Hostname: page-component-586b7cd67f-gb8f7 Total loading time: 0 Render date: 2024-11-23T00:31:58.891Z Has data issue: false hasContentIssue false
  • English
  • Français

Age and depression in patients with metastatic cancer: the protective effects of attachment security and spiritual wellbeing

Published online by Cambridge University Press:  24 September 2009

CHRISTOPHER LO ,
JUDY LIN ,
LUCIA GAGLIESE ,
CAMILLA ZIMMERMANN ,
MARIO MIKULINCER  and
GARY RODIN
CHRISTOPHER LO*
Affiliation:
Behavioural Sciences and Health Research Division, Toronto General Hospital, Toronto, Canada.
JUDY LIN
Affiliation:
Department of Psychiatry, University of Toronto, Toronto, Canada.
LUCIA GAGLIESE
Affiliation:
School of Kinesiology and Health Science, York University, Toronto, Canada.
CAMILLA ZIMMERMANN
Affiliation:
Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, Toronto, Canada.
MARIO MIKULINCER
Affiliation:
New School of Psychology, Interdisciplinary Center Herzliya, Herzliya, Israel.
GARY RODIN
Affiliation:
Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, Toronto, Canada.
*
Address for correspondence: Christopher Lo, Behavioural Sciences and Health Research Division, Toronto General Hospital, Eaton North 9-232, 200 Elizabeth Street, Toronto, Ontario M5G2C4, Canada. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Psychological distress in cancer patients is inversely related to age, although the reasons are unclear. The adult development literature suggests that ageing may be associated with the development of adaptive capacities, specifically greater attachment security (the sense that others will be available and supportive when needed) and spirituality (the capacity to view one's life as having meaning, purpose and value), that enable older people to cope better with disease. We examined whether age-related patterns in attachment security and spiritual wellbeing account for the protective effect of age against distress. Measures of depression, attachment security, spiritual wellbeing and disease burden were collected from 342 patients aged from 21 to 88 years with advanced, metastatic cancer. Attachment security and spiritual wellbeing were tested as mediators of the effect of age on depression, controlling for disease burden. It was found that age was associated inversely with depression and positively with spiritual wellbeing and attachment security. Depression was inversely related to attachment security and spiritual wellbeing, and the effect of age on depression was fully mediated by attachment security and spiritual wellbeing. The relative protection from psychological distress among older cancer patients may be the result of age-related developmental accomplishments and/or differences in the response to adverse life-events.

