Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2018 May:108:39-46.
doi: 10.1016/j.jpsychores.2018.02.014. Epub 2018 Feb 24.

The relationship between attachment orientations and the course of depression in coronary artery disease patients: A secondary analysis of the SPIRR-CAD trial

Wolfgang Söllner  1 , Markus M Müller  2 , Christian Albus  3 , Rüdiger Behnisch  2 , Manfred E Beutel  4 , Martina de Zwaan  5 , Kurt Fritzsche  6 , Anita Habermeier  2 , Martin Hellmich  7 , Jochen Jordan  8 , Jana Jünger  9 , Karl-Heinz Ladwig  10 , Matthias Michal  4 , Katja Petrowski  11 , Joram Ronel  12 , Barbara Stein  2 , Cora Weber  13 , Rainer Weber  3 , Christoph Herrmann-Lingen  14
Affiliations
Multicenter Study

The relationship between attachment orientations and the course of depression in coronary artery disease patients: A secondary analysis of the SPIRR-CAD trial

Wolfgang Söllner et al. J Psychosom Res. 2018 May.

Abstract

Objective: The relationship between attachment orientations and the recovery from depressive symptoms in patients diagnosed with coronary artery disease (CAD) with and without a psychotherapeutic intervention was examined in this study.

Methods: In a multicenter trial of 570 depressed CAD patients (SPIRR-CAD), assigned to usual care plus either a stepwise psychotherapy intervention or one information session, 522 patients provided attachment data at baseline. Attachment was measured with the Relationship Scales Questionnaire (RSQ), yielding four attachment orientations. The primary outcome was change in Hospital Anxiety and Depression Scale depression (HADS-D) scores from baseline to follow-up at 18 months. Secondary outcomes were HADS-D scores at 1, 6, 12, and 24 months.

Results: Independent of treatment assignment, attachment was related to change in depression at 18 months (p < 0.01) with secure attachment resulting in a significant reduction (-2.72, SE = 0.27) in depression compared to dismissive-avoidant (-1.51, SE = 0.35, p = 0.040) and fearful-avoidant (-0.65, SE = 0.61, p = 0.012) attachment. Patients with anxious-preoccupied attachment showed changes similar to secure attachment (-2.01, SE = 0.47). An explorative subgroup analysis across all assessment time points revealed patients with a dismissive-avoidant attachment benefitted from psychotherapy (average mean difference = 0.93, SE = 0.47, p = 0.048).

Conclusion: Attachment played an important role for improvement in depressive symptoms. Only dismissive-avoidant patients seemed to benefit from the intervention. The lack of improvement in fearful-avoidant patients shows a need for specific interventions for this group.

Trial registration: www.clinicaltrials.govNCT00705965; www.isrctn.com ISRCTN76240576.

Keywords: Adult attachment; Coronary artery disease; Depression; Psychotherapy; Randomized controlled trial.

PubMed Disclaimer

Similar articles

See all similar articles

Cited by

Publication types

Associated data

LinkOut - more resources