Attachment and Psychological Health in Older Couples Coping with Pain

[Old age and attachment theory, a systematic review of attachment typology, continuity, prevalence and association with psychological and health variables in older adults]

The aim of this paper is to review the research on attachment theory during old age in the last 10 years, in order to obtain: a) the prevalence of different types of attachment, b) the assessment of attachment methods, c) the relationship established between attachment and other psychosocial and health variables in the aging process. A systematic search of PsycINFO, PsycArticles, WOS, and Scopus identified 17 studies, in which attachment had been assessed in a population of 7118 older adults. The results of this research present a clear evolution and some differences, with respect to the previous systematic 2010 review. Regarding the prevalence of the different types of attachment, it is confirmed that secure attachment and avoidant attachment are more abundant in old age than in adulthood or youth people. There is no consensus on the instruments used for the evaluation, and results are presented that associate insecure attachment with depression, life satisfaction, physical illness and loneliness. The attachment construct appears as an explanatory and mediating variable, directly involved in the psychology and psychopathology of old age.

Attachment Style and Burn Pain

Pain management is a challenge when treating patients with burn injuries. Understanding the behavioral and interpersonal aspects of the experience of burn pain may aid in its management. Attachment style-which influences how an individual relates to other people-is one aspect that may affect the experience of burn pain. Past research has shown a relationship between an individual's attachment style and certain types of pain and disorders. The study builds upon that past work to investigate specifically how attachment style affects the experience of acute burn pain. Participants were at least 18 years old and admitted to an American Burn Association verified burn center with burns encompassing 30% or less total body surface area. Participants completed demographic questionnaires and a standardized measure of adult attachment style. Data regarding use of analgesics, daily pain scores, and burn-related information were collected through medical chart review. Participants who reported a secure attachment style required less pain medication and reported less pain compared with participants who reported an insecure attachment style. There was no difference in burn-related variables between participants with secure and insecure attachment styles, suggesting that these differences were not due to burn-related factors. Attachment, therefore, may play a role in an individual's perception of acute burn pain, which impacts analgesic requirements needed to manage the pain. These results have potential implications for the use of psychosocial interventions to reduce the experience of pain and the amount of pain medication needed to manage acute burn pain.

Moderating Role of Attachment Orientation in the Association between the Level of Depressive Symptoms and Informal Support among Hospitalized Older Adults

Objectives: Close family members or friends support hospitalized older adults in many countries. This support might act as a protective factor against the adverse consequences of hospitalization. However, individual differences might interfere with the ability to gain from this kind of support, especially if the patient in question is suffering from a high level of depression. This study explores how attachment predispositions shape the relationship between depression and informal support in the hospital setting. Methods: A short version of the attachment orientation questionnaire and the level of depression questionnaire were completed by 387, age M(SD) = 75.4(7.1) hospitalized older adults at admission. The number of hours informal caregivers stayed in the hospital and support received were collected for up to three consecutive hospitalization days. Results: Both attachment anxiety (t = -2.47, p = .01) and avoidance (t = -2.17, p = .03) moderated the relationship between depression and hours of support. Post hoc analysis revealed that older adults with high levels of attachment anxiety and avoidance received fewer hours of support under conditions of high depression (t = -3.04, p = .003; t = -2.92, p = .004, respectively). There were no significant results for received support. Conclusions: The study results emphasize the relevance of attachment orientation to caregiving relations in health-related contexts and call for awareness of the effect that level of depression combined with attachment orientation can have during hospitalization. Clinical implications: Assessing attachment orientation and depression in hospitalized elders might be useful for identifying older adults at risk for insufficient informal support during hospitalization.

Lived experiences of informal caregivers of people with chronic musculoskeletal pain: a systematic review and meta-ethnography

Background

People with chronic pain often seek support from friends and family for everyday tasks. These individuals are termed informal caregivers. There remains uncertainty regarding the lived experiences of these people who care for individuals with chronic musculoskeletal pain. The aim of this article is to synthase the evidence on the lived experiences of informal caregivers providing care to people with chronic musculoskeletal pain.

