Spiritual well-being mediates the association between attachment insecurity and psychological distress in advanced cancer patients
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The diagnosis of a terminal disease bears existential challenges, which activate the attachment system. Attachment insecurity, as well as existential resources, such as spiritual well-being, influences patients’ extent of psychological distress. Knowledge about the interrelation of these constructs is limited. Based on current research, we assume spiritual well-being to mediate the association of attachment insecurity and psychological distress.
We obtained data from the baseline measurement of a randomized controlled trial in advanced cancer patients. Patients were sampled from the University Medical Centers of Hamburg and Leipzig, Germany. Main outcome measures included the Patient Health Questionnaire (PHQ-9), the Death and Dying Distress Scale (DADDS), the Functional Assessment of Chronic Illness Therapy–Spiritual Well-Being Scale (FACIT-Sp), and the Experience in Close Relationships Scale (ECR-M16) for assessing attachment insecurity. We tested the mediation hypothesis with two regression analyses using bootstrapping procedure.
A total of 190 patients were included. Spiritual well-being mediated the association of attachment insecurity and depression (R2 = 11%), as well as death anxiety (R2 = 15%), in fearful-avoidant attached patients. Neither dismissingly nor preoccupied attached patients differ in terms of spiritual well-being and psychological distress in comparison with secure attached patients.
Spiritual well-being plays a relevant role in advanced cancer patient’s mental health through mediating the association of attachment and psychological distress. Developing a better understanding of the interdependency of the constructs of spiritual well-being and attachment can help to develop individually tailored advanced cancer care programs and psychotherapeutic interventions.
KeywordsAdvanced cancer Attachment Spiritual well-being Depression Death anxiety
Compliance with ethical standards
The study protocol was approved by local ethics committees in both study centers (Hamburg reference number: PV4435; Leipzig reference number: 143–14–14042014). All patients provided written informed consent prior to participation and could withdraw their informed consent at all times without having any disadvantage in their medical or psychological treatment
Conflict of interest
This research was supported by the German Cancer Aid. The authors declare not having any financial relationship with the organization. The authors have full control of all primary data and agree to allow the journal to review the data if requested.
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