings suggest that attachment style is associated with pain-related outcomes and perceptions of spouse responses. The hypothesized moderation effects for attachment were not found; however, mediation analyses showed that perceived spouse responses may partially explain associations between attachment and adjustment to pain. Future research is needed to clarify how attachment style and the social environment affect the pain experience.
authors.affiliation: Department of Psychology, The University of Alabama, Tuscaloosa, AL, USA. laura.forsythe@nih.gov
authors.forename: Laura P
authors.initials: LP
authors.lastname: Forsythe
authors.forename: Joan M
authors.initials: JM
authors.lastname: Romano
authors.forename: Mark P
authors.initials: MP
authors.lastname: Jensen
authors.forename: Beverly E
authors.initials: BE
authors.lastname: Thorn
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000671:Amputation, Surgical / Q000523:psychology / Q000534:rehabilitation; D018771:Arthralgia / Q000523:psychology / Q000534:rehabilitation; D001168:Arthritis / Q000523:psychology / Q000534:rehabilitation; D058443:Catastrophization / Q000523:psychology / Q000534:rehabilitation; D059350:Chronic Pain / Q000523:psychology* / Q000534:rehabilitation*; D003866:Depressive Disorder / Q000523:psychology / Q000534:rehabilitation; D004185:Disability Evaluation; D005260:Female; D005356:Fibromyalgia / Q000523:psychology / Q000534:rehabilitation; D020773:Headache Disorders / Q000523:psychology / Q000534:rehabilitation; D006801:Humans; D055809:Illness Behavior; D017116:Low Back Pain / Q000523:psychology / Q000534:rehabilitation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D059352:Musculoskeletal Pain / Q000523:psychology / Q000534:rehabilitation; D009769:Object Attachment; D010147:Pain Measurement; D012917:Social Adjustment; D018454:Spouses / Q000523:psychology*; D013223:Statistics as Topic; D016896:Treatment Outcome