The role of attachment avoidance: A longitudinal mediation model predicting existential distress in patients with advanced cancer

Abstract

Objective Although a protective effect of reliable interpersonal relationships on existential distress has been established, evidence remains inconclusive for attachment insecurity as an underlying factor of persistent psychological distress. We tested a longitudinal model hypothesizing attachment avoidance as a mediator of high demoralization and anxiety over time. Methods We studied 206 patients with advanced cancer (mean age = 59.6, 61% female) participating in an intervention trial. Patients completed self‐report measures for demoralization, anxiety, perceived relatedness, attachment insecurity, and death anxiety. Our mediated path model included perceived relatedness and death anxiety at baseline as predictors, attachment avoidance at baseline as mediator, and demoralization and anxiety at 6‐month follow‐up (N = 125) as outcomes. Results Attachment avoidance partially mediated the relationship between death anxiety and demoralization (β = 0.07, 95% CI 0.02–0.12) and anxiety (β = 0.05, 95% CI 0.001–0.10). Findings for perceived relatedness were less conclusive. Its indirect effects through attachment avoidance were significant for both outcomes (demoralization: β = −0.07, 95% CI −0.13 to −0.02, anxiety: β = −0.05, 95% CI −0.11 to −0.003). Conclusions Due to its trait‐like quality, attachment avoidance may play a less central role in explaining the course of existential distress over time than previous research indicated. Addressing change‐sensitive relational concerns in psychosocial interventions may be more effective to alleviate existential distress.

Death anxiety and its relationship with family function and meaning in life in patients with advanced cancer—A cross-sectional survey in China

“…Third, for exploring associated factors of death anxiety, some variables may be less sensitive and representative due to convenience sampling method rather than purpose sampling method. At the same time, literature review suggested that physical symptoms, self-esteem, attachment security, 7 attachment avoidance, 68 anxiety, depression, and demoralization 14 , 58 , 68 were correlated with death anxiety. Finally, we did not involve and analyze the interaction or the intermediary role between various factors, which need to be further explored in future studies.…”

Prevalence, Associated Factors and Adverse Outcomes of Demoralization in Cancer Patients: A Decade of Systematic Review

“…Two studies reported a positive association between attachment security and demoralization, 43 one of which highlighted the positive relationship between attachment avoidance (one of the dimensions of attachment security) and demoralization. 41 In addition, social relatedness (consisting of attachment security and social support) was negatively associated with demoralization. 17 Two studies reported a positive association between death anxiety and demoralization.…”

“…17 Two studies reported a positive association between death anxiety and demoralization. 17,41 The positive relationship between suicidal ideation, 45 anger, 32 and demoralization has only been investigated in a single study.…”

“…33 Five studies concluded that symptom burden was a positive predictor of demoralization, 17,18,30,37,43 but one study suggested that symptom burden was not significantly related to demoralization. 41 Two studies reported a negative association between KPS scores and demoralization, 37,40 but two studies reported no association between KPS scores and demoralization. 29,44 In addition, patient fatigue 32 and previous history of depression or anxiety 37 have been associated with demoralization.…”

Finding Meaning in Life After a Cancer Diagnosis: What Is the Role of Financial Strain?

“…While a sense of meaning in life is important for maintaining happiness and well-being in general (Cohen & Cairns, 2012; Guerrero-Torrelles et al., 2017; Melton & Schulenberg, 2008), it may be especially important for patients with cancer (Winger et al., 2020). A cancer diagnosis can, at least temporarily, leave some patients feeling demoralized, existentially distressed, and that they lack meaning and purpose in their lives (Kissane et al., 2001; Lee, 2008; Lee et al., 2004; Philipp et al., 2021; Vehling & Kissane, 2018). As many as 40% of patients with cancer in one study reported that they needed help finding meaning in life after their diagnosis (Moadel et al., 1999).…”