Background: Spinal cord injury (SCI) can cause psychological consequences that negatively affect quality of life. It is increasingly recognized that factors such as resilience and social support may produce a buffering effect and are associated with improved health outcomes. However, the influence of adult attachment style on an individual’s ability to utilize social support after SCI has not been examined. Objective: The purpose of this study was to examine relationships between adult romantic attachment, perceived social support, depression, and resilience in individuals with SCI. In addition, we evaluated potential mediating effects of social support and adult attachment on resilience and depression. Methods: Participants included 106 adults with SCI undergoing inpatient rehabilitation. Individuals completed measures of adult attachment (avoidance and anxiety), social support, resilience, and depression. Path analysis was performed to assess for presence of mediation effects. Results: When accounting for the smaller sample size, support was found for the model (comparative fit index = .927; chi square = 7.86, P = .01; β = -0.25, standard error [SE ] = -2.93, P < .05). The mediating effect of social support on the association between attachment avoidance and resilience was the only hypothesized mediating effect found to be significant (β = -0.25, SE = -2.93, P < .05). Conclusion: Results suggest that individuals with SCI with higher levels of attachment avoidance have lower perceived social support, which relates to lower perceived resilience. Assessing attachment patterns during inpatient rehabilitation may allow therapists to intervene to provide greater support.
National Spinal Cord Injury Statistical Center. https://www.nscisc.uab.edu/. Updated 2013. Accessed February 27, 2014. www.nscisc.uab.edu/.
Craig A, Tran Y, Middleton J. Psychological morbidity and spinal cord injury: A systematic review. SpinalCord. 2009;47(2):108–114.
,
Psychological morbidity and spinal cord injury: A systematic review
, SpinalCord.
, vol. 47
(pg. 108
-114
) Hancock KM, Craig AR, Dickson HG, Chang E, Martin J. Anxiety and depression over the first year of spinal cord injury: A longitudinal study. Paraplegia. 1993;31(6):349–357.
,
Anxiety and depression over the first year of spinal cord injury: A longitudinal study
, Paraplegia.
, vol. 31
(pg. 349
-357
) Pollard C, Kennedy P. A longitudinal analysis of emotional impact, coping strategies and posttraumatic psychological growth following spinal cord injury: A 10-year review. Br J Health Psychol. 2007;12:347–362.
,
A longitudinal analysis of emotional impact, coping strategies and posttraumatic psychological growth following spinal cord injury: A 10-year review
, Br J Health Psychol.
, vol. 12