William J. Lancee

Adult attachment measures: A 25-year review

OBJECTIVE Over the past 25 years, attachment research has extended beyond infant-parent bonds to examine dyadic relationships in children, adolescents, and adults. Attachment has been shown to influence a wide array of biopsychosocial phenomena, including social functioning, coping, stress response, psychological well-being, health behavior, and morbidity, and has thus emerged as an important focus of psychosomatic research. This article reviews the measurement of adult attachment, highlighting instruments of relevance to-or with potential use in-psychosomatic research. METHODS Following a literature search of articles that were related to the scales and measurement methods of attachment in adult populations, 29 instruments were examined with respect to their utility for psychosomatic researchers. RESULTS Validity, reliability, and feasibility were tabulated on 29 instruments. Eleven of the instruments with strong psychometric properties, wide use, or use in psychosomatic research are described. These include the following: Adult Attachment Interview (George, Kaplan, and Main); Adult Attachment Projective (George and West); Adult Attachment Questionnaire (Simpson, Rholes, and Phillips); Adult Attachment Scale (and Revised Adult Attachment Scale) (Collins and Read); Attachment Style Questionnaire (Feeney); Current Relationship Interview (Crowell and Owens); Experiences in Close Relationships (Brennan, Clark, and Shaver) and Revised Experiences in Close Relationships (Fraley, Waller, and Brennan); Parental Bonding Instrument (Parker, Tupling, and Brown); Reciprocal Attachment Questionnaire (West and Sheldon-Keller); Relationship Questionnaire (Bartholomew and Horowitz); and Relationship Scales Questionnaire (Grifiin and Bartholomew). CONCLUSION In addition to reliability and validity, investigators need to consider relationship focus, attachment constructs, dimensions or categories of interest, and the time required for training, administration, and scoring. Further considerations regarding attachment measurement in the context of psychosomatic research are discussed.

Ethinylestradiol and dl-norgestrel as a postcoital contraceptive.

Six hundred and eight women were treated with 200 microgram of ethinylestradiol and 2 mg of dl-norgestrel, administered in two divided doses, as a postcoital contraceptive. Criteria for entry into the study included definite unprotected coital exposure within the previous 72 hours and the absence of any contraindications to the use of estrogen/progestin-containing compounds. Women with coital exposures outside of the 72-hours-to-treatment time frame were excluded. Four hundred and sixty-four of the patients were cycling regularly and, of these, 152 were exposed at midcycle. Only one patient became pregnant as a result of probable method failure as compared with the minimal estimated number of 12 to 30 pregnancies.

Long-term psychological and occupational effects of providing hospital healthcare during SARS outbreak.

TOC Summary Line: Healthcare workers in hospitals affected by SARS experience increased psychological stress 1–2 years after the outbreak.

Psychoanalytic patients in the U.S., CANADA, and Australia: I. DSM-III-R disorders, indications, previous treatment, medications, and length of treatment.

To determine the demographics, DSM-III-R disorders diagnosed, indications used in recommending psychoanalysis, previous treatment histories, use of medication, and length of treatment in patients in psychoanalysis in the U.S., Canada, and Australia, a mail survey of practice was sent to every other active member of the American Psychoanalytic Association and every member of the Australian Psychoanalytical Society. This supplemented an earlier survey sent to all Ontario psychoanalysts. The response rates were 40.1 % (n=342) for the U.S., 67.2% (n=117) for Canada, and 73.9% (n=51) for Australia. Respondents supplied data on 1,718 patients. The employment rate for patients increases as analysis progresses (p < .0001). The mean number of concurrent categories of disorders (Axis I, Axis II, and Disorders First Evident in Childhood) per patient at the start of treatment is 5.01 (SD=3.66; median=4; mode=3). There are no statistically significant differences across countries. Mood, anxiety, sexual dysfunction, and personality disorders are most common. American Psychiatric Association / American Psychoanalytic Association peer review criteria for indicating psychoanalysis are followed for 86.5% of patients. Over 80% of patients in all three countries had undergone previous treatments prior to analysis. In the U.S., 18.2% of analysands are on concurrent psychoactive medication; in Australia, 9.6%. The mean length of analyses conducted in the U.S. is 5.7 years, in Australia 6.6, and in Canada 4.8. Psychoanalytic patients in all three countries have similar rates of DSM-III-R psychopathology, and many indications of chronicity.

The perceived family burden scale: measurement and validation.

Findings in family burden research suggest that, in families with a mentally ill relative, patterns of family interaction develop in response to the onset of major mental illness and result from the burden experienced by family members in coping with illness. The present study focused on instrument development and validation of the Perceived Family Burden Scale (PFBS), a measure of those patient behaviors associated with schizophrenia and the impact of these behaviors on relatives. The PFBS was found to be a valid and reliable instrument which demonstrated greater predictive power for early symptomatic relapse in schizophrenia than another measure of family interaction, expressed emotion.

