Date of Award

January 2013

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Joan K. Monin



Attachment theory provides a useful framework for understanding how caregiving dyads maintain feelings of security in reaction to a loved one's chronic condition. To our knowledge, no existing research has examined associations among individual differences in attachment (anxiety, avoidance), health, and relationship satisfaction in later-life marriages in which one individual suffers from chronic pain. In this study, we examined similarity of attachment orientation between spousal caregivers and care recipients, and the influence of one's attachment orientation on one's own, as well as their partner's, depressive symptoms, physical conditions, and marital satisfaction.

Seventy-seven individuals with chronic pain and their spousal caregivers both completed self-report measures of attachment, physical conditions, depressive symptoms, and marital satisfaction.

The Actor Partner Interdependence Model was used to analyze the data. Results showed that attachment anxiety in caregivers was associated with attachment avoidance in care recipients. Next, we found intrapersonal effects of attachment on well-being such that more avoidantly attached caregivers had more physical conditions, more anxiously attached caregivers and care recipients experienced more depressive symptoms, and more avoidantly attached caregivers and care recipients had lower marital satisfaction. We also found interpersonal effects such that caregiver's attachment avoidance was associated with more depressive symptoms and physical conditions in care recipients, caregivers experienced lower marital satisfaction when care recipients were more anxiously attached, and both caregivers and care recipients had lower marital satisfaction when their partners were more avoidantly attached.

This study highlights the importance of taking into account the intra- and interpersonal effects of attachment insecurity on physical and psychological health and marital satisfaction among elder spouses. Our results suggest that dyads in which caregivers are insecurely attached may be at a heightened risk for negative mental and physical health outcomes, and they may benefit from targeted, tailored caregiver interventions that address issues of attachment security.

Keywords: caregiving; attachment; chronic pain; marriage; physical conditions, depressive symptoms, marital satisfaction


This is an Open Access Thesis.

Open Access

This Article is Open Access