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Am J Geriatr Psychiatry. 2014 Jun;22(6):623-31. doi: 10.1016/j.jagp.2012.12.003. Epub 2013 May 2.

Effects of attachment quality on caregiving of a parent with dementia.

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VA NY Harbor Healthcare System, New York University, New York, NY; Department of Psychiatry, New York University, New York, NY. Electronic address:
Department of Psychology, University Bochum, Ruhr, Germany.
Department of Psychiatry, University Bochum, Ruhr, Germany.



The purpose of the current study was to examine the moderating role of attachment quality on the relationship between dementia-specific stressors and: (a) caregiver distress and (b) caregiver satisfaction.


Caregivers (N = 91) of a parent with dementia completed questionnaires that assessed caregiving stressors (parental cognitive impairment and behavioral problems), attachment (early and present-day attachment) and measures of caregiver distress and satisfaction. A series of regression analyses were conducted to test the hypothesis that better attachment quality may buffer the effects of cognitive impairment and behavioral problems on the caregiver's experience of distress and enhance caregiver satisfaction.


Results did suggest that present-day attachment moderates the effects of both cognitive impairment and behavioral problems on global distress but, contrary to our hypotheses, attachment security did not buffer the negative impact associated with these demands. Instead, secure present-day attachment was positively associated with an increased risk for emotional distress at mild levels of care-recipient cognitive impairment. Most analyses indicated no significant relationship between caregiving stressors and caregiver distress or satisfaction and few interactions based on attachment quality were found.


Our study indicates that attachment security does not always have a protective or stress-buffering function but may amplify the effect of stressors under certain conditions. Different ways of understanding the obtained pattern of findings are discussed and additional work is required to test if secure attachment may be associated with increased resilience when the disease is more advanced. Clinical implications of the present findings are discussed.


Caregiving; attachment; dementia

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