Department of Psychosocial Oncology and Palliative Care 16-755, University Health Network, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada.
Support Care Cancer. 2011 Oct;19(10):1539-48. doi: 10.1007/s00520-010-0981-z. Epub 2010 Aug 27.
The purpose of this study is to determine levels of depression and hopelessness and to explore the relationship between attachment security and psychosocial distress in patients with metastatic/recurrent cancer and spouse-caregivers, experiencing marital distress.
Couple-participants were from a pilot study and a larger clinical trial prior to randomization. Participation required that one partner endorsed marital distress on the Revised Dyadic Adjustment Scale (RDAS). Outcome measures included the Beck Depression Inventory-II (BDI-II), Beck Hopelessness Scale (BHS), and Experiences in Close Relationships Inventory.
Caregivers, compared with their matched ill-partners, had significantly higher scores on the RDAS (<distress) after taking sex, avoidance, and anxiety into account. Fifty-two percent of patients and 33% of caregivers scored above the BDI-II cut-off (≥ 15) for depression, with patients and females reporting higher levels of depression compared to caregivers and males. Thirty-three percent of patients and 24% of caregivers scored above the BHS cut-off (≥ 8) for hopelessness, with males and patients displaying significantly higher mean scores compared with females and caregivers. There was a significant interaction effect of sex and avoidance for RDAS; as the male avoidance subscale score increased, the female caregiver RDAS declined (>distressed).
Marital distress may be amplified within insecure attachment bonds, especially among avoidant male patients and their female caregivers, which may influence caregiving/care-receiving. We offer unique, preliminary support for identifying couples at risk to help reduce suffering and complicated bereavement in the terminal cancer population. Further research that include larger studies, are needed to determine relationships among attachment and psychosocial outcomes.
本研究旨在确定患有转移性/复发性癌症的患者及其经历婚姻困扰的配偶护理者的抑郁和绝望水平，并探讨依恋安全性与心理社会困扰之间的关系。
夫妻参与者来自一项试点研究和一项较大的临床试验，在随机分组之前。参与需要夫妻一方在修订后的对偶适应量表（RDAS）上表示婚姻困扰。结果测量包括贝克抑郁量表第二版（BDI-II）、贝克绝望量表（BHS）和亲密关系体验量表。
在考虑了性别、回避和焦虑之后，与匹配的患病伴侣相比，护理者在 RDAS 上的得分（<困扰）显著更高。52%的患者和 33%的护理者的 BDI-II 得分（≥15）高于抑郁的临界值，与护理者和男性相比，患者和女性报告的抑郁水平更高。33%的患者和 24%的护理者的 BHS 得分（≥8）高于绝望的临界值，与女性和护理者相比，男性和患者的平均得分显著更高。RDAS 的性别和回避之间存在显著的交互效应；随着男性回避子量表得分的增加，女性护理者的 RDAS 下降（>困扰）。
在不安全的依恋关系中，婚姻困扰可能会加剧，尤其是在回避的男性患者及其女性护理者中，这可能会影响护理/接受护理。我们为识别处于风险中的夫妇提供了独特的、初步的支持，以帮助减少晚期癌症患者的痛苦和复杂的丧亲之痛。需要进一步的研究，包括更大的研究，以确定依恋与心理社会结果之间的关系。