Methods

A systematic literature review was undertaken of published and unpublished literature databases including EMBASE, MEDLINE, CINAHL, PubMed, the WHO International Clinical Trial Registry and ClinicalTrials.gov registry (to September 2019). Qualitative studies exploring the lived experiences of informal caregivers of people with chronic musculoskeletal pain were included. Data were synthesised using a meta-ethnography approach. Evidence was evaluated using the Critical Appraisal Skills Programme qualitative appraisal tool.

Results

From 534 citations, 10 studies were eligible (360 participants: 171 informal caregivers of 189 care recipients). The evidence was moderate quality. Seven themes arose: the relationship of caregivers to healthcare professionals; role reversal with care recipients; acting the confidant to the care recipient; a constant burden in caregiving; legitimising care recipient's condition; knowledge and skills to provide caregiving; and the perception of other family members and wider society to the caregiver/care recipient dyad.

Conclusion

The lived experiences of caregivers of people with chronic musculoskeletal pain is complex and dynamic. There is an inter-connected relationship between caregivers, care recipients and healthcare professionals. Exploring how these experiences can be modified to improve a caregiving dyad's lived experience is now warranted.

Associations between spouses' oxytocin receptor gene polymorphism, attachment security, and marital satisfaction

OXTR rs53576, a polymorphism on the oxytocin receptor gene, has previously been linked to individual differences in social behaviors. That is, individuals with the GG genotype show greater empathy, sociability, and emotional stability. In the context of close relationships, such psychological resources are associated with better relationship outcomes. However, no studies to our knowledge have examined associations between spouses’ OXTR polymorphisms, attachment security, and marital satisfaction. In the current study, 178 married couples (N = 356; ages 37–90) completed self-report measures of attachment security and marital satisfaction and provided saliva samples for genotyping. Results from Actor Partner Interdependence Models showed that individuals who had the GG genotype (actor effect) or had a spouse with the GG genotype (partner effect) reported greater marital satisfaction than individuals with AA or AG genotypes. Furthermore, greater attachment security mediated associations between GG genotype and marital satisfaction.

Recalling support provision decreases distress and anger in response to partner suffering

OBJECTIVES

Thinking about a loved one's suffering can be emotionally stressful and have negative effects on a person's psychological and physical health over time. This study examined the hypotheses that when thinking about a partner's suffering (1) recalling past support provision to the suffering partner can decrease distress and anger and increase compassion, and (2) attachment orientation moderates these effects.

METHOD

Seventy-seven older adult spouses of individuals with chronic pain were video-recorded while they disclosed: (1) an instance of partner suffering and (2) an instance of partner suffering plus their support provision. Compassion for the partner and their own distress and anger were self-reported immediately after each account. Accounts were coded for statements of support. Attachment was assessed with the Experiences with Close Relationships measure.

RESULTS

As hypothesized, distress and anger were lower in the 'suffering with support' condition versus the 'suffering only' condition. There was no evidence that attachment orientation significantly moderated the effect of support recollection on emotional responses; however, more avoidant individuals reported less compassion and anger and used more words reflecting anger across conditions. More anxiously attached individuals reported greater compassion across conditions.

CONCLUSION

When thinking about a partner's suffering, there are attachment-related differences in emotional reactions. Yet, regardless of these differences, it may be adaptive for spouses to think about their role in providing support to their partner to decrease their own negative emotions.

Secure attachment and eudaimonic well-being in late adulthood: The mediating role of self-compassion

OBJECTIVES

Attachment style refers to a systematic pattern of emotions, behaviors, and expectations that people have for how others will respond in relationships. Extensive evidence has documented the importance of attachment security in infants, children, adolescents, and adults, but the effects of attachment among exclusively older adult populations have received less attention. The present study explored the relationships between attachment style in late adulthood and eudaimonic well-being, which refers to a life replete with meaning, productive activity, and striving to reach one's potential. It also explored the mediating role of self-compassion, which can be described as a kind and forgiving attitude toward the self.

METHOD

A sample of 126 community-dwelling older adults (mean age = 70.40 years) completed measures tapping adult attachment, self-compassion, and six theoretically derived markers of eudaimonic well-being.