Keywords

adult developmentadvanced cancerageingattachmentdepressionspirituality
Type
Articles
Information
Ageing & Society , Volume 30 , Issue 2 , February 2010 , pp. 325 - 336
Copyright
Copyright © Cambridge University Press 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Beck, A. T., Steer, R. A. and Brown, G. K. 1996. Manual for the Beck Depression Inventory-II. Psychological Corporation, San Antonio, Texas.Google Scholar
Bekelman, D. B., Dy, S. M., Becker, D. M., Wittstein, I. S., Hendricks, D. E., Yamashita, T. E. and Gottlieb, S. H. 2007. Spiritual well-being and depression in patients with heart failure. Journal of General Internal Medicine, 22, 4, 470–7.CrossRefGoogle ScholarPubMed
Bouchardy, C., Rapiti, E., Blagojevic, S., Vlastos, A. and Vlastos, G. 2007. Older female cancer patients: importance, causes, and consequences of undertreatment. Journal of Clinical Oncology, 25, 14, 1858–69.CrossRefGoogle ScholarPubMed
Brady, M. J., Peterman, A. H., Fitchett, G., Mo, M. and Cella, D. 1999. A case for including spirituality in quality of life measurement in oncology. Psycho-Oncology, 8, 5, 417–28.3.0.CO;2-4>CrossRefGoogle ScholarPubMed
Brandtstadter, J. and Greve, W. 1994. The aging self: stabilizing and protective processes. Developmental Review, 14, 1, 52–80.CrossRefGoogle Scholar
Breitbart, W. 2002. Spirituality and meaning in supportive care: spirituality – and meaning-centered group psychotherapy interventions in advanced cancer. Supportive Care in Cancer, 10, 4, 272–80.CrossRefGoogle ScholarPubMed
Chochinov, H. M. and Cann, B. J. 2005. Interventions to enhance the spiritual aspects of dying. Journal of Palliative Medicine, 8, S1, S103–15.CrossRefGoogle ScholarPubMed
Cleeland, C. S. 1989. Measurement of pain by subjective report. In Chapman, C. R. and Loeser, J. D. (eds), Advances in Pain Research and Therapy. Twelfth edition, Raven, New York, 391–430.Google Scholar
Dalby, P. 2006. Is there a process of spiritual change or development associated with ageing? A critical review of research. Aging and Mental Health, 10, 1, 4–12.CrossRefGoogle ScholarPubMed
Davila, J., Karney, B. R. and Bradbury, T. N. 1999. Attachment change processes in the early years of marriage. Journal of Personality and Social Psychology, 76, 5, 783–802.CrossRefGoogle ScholarPubMed
Edmondson, D., Park, C. L., Blank, T. O., Fenster, J. R. and Mills, M. A. 2008. Deconstructing spiritual well-being: existential well-being and HRQOL in cancer survivors. Psycho-Oncology, 17, 2, 161–9.CrossRefGoogle ScholarPubMed
Ellis, J., Lin, J., Walsh, A., Lo, C., Shepherd, F. A., Moore, M., Li, M., Gagliese, L., Zimmermann, C. and Rodin, G. 2009. Predictors of referral for specialized psychosocial oncology care in patients with metastatic cancer: the contributions of age, distress and marital status. Journal of Clinical Oncology, 27, 5, 699–705.CrossRefGoogle ScholarPubMed
Exley, C. and Letherby, G. 2001. Managing a disrupted lifecourse: issues of identity and emotion work. Health, 5, 1, 112–32.CrossRefGoogle Scholar
Gross, J. J., Carstensen, L. L., Pasupathi, M., Tsai, J., Skorpen, C. G. and Hsu, A. Y. C. 1997. Emotion and aging: experience, expression, and control. Psychology and Aging, 12, 4, 590–9.CrossRefGoogle ScholarPubMed
Grossmann, K. E., Grossmann, K. and Waters, E. 2005. Attachment from Infancy to Adulthood: The Major Longitudinal Studies. Guilford, New York.Google Scholar
Holland, J. C. 2003. Psychological care of patients: psycho-oncology's contribution. Journal of Clinical Oncology, 21, 23S, 253s–65s.CrossRefGoogle ScholarPubMed
Hunter, M. J., Davis, P. J. and Tunstall, J. R. 2006. The influence of attachment and emotional support in end-stage cancer. Psycho-Oncology, 15, 5, 431–44.CrossRefGoogle ScholarPubMed
Jorm, A. F., Windsor, T. D., Dear, K. B. G., Anstey, K. J., Christensen, H. and Rodgers, B. 2005. Age group differences in psychological distress: the role of psychosocial risk factors that vary with age. Psychological Medicine, 35, 9, 1253–63.CrossRefGoogle ScholarPubMed
Katzman, R., Brown, T., Fuld, P., Peck, A., Schechter, R. and Schimmel, H. 1983. Validation of a Short Orientation-Memory-Concentration Test of cognitive impairment. American Journal of Psychiatry, 140, 6, 734–9.Google Scholar
