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Attachment style and anxiety in carers of people with Alzheimer's disease: results from the LASER-AD study

Published online by Cambridge University Press:  06 December 2007

Claudia Cooper ,
Colm Owens ,
Cornelius Katona  and
Gill Livingston
Claudia Cooper*
Affiliation:
Department of Mental Health Sciences, University College London, U.K.
Colm Owens
Affiliation:
Department of Mental Health Sciences, University College London, U.K.
Cornelius Katona
Affiliation:
Department of Mental Health Sciences, University College London, U.K.
Gill Livingston
Affiliation:
Department of Mental Health Sciences, University College London, U.K.
*
Correspondence should be addressed to: Dr Claudia Cooper, Medical Research Council Research Training Fellow in Health Services Research, Dept of Mental Health Sciences, University College London (Hampstead Campus), Rowland Hill Street, London, NW3 2PF, U.K. Phone: +44 20 7561 4218; Fax: +44 20 7561 4236. Email: [email protected].
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Abstract

Background: Preliminary evidence indicates that the quality of the carer-care recipient relationship predicts those carers most at risk from anxiety. Attachment style is related to higher carer burden, psychological morbidity and increased care recipient institutionalization. We tested, for the first time, the hypothesis that carer burden and the coping strategies used mediate a relationship between attachment style and anxiety.

Methods: We interviewed 83 people with Alzheimer's disease and their family carers, originally recruited for a larger community study. Carers filled in a validated measure about their attachment style, the Hospital Anxiety and Depression Scale, the COPE to measure coping strategies, and the Zarit-Burden interview.

Results: More avoidant attachment (β = 0.28) and less secure attachment (β = −0.32) predicted anxiety. After adding coping strategies to the equation, the relationship with avoidant attachment (β = 0.15) was no longer significant, and that with less secure attachment was reduced (β = −0.23). A well-fitting structural equation model supported our finding that dysfunctional coping mediated the relationship between attachment style and anxiety.

Conclusion: Carers who were less secure or more avoidantly attached reported higher anxiety. Interventions that aim to modify coping strategies have shown promise in reducing carer anxiety. Our finding that coping strategies also appear partially to explain the excess of anxiety among less securely attached carers suggests they are likely to benefit from such interventions.

Keywords

dementiacoping strategiescarer burden
Type
Research Article
Information
International Psychogeriatrics , Volume 20 , Issue 3 , June 2008 , pp. 494 - 507
Copyright
Copyright © International Psychogeriatric Association 2007

