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

Söllner, Wolfgang; Müller, Markus M; Albus, Christian; Behnisch, Rüdiger; Beutel, Manfred E; de Zwaan, Martina; Fritzsche, Kurt; Habermeier, Anita; Hellmich, Martin; Jordan, Jochen; Jünger, Jana; Ladwig, Karl-Heinz; Michal, Matthias; Petrowski, Katja; Ronel, Joram; Stein, Barbara; Weber, Cora; Weber, Rainer; Herrmann-Lingen, Christoph

doi:10.1016/j.jpsychores.2018.02.014

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Title:: The relationship between attachment orientations and the course of depression in coronary artery disease patients: A secondary analysis of the SPIRR-CAD trial.
Document type:: Article; Journal Article
Author(s):: Söllner, Wolfgang; Müller, Markus M; Albus, Christian; Behnisch, Rüdiger; Beutel, Manfred E; de Zwaan, Martina; Fritzsche, Kurt; Habermeier, Anita; Hellmich, Martin; Jordan, Jochen; Jünger, Jana; Ladwig, Karl-Heinz; Michal, Matthias; Petrowski, Katja; Ronel, Joram; Stein, Barbara; Weber, Cora; Weber, Rainer; Herrmann-Lingen, Christoph
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.
Journal title abbreviation:: J Psychosom Res
Year:: 2018
Journal volume:: 108
Pages contribution:: 39-46
Fulltext / DOI:: doi:10.1016/j.jpsychores.2018.02.014
Pubmed ID:: http://view.ncbi.nlm.nih.gov/pubmed/29602324
Print-ISSN:: 0022-3999
TUM Institution:: Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie
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mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie (Prof. Henningsen)2018