Lo, C., Walsh, A., Mikulincer, M., Gagliese, L., Zimmermann, C. and Rodin, G. 2009. Measuring attachment security in patients with advanced cancer: psychometric properties of a modified and brief ‘Experiences in Close Relationships’ scale. Psycho-Oncology, 18, 5, 490–9.CrossRefGoogle ScholarPubMed
McClain, C. S., Rosenfeld, B. and Breitbart, W. 2003. Effect of spiritual well-being on end-of-life despair in terminally-ill cancer patients. Lancet, 361, 9369, 1603–7.CrossRefGoogle ScholarPubMed
Mikulincer, M. and Shaver, P. R. 2007. Attachment in Adulthood: Dynamics, Structure, and Change. Guilford, New York.Google Scholar
Mosher, C. E. and Danoff-Burg, S. 2005. A review of age differences in psychological adjustment to breast cancer. Journal of Psychosocial Oncology, 23, 2/3, 101–14.CrossRefGoogle ScholarPubMed
Muldoon, M. and King, N. 1995. Spirituality, health care, and bioethics. Journal of Religion and Health, 34, 4, 329–49.CrossRefGoogle ScholarPubMed
Peterman, A. H., Fitchett, G., Brady, M. J., Hernandez, L. and Cella, D. 2002. Measuring spiritual well-being in people with cancer: the Functional Assessment of Chronic Illness Therapy – Spiritual Well-Being Scale (FACIT-Sp). Annals of Behavioral Medicine, 24, 1, 49–58.CrossRefGoogle ScholarPubMed
Portenoy, R. K., Thaler, H. T., Kornblith, A. B., Lepore, J. M., Friedlander-Klar, H., Kiyasu, E., Sobel, K., Coyle, N., Kemeny, N., Norton, L. and Scher, H. 1994. The Memorial Symptom Assessment Scale: an instrument for the evaluation of symptom prevalence, characteristics and distress. European Journal of Cancer, 30A, 9, 1326–36.CrossRefGoogle ScholarPubMed
Preacher, K. J. and Hayes, A. F. 2008. Asymptotic and re-sampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40, 3, 879–91.CrossRefGoogle Scholar
Ries, L. A. G., Reichman, M. E., Lewis, D. R., Hankey, B. F. and Edwards, B. K. 2003. Cancer survival and incidence from the Surveillance, Epidemiology, and End Results (SEER) program. Oncologist, 8, 6, 541–52.CrossRefGoogle Scholar
Rodin, G., Walsh, A., Zimmermann, C., Gagliese, L., Jones, J., Shepherd, F. A., Moore, M., Braun, M., Donner, A. and Mikulincer, M. 2007 a. The contribution of attachment security and social support to depressive symptoms in patients with metastatic cancer. Psycho-Oncology, 16, 12, 1080–91.CrossRefGoogle ScholarPubMed
Rodin, G., Zimmermann, C., Rydall, A., Jones, J., Shepherd, F. A., Moore, M., Fruh, M., Donner, A. and Gagliese, L. 2007 b. The desire for hastened death in patients with metastatic cancer. Journal of Pain and Symptom Management, 33, 6, 661–75.CrossRefGoogle ScholarPubMed
Schneider, R. A. 1998. Concurrent validity of the Beck Depression Inventory and the Multidimensional Fatigue Inventory-20 in assessing fatigue among cancer patients. Psychological Reports, 82, 3, part 1, 883–6.CrossRefGoogle ScholarPubMed
Shepherd, F. 2000. Treatment of non-small cell lung cancer: chemotherapy. In Hansen, H. H. (ed.), Textbook of Lung Cancer. Martin Dunitz, London, 213–42.Google Scholar
Stanton, A. L. 2006. Psychosocial concerns and interventions for cancer survivors. Journal of Clinical Oncology, 24, 32, 5132–7.CrossRefGoogle ScholarPubMed
Stefanek, M., McDonald, P. G. and Hess, S. A. 2005. Religion, spirituality and cancer: current status and methodological challenges. Psycho-Oncology, 14, 6, 453–63.CrossRefGoogle ScholarPubMed
Strong, V., Waters, R., Hibberd, C., Rush, R., Cargill, A., Storey, D., Walker, J., Wall, L., Fallon, M. and Sharpe, M. 2007. Emotional distress in cancer patients: the Edinburgh Cancer Centre symptom study. British Journal of Cancer, 96, 6, 868–74.CrossRefGoogle Scholar
Tan, A., Zimmermann, C. and Rodin, G. 2005. Interpersonal processes in palliative care: an attachment perspective on the patient–clinician relationship. Palliative Medicine, 19, 2, 143–50.CrossRefGoogle ScholarPubMed
Torstam, L. 1996. Gerotranscendence: a theory about maturing into old age. Journal of Aging and Identity, 1, 1, 37–50.Google Scholar
Wink, P. and Dillon, M. 2002. Spiritual development across the adult life course: findings from a longitudinal study. Journal of Adult Development, 9, 1, 79–94.CrossRefGoogle Scholar
Zhang, F. and Labouvie-Vief, G. 2004. Stability and fluctuation in adult attachment style over a 6-year period. Attachment and Human Development, 6, 4, 419–37.CrossRefGoogle Scholar