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References

Baldwin, M. W. and Fehr, B. (1995). On the instability of attachment style ratings. Personal Relationships, 2, 247–261.CrossRefGoogle Scholar
Baron, R. M. and Kenny, D. A. (1986). The moderator mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173–1182.CrossRefGoogle ScholarPubMed
Bjelland, I., Dahl, A. A., Haug, T. T. and Neckelmann, D. (2002). The validity of the Hospital Anxiety and Depression Scale: an updated literature review. Journal of Psychosomatic Research, 52, 69–77.CrossRefGoogle ScholarPubMed
Bowlby, J. and Parkes, C. M. (1970). Separation and loss within the family. In Anthony, E. J. and Koupernik, C. (eds.), The Child in his Family: International Yearbook of Child Psychiatry and Allied Professions (pp. 197–216). New York: Wiley.Google Scholar
Bretherton, I. (1992). The origins of attachment theory: John Bowlby and Mary Ainsworth. Developmental Psychology, 28, 759–775.CrossRefGoogle Scholar
Brodaty, H., Green, A. and Koschera, A. (2003). Meta-analysis of psychosocial interventions for caregivers of people with dementia. Journal of the American Geriatrics Society, 51, 657–664.CrossRefGoogle ScholarPubMed
Carpenter, B. D. (2001). Attachment bonds between adult daughters and their older mothers: associations with contemporary caregiving. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 56, 257–266.CrossRefGoogle ScholarPubMed
Carver, C. S. (1997). You want to measure coping but your protocol's too long: consider the brief COPE. International Journal of Behavioral Medicine, 4, 92–100.CrossRefGoogle ScholarPubMed
Carver, C. S. and Scheier, M. E. (1994). Situational coping and coping dispositions in a stressful transaction. Journal of Personality and Social Psychology, 66, 184–195.CrossRefGoogle Scholar
Coolidge, F. L., SegalD. L., Hook, J. N. D. L., Hook, J. N. and Stewart, S. (2000). Personality disorders and coping among anxious older adults. Journal of Anxiety Disorders, 14, 157–172.CrossRefGoogle ScholarPubMed
Cooper, C., Balamurali, T. and Livingston, G. (2006a). A systematic review of the prevalence and associates of anxiety in caregivers of people with dementia. International Psychogeriatrics, 19, 175–196.CrossRefGoogle ScholarPubMed
Cooper, C., Katona, C., Orrell, M. and Livingston, G. (2006b). Coping strategies and anxiety in caregivers of people with Alzheimer's disease: the LASER-AD study. Journal of Affective Disorders, 90, 15–20.CrossRefGoogle ScholarPubMed
Cooper, C., Katona, C., Orrell, M., Blizzard, R. and Livingston, G. (in preparation). Coping strategies as predictors of anxiety and depression in carers of people with Alzheimer's disease: the LASER-AD longitudinal study.Google Scholar
Crespo, M., Lopez, J. and Zarit, S. H. (2005). Depression and anxiety in primary caregivers: a comparative study of caregivers of demented and nondemented older persons. International Journal of Geriatric Psychiatry, 20, 591–592.CrossRefGoogle ScholarPubMed
Crispi, E. L., Schiaffino, K. and Berman, W. H. (1997). The contribution of attachment to burden in adult children of institutionalized parents with dementia. Gerontologist, 37, 52–60.CrossRefGoogle ScholarPubMed
Cummings, J. L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D. A. and Gornbein, J. (1994). The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology, 44, 2308–2314.CrossRefGoogle ScholarPubMed
Ferri, C. P. et al. (2005). Global prevalence of dementia: a Delphi consensus study. Lancet, 366, 2112–2117.CrossRefGoogle ScholarPubMed
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle ScholarPubMed
Fraley, R. C. and Waller, N. G. (1998). Adult attachment patterns: a test of the typological model. In Simpson, J. A. and Rholes, W. S. (eds.), Attachment Theory and Close Relationships (pp. 77–114). New York: Guilford Press.Google Scholar
Fratiglioni, L. (1998). Epidemiology. In Wimo, A. et al. (eds.), Health Economics of Dementia, Chichester: John Wiley and Sons Ltd.Google Scholar
Galasko, D., Bennett, D., Sano, M., Ernesto, C., Thomas, R., Grundman, M. and Ferris, S. (1997). An inventory to assess activities of daily living for clinical trials in Alzheimer's disease. The Alzheimer's Disease Cooperative Study. Alzheimer Disease and Associated Disorders, 11, S33–S39.CrossRefGoogle ScholarPubMed
Hazan, C. and Shaver, P. (1987). Romantic love conceptualized as an attachment process. Journal of Personality and Social Psychology, 52, 511–524.CrossRefGoogle ScholarPubMed
Hazan, C. and Shaver, P. R. (1990). Love and work – an attachment-theoretical perspective. Journal of Personality and Social Psychology, 59, 270–280.CrossRefGoogle Scholar
Hebert, R., Bravo, G. and Preville, M. (2000). Reliability, validity and reference values of the Zarit Burden Interview for assessing informal caregivers of community-dwelling older persons with dementia. Canadian Journal on Aging, 19, 494–507.CrossRefGoogle Scholar
Kirkpatrick, L. A. and Hazan, C. (1994). Attachment styles and close relationships: a four-year prospective study. Personal Relationships, 1, 123–142.CrossRefGoogle Scholar
Lee, H. S., Kim, D. K. and Kim, J-H. (2006). Stress in caregivers of demented people in Korea – a modification of Pearlin and colleagues' stress model. International Journal of Geriatric Psychiatry, 21, 784–91.CrossRefGoogle ScholarPubMed
Livingston, G., Katona, C., Roch, B., Guilhaume, C. and Rive, B. (2004). A dependency model for patients with Alzheimer's disease: its validation and relationship to the costs of care – the LASER-AD Study. Current Medical Research Opinion, 20, 1007–1016.CrossRefGoogle Scholar
Mahoney, R., Regan, C., Katona, C. and Livingston, G. (2005). Anxiety and depression in family caregivers of people with Alzheimer's disease – the LASER-AD study. American Journal of Geriatric Psychiatry, 13, 795–801.CrossRefGoogle ScholarPubMed
Markiewicz, D., Reis, M. and Gold, D. P. (1997). An exploration of attachment styles and personality traits in caregiving for dementia patients. International Journal of Aging and Human Development, 45, 111–132.CrossRefGoogle ScholarPubMed
McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D. and Stadlan, E. M. (1984). Clinical diagnosis of Alzheimer's disease – Report of the NINCDS-ADRDA Work Group under the Auspices of the Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology, 34, 939–944.CrossRefGoogle ScholarPubMed
Soper, D. S. (2007). Effect size calculator. Free Statistics Calculators (Online Software), http://www.danielsoper.com/statcalc.Google Scholar
Zarit, S. H., Reever, K. E. and Bachpeterson, J. (1980). Relatives of the impaired elderly – correlates of feelings of burden. Gerontologist, 20, 649–655.CrossRefGoogle ScholarPubMed
Zigmond, A. S. and Snaith, R. P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67, 361–370.CrossRefGoogle ScholarPubMed