Attachment Insecurity Moderates the Relationship Between Disease Activity and Depressive Symptoms in Ulcerative Colitis

Background: Among people with ulcerative colitis, depression occurs more frequently when inflammation is active. We hypothesized that individual differences in interpersonal style affect the risk that active disease will be accompanied by depressive symptoms. Methods: In this study, disease activity, depressive symptoms, and 2 dimensions of interpersonal style, attachment anxiety and attachment avoidance, were measured in 146 ulcerative colitis outpatients at time 1 and in 99 of these patients at a second time‐point, 7 to 37 months later. Test‐retest correlations of attachment anxiety (r = 0.83, P < 0.001) and attachment avoidance (r = 0.76, P < 0.001) confirmed that these dimensions are stable. Results: There was a stepwise increase in the correlation between time 2 disease activity and depression from the lowest tercile of attachment anxiety (r = 0.00, P = 0.99), through the middle tercile (r = 0.36, P = 0.05), to the highest tercile (r = 0.52, P = 0.002). For attachment avoidance, disease activity and depression were only significantly correlated in the highest tercile (r = 0.49, P = 0.005). Conclusions: Attachment anxiety meets all tested criteria as a moderator of the relationship between disease activity and depressive symptoms. Further attention to interpersonal style as a moderator of depressive risk in ulcerative colitis is warranted.

Factors associated with the psychological impact of severe acute respiratory syndrome on nurses and other hospital workers in Toronto.

Objectives: A survey was conducted to measure psychological stress in hospital workers and measure factors that may have mediated acute traumatic responses. Methods: A self-report survey was completed by 1557 healthcare workers at three Toronto hospitals in May and June 2003. Psychological stress was measured with the Impact of Event Scale. Scales representing attitudes to the outbreak were derived by factor analysis of 76 items probing attitudes to severe acute respiratory syndrome. The association of Impact of Event Scale scores to job role and contact with severe acute respiratory syndrome patients was tested by analysis of variance. Between-group differences in attitudinal scales were tested by multivariate analysis of variance. Attitudinal scales were tested as factors mediating the association of severe acute respiratory syndrome patient contact and job role with total Impact of Event Scale by linear regression. Results: Higher Impact of Event Scale scores are found in nurses and healthcare workers having contact with patients with severe acute respiratory syndrome. The relationship of these groups to the Impact of Event Scale score is mediated by three factors: health fear, social isolation, and job stress. Conclusions: Although distress in response to the severe acute respiratory syndrome outbreak is greater in nurses and those who care for patients with severe acute respiratory syndrome, these relationships are explained by mediating variables that may be available for interventions to reduce stress in future outbreaks. In particular, the data suggest that the targets of intervention should include job stress, social isolation, and health fear. SARS = severe acute respiratory syndrome; IES = Impact of Event Scale; HCW = healthcare worker; MSH = Mount Sinai Hospital; SMH = St. Michael’s Hospital; CAMH = Centre for Addiction and Mental Health.

Help-seeking behaviour of depressed students

Depression, the most common form of psychological distress among university students, is often serious enough to warrant professional help but only a minority of depressed students seek formal help. This paper reports on the characteristics which differentiate two groups of depressed students--the help-seekers from the non-help-seekers. A university psychiatric clinic population (N = 183) was compared with a non-clinic sample (N = 55). Data about depressive symptoms, social supports, the use of medical, psychiatric and other helping services, sources of referral and the usual demographic and sociocultural information were obtained. The Beck Depression Inventory was used as the measure of depression. Severity of depression was the single most important predictor of use of the psychiatric service. In addition, being female was also an important predictor. After controlling for severity and sex, the demographic factors which distinguished help-seekers from non-help-seekers were as follows: The help-seekers were more likely to be graduate students, older, living away from family and/or to use a non-psychiatric physician. Contrary to expectation, having a confidant was not related to help-seeking, suggesting that the presence of a confidant may be preventive but does not necessarily decrease the need for professional help once a student has become depressed. A depressed students decision to seek help may be influenced by four factors: the severity of the problem; the individuals propensity to seek help; the availability of alternate resources; and the accessibility of psychiatric services. The findings are discussed in the light of these factors.

Help for Families of Suicide: Survivors Support Program*

The Survivors Support Program attempts preventive intervention with a high risk population. As with most preventive efforts in psychiatry, it is difficult to predict who will be most at risk, what services will best meet their needs, and what positive effects are due to the services. To answer these questions through properly controlled and designed experimental programs conforming to scientific methodology would require the investment of much time, personnel and money. To postpone attempts at intervention until answers are provided by such experimental programs would be to ignore the evidence of common sense and clinical experience. The Survivors Support Program demonstrates that a volunteer self-referral service, organized through professional liaison with a community organization and committed to providing service and gathering information, can suggest interim answers to the questions while providing support and counselling to a needy population.

From hospital to community: Six-month and two-year outcomes for 505 patients.

The authors have completed a large descriptive study of the system of psychiatric aftercare in Metropolitan Toronto. This article describes the relevant 6-month and 2-year postdischarge outcome in each of five aftercare components for 505 subjects in a traditional system of service delivery. Provincial hospital, research institute, and general hospital subgroups are compared. For the total group, recidivism and employment rates are similar to those found in previous studies. Symptoms and distress levels are high. Considerable numbers of subjects live in inadequate and unsatisfactory housing. Social isolation, inadequate income, and difficulties with instrumental role functioning are persistent problems with little improvement between 6 months and 2 years postdischarge. Differences among the subgroups vary according to type of outcome and, for the most part, can be explained by differences in the characteristics of the patients served by the three types of inpatient treatment settings. These findings provide additional information about serious deficiencies in discharge planning and aftercare service delivery that is focused primarily upon the treatment of illness. The authors conclude that a more balanced system of aftercare requires a shift in resources to rehabilitation programs in the community.