RESULTS

Attachment anxiety and avoidance were inversely related to self-acceptance, personal growth, interpersonal relationship quality, purpose in life, and environmental mastery. Mediation analyses showed that self-compassion mediated each of these relationships.

CONCLUSION

Results support the importance of attachment orientation for psychological well-being in late life and indicate that secure attachment facilitates an attitude of kindness and acceptance toward the self.

To Love is to Suffer: Older Adults' Daily Emotional Contagion to Perceived Spousal Suffering

Objectives

For older adults coping with a spouse's chronic condition, greater marital satisfaction may not be entirely protective for psychological health. We examined marital satisfaction and gender as moderators of the association between perceived spousal suffering and daily emotional contagion. Based on empathy-altruism and interdependent self-construal theories, we hypothesized that high marital satisfaction and being female would heighten daily emotional contagion, or within-person associations between perceived spouse suffering and distress to spouse suffering.

Method

Forty-five older adults who had a spouse with a musculoskeletal condition completed daily interviews. Participants reported their marital satisfaction once in the laboratory and then daily perceptions of their spouse's physical suffering and their own distress to spouse suffering via phone at home for 7 days.

Results

Consistent with hypotheses, there were significant within-person effects such that highly satisfied wives experienced heightened emotional contagion on days when they perceived higher than average spouse suffering. Unexpectedly, men who were high in marital satisfaction experienced heightened daily distress irrespective of their perceptions of level of spousal suffering.

Discussion

Marital satisfaction can increase daily emotional contagion to spousal suffering among older couples dealing with chronic conditions. Wives' distress may be more dependent on perceiving high levels of partner suffering compared with husbands' distress.

Attachment Style and Chronic Pain: Toward an Interpersonal Model of Pain

Chronic pain (CP) is a burdensome symptom. Different psychological models have been proposed to explain the role of psychological and social factors in developing and maintaining CP. Attachment, for example, is a psychological construct of possible relevance in CP. The first studies on the role of attachment in CP did not investigate the partner’s psychological factors, thus neglecting the influence of the latter. The main aim of this mini-review was to examine the more recent literature investigating the relationship between CP and attachment style. In particular, whether or not more recent studies assessed the psychological variables of a patient’s partner. The articles were selected from the Medline/PubMed database using the search terms “attachment” AND “pain”; “CP” AND “attachment style,” which led to nine papers being identified. The results showed that, even though the key point was still the hypothesis that an insecure attachment style is associated with CP, in recent years researchers have focused on the possible psychological aspects mediating between attachment style and CP. In particular, worrying, coping strategies, catastrophizing and perceived spouse responses to pain behavior were taken into account. Only one study considered the role of the reciprocal influence of attachment style of both patient and partner, underlining the role of real significant others’ responses to pain behaviors. In conclusion, the results of the present mini-review highlight how in recent years researchers have moved toward investigating those psychological aspects that could mediate the relationship between attachment and CP, while only partially evaluating the interpersonal perspective.

Dyadic Associations Between Physical Activity and Depressive Symptoms in Older Adults with Musculoskeletal Conditions and Their Spouses

This study examined the association between physical activity of older individuals with musculoskeletal conditions (IMCs) and their spouses' physical activity, how physical activity related to one's own and one's partner's depressive symptoms, and whether the similarity of partners' physical activity related to each partner's depressive symptoms using the actor-partner interdependence model. Seventy-seven dyads completed self-report measures of physical activity, depressive symptoms and potential covariates (socio-demographics, physical health conditions and marital satisfaction; IMCs' functional impairment and pain; and spouses' support-related stress). As hypothesized, we found a positive association between the IMC's and the spouse's physical activity. Also, spouses had more depressive symptoms when IMCs engaged in less physical activity. However, for both partners, one's own physical activity was not significantly associated with one's own depressive symptoms. The spouse's physical activity was also not significantly associated with the IMC's depressive symptoms, and the similarity between partners' physical activity did not significantly relate to either partner's depressive symptoms. Our findings suggest that interventions that help increase the physical activity of both partners, but particularly IMCs, may benefit spouses' well-being. Copyright © 2014 John Wiley & Sons, Ltd.