The relationship between marital attachment and caregiver depression in older couples facing major medical illness

Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)


Marriage and Family Therapy


Dean M. Busby


Caregiver, Depression, Marital attachment, Older couples

Subject Categories

Family, Life Course, and Society | Medicine and Health Sciences | Mental and Social Health | Social and Behavioral Sciences | Sociology


Caring for an ailing spouse is a challenging and stressful endeavor, particularly in later-life and when illness threatens to take away a long-term companion. Depression often renders caregiving spouses unable to provide the care needed, and dramatically decreases the quality of life of both partners. The purpose of this study was to identify individual and relationship characteristics associated with depressive symptomatology in caregivers. Adult Attachment Theory and a family-based model of depression (Coyne, Downey, & Boergers, 1992) were used to frame the study.

A sample of 52 couples were recruited based on one partner's recent diagnosis of Alzheimers Disease, cancer, or a stroke. Couples were asked to complete the Beck Depression Inventory (Beck, Ward, Mendelsohn, Mock, & Erbaugh, 1961) and to participate in the one-hour Present Attachment Interview (Christensen, Shields, Rousseau, Sauvain, & Black, 1996). The interviews were then coded using the Present Attachment Coding System (Shields, Christensen, Young, and Anderson, 1996) for attachment-salient statements and behavior.

It was initially proposed that a secure model of attachment would provide a buffer against depressive symptomatology, and that anxious and avoidant internal models would be associated with either escalation or dysregulation of affect in the couple.

Regression results indicated caregivers' reported level of depressive symptoms are most strongly related to caregivers' anxious and avoidant attachment statements and behaviors. Caregiver anxious attachment is related positively to caregivers' depressive symptoms, and caregivers' avoidant scores are negatively related. Ill spouses' secure attachment is negatively associated with caregiver depression, but only when ill spouse characteristics were considered separately from caregiver attachment variables.

The pairing of couples' attachment characteristics were also examined. Each partner was assigned a predominant attachment style, and partner styles were matched. In a regression of gender, caregiver style, ill spouse style, and interaction-of-styles, only the interaction was significant. Couples' styles were matched and grouped by pairings to test the hypothesis that different pairings of attachment scores are associated with different levels of caregiver depression. Couples with an anxious caregiver and couples with mutual avoidance show significantly higher rates of depression than other couples.


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