Correlates of self-rated attachment in patients with cancer and their caregivers: a systematic review and meta-analysis

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This study aimed to evaluate the association between an anxious/avoidant attachment style and psychosocial variables in patients with cancer and their caregivers.


PsycINFO, PubMed, Google Scholar, and SCOPUS were searched for empirical studies published in peer-reviewed journals between 1994 and 2015, and unpublished data from one cohort were added. Meta-analyses synthesized results from studies investigating the correlates of attachment styles, measured with validated scales, among patients with cancer or their caregivers.


Thirteen studies (k = 13) were included in the quantitative synthesis (including unpublished data from one cohort). Anxious attachment was associated with depression (r = 0.29, CI 0.19–0.38, I2 = 76%), anxiety (r = 0.34, CI 0.13–0.52, I2 = 69%), and social support (r = −0.39, CI −0.55–0.21, I2 = 87%). Avoidant attachment was associated with depressive symptoms (r = 0.20, CI 0.15–0.25, I2 = 16%), anxiety (r = 0.13, CI 0.01–0.24, I2 = 4%), and social support (r = −0.28, CI −0.42–0.14, I2 = 75%).


Patients with cancer and their caregivers showing high levels of insecure attachment are at risk of experiencing higher levels of depressive symptoms, anxiety, and poor social support. Findings suggest that clinicians’ awareness of attachment styles may serve as important clinical insight to improve treatment outcomes. Large-scale studies and longitudinal studies are required to investigate distinct longitudinal pathways in cancer-related distress across different attachment styles Copyright © 2016 John Wiley & Sons, Ltd.

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