Traumatic Stress, Attachment Style, and Health Outcomes in Cardiac Rehabilitation Patients

Abstract

Objective: Research on psychosocial risk factors in cardiovascular disease (CVD) has identified traumatic stress and attachment style as independent risk factors for the development of CVD and poor prognosis for those with established CVD. Exploring the interrelationships between these variables will inform psychosocial risk factor modeling and potential avenues for intervention. Therefore, the hypothesis that attachment style is related to health outcomes among CR patients and that traumatic stress mediates this relationship was tested.Methods: Patients in a cardiac rehabilitation program (n = 201) completed validated self-report measures of traumatic stress and attachment style at baseline (program intake). Health outcomes were assessed at baseline and 3 months, including anxiety, depression, quality of life, fasting blood glucose, glycated hemoglobin (HbA1c), and cholesterol (HDL ratio). Multivariate structural equation modeling was used to fit the data.Results: Of the 201 participants, 42 (21%) had trauma scores indicating the probable presence of posttraumatic stress disorder. Via greater levels of traumatic stress, greater attachment anxiety at baseline was indirectly related to greater anxiety, depression, fasting blood glucose, and HbA1c, and poorer physical and mental quality of life. There were no significant indirect effects on HDL ratios. Conclusion:Greater attachment anxiety predicted greater traumatic stress; this, in turn, predicted poorer health outcomes. Screening and treatment for these constructs in CVD patients is warranted.

Attachment avoidance and health-related quality of life: Mediating effects of avoidant coping and health self-efficacy in a rehabilitation sample.

“…This is in line with other studies showing that high attachment avoidance is related to lower quality of life. The nonsignificant association between attachment anxiety and HRQoL after controlling for attachment avoidance is consistent with some research showing no direct relationship (Brandão et al, 2018) but contrary to findings of other studies (Fagundes et al, 2014; Heenan et al, 2020). Overall, our findings suggest a clear role of attachment avoidance in HRQoL of individuals with CID.…”

“…For example, cognitive impairments accompanying some CIDs (e.g., mild ABI/PCS, MS) might impact some of the pathways in our model (Boosman et al, 2017), although this is less likely in our sample given our exclusion criteria. Additionally, relationships with health care providers (e.g., Brenk-Franz et al, 2017) and dyadic coping (Greenman et al, 2014; Van Vleet & Helgeson, 2019) may explain the relationship between attachment insecurity dimensions and adaptation to CIDs. However, the broad and well-researched constructs related to attachment insecurity are known to subsume concepts like affect regulation, relationship style, self-concept, and coping (Mikulincer & Shaver, 2005, 2019).…”

“…While it is generally established that attachment insecurity correlates with poor health outcomes (Andersen et al, 2019; Bennett et al, 2011; Kowal et al, 2015; Meredith & Strong, 2019; Pietromonaco & Beck, 2019; Schmidt et al, 2002; Sirois & Gick, 2016), the differential contributions of the dimensions of attachment anxiety and attachment avoidance are less consistently documented in the research. Some researchers demonstrated that attachment anxiety is a stronger predictor of poor health indicators (Heenan et al, 2020; Martin et al, 2012), whereas others have shown that attachment avoidance is the stronger predictor (Ávila et al, 2015; Brandão et al, 2018). Attachment insecurity dimensions are also differentially related to health conditions.…”

The prevalence of acute stress disorder after acute myocardial infarction and its psychosocial risk factors among young and middle-aged patients

“…Previous research showed that insecure attachment style (greater attachment-related avoidance or anxiety) predicted greater anxiety, depression, fasting blood glucose and glycosylated hemoglobin. Insecure attachment style is associated with poorer health outcomes in coronary heart disease patients experiencing traumatic stress 26 . As a traumatic stress, AMI can trigger the attachment system in patients; those with greater attachment-related anxiety are eager to get help from others but generally lack self-confidence and have abandonment issues.…”

Impact of the COVID-19 pandemic in patients with a previous history of premature myocardial infarction

“…On the other hand, we have to mention that severe anxiety levels might yield to poor prognosis as it was revealed that patients with generalized anxiety disorder have increased major adverse cardiac event risk [ 9 ]. A recent study including patients attending a cardiac rehabilitation program concluded that greater baseline levels of traumatic stress related to poor cardiac outcomes such as higher fasting blood glucose and HbA1C [ 10 ].…”