Attachment security and existential distress among patients with advanced cancer

Vehling, S., Tian, Y., Malfitano, C., Schnall, J., Watt, S., Mehnert, A., Rydall, A., Zimmermann, C., Hales, S., Lo, C., and Rodin, G. (2019) Attachment security and existential distress among patients with advanced cancer. Journal of Psychosomatic Research, 116. pp. 93-99.

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Background: Felt security in close relationships may affect individual adaptation responses to existential threat in severe illness. We examined the contribution of attachment security to demoralization, a state of existential distress involving perceived pointlessness and meaninglessness in advanced cancer.

Method: A mixed cross-sectional sample of 382 patients with advanced cancer (mean age 59, 60% female) was recruited from outpatient oncology clinics. Participants completed self-report measures of attachment security, demoralization, depression, and physical symptom burden. We used multiple linear regression to analyze the association between attachment security and demoralization, controlling for demographic factors and symptom burden and tested whether attachment security moderated the association of symptom burden with demoralization. Separate analyses compared the contribution of the dimensions of attachment anxiety and attachment avoidance.

Results: The prevalence of clinically relevant demoralization was 35%. Demoralization was associated with lower attachment security (β = −0.54, 95%CI: −0.62 to 0.46). This effect was empirically stronger for attachment anxiety (β = 0.52, 95%CI: 0.44 to 0.60) compared to attachment avoidance (β = 0.36, 95%CI: 0.27 to 0.45). Attachment security also significantly moderated the association of physical symptom burden with demoralization, such that with less attachment security, there was a stronger association between symptom burden and demoralization.

Conclusion: Attachment security may protect from demoralization in advanced cancer. Its relative lack, particularly on the dimension of attachment anxiety, may limit adaptive capacities to deal with illness burden and to sustain morale and purpose in life. An understanding of individual differences in attachment needs can inform existential interventions for severely ill individuals.

Item ID: 69201
Item Type: Article (Research - C1)
ISSN: 1879-1360
Keywords: Demoralization; Attachment security; Psychological adaptation; Existential distress; Advanced cancer; Palliative care
Copyright Information: © 2018 Published by Elsevier Inc.
Funders: Canadian Institutes of Health Research (CIHR), German Research Society (DFG), Princess Margaret Cancer Foundation (PMCF) Canada, Princess Margaret Cancer Centre (PMCC) and Research Institute, Canada, Ontario Ministry of Health and Long Term Care (OMOHLTC)
Projects and Grants: CIHR #MOP 106473, PMCF - Al Hertz, Kirchmann and Kirsh Family Funds
Date Deposited: 31 Aug 2021 03:42
FoR Codes: 52 PSYCHOLOGY > 5203 Clinical and health psychology > 520304 Health psychology @ 100%
SEO Codes: 20 HEALTH > 2001 Clinical health > 200105 Treatment of human diseases and conditions @ 100%
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