Tuborgh Astrid, Svendsen Susanne Wulff, Elklit Ask, Hunter Jon, Jensen Jens Søndergaard, Ørnbøl Eva, Schröder Andreas, Nielsen Jørgen Feldbæk, Thastum Mille Møller, Næss-Schmidt Erhard Trillingsgaard, Rask Charlotte Ulrikka
Department of Child and Adolescent Psychiatry, Research Unit, Aarhus University Hospital, Aarhus, Denmark.
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Scand J Psychol. 2025 Aug;66(4):459-472. doi: 10.1111/sjop.13094. Epub 2025 Feb 20.
Insecure adult attachment patterns have recently been associated with an increased risk of developing persistent post-concussion symptoms (PCS) and poorer treatment outcomes, highlighting the potential of attachment-informed treatment protocols for persistent PCS. A key requirement for such approaches is that attachment patterns remain relatively stable during the post-injury illness course, allowing them to serve as reliable indicators for guiding initial care and treatment planning. This study aimed to assess the stability of self-reported attachment anxiety and attachment avoidance in individuals aged 15-30 years, from three (T1) to nine (T2) months after a concussion, corresponding to the period when treatment for PCS typically becomes relevant. This study is a methodological follow-up of a larger clinical cohort study comprising 3080 individuals aged 15-30 years who were diagnosed with a concussion. Attachment dimensions were measured using the Experiences in Close Relationships-Relationship Structures Questionnaire at three (T1) and nine (T2) months post-injury. Both mean-level and individual changes were examined, taking relevant covariates such as sex, age, level of PCS, post-traumatic stress disorder symptoms, and social support into account. At T1, 958 respondents were included (39%), with 416 also responding at T2 (43%). Mean-level changes were minimal (attachment anxiety: β = -0.07 (95% confidence interval [CI]: -0.22; 0.08)), attachment avoidance: β = 0.00 (95% CI: -0.11; 0.11). Larger individual changes that could not be explained by measurement error were observed in 12% of participants. No association was found with any of the covariates. Self-reported attachment patterns appear to remain stable in most young people with a concussion from 3 to 9 months post-injury. The findings strengthen confidence in conducting research to investigate whether attachment-informed treatment approaches can improve healthcare for these patients.
不安全的成人依恋模式最近被认为与发生持续性脑震荡后症状（PCS）的风险增加以及较差的治疗结果有关，这凸显了基于依恋的治疗方案对持续性PCS的潜在作用。此类方法的一个关键要求是，依恋模式在受伤后的病程中保持相对稳定，以便能够作为指导初始护理和治疗计划的可靠指标。本研究旨在评估15至30岁个体在脑震荡后3个月（T1）至9个月（T2）期间自我报告的依恋焦虑和依恋回避的稳定性，这一时期对应于PCS治疗通常开始起作用的阶段。本研究是一项对一个更大的临床队列研究的方法学随访，该队列研究包括3080名15至30岁被诊断为脑震荡的个体。在受伤后3个月（T1）和9个月（T2）使用亲密关系经历-关系结构问卷测量依恋维度。同时考察了平均水平变化和个体变化，并考虑了相关协变量，如性别、年龄、PCS水平、创伤后应激障碍症状和社会支持。在T1时，纳入了958名受访者（39%），其中416人在T2时也做出了回应（43%）。平均水平变化极小（依恋焦虑：β = -0.07（95%置信区间[CI]：-0.22；0.08）），依恋回避：β = 0.00（95%CI：-0.11；0.11）。12%的参与者出现了无法用测量误差解释的较大个体变化。未发现与任何协变量存在关联。在大多数受伤后3至9个月的脑震荡年轻人中，自我报告的依恋模式似乎保持稳定。这些发现增强了开展研究以调查基于依恋的治疗方法是否能改善这些患者医疗护理的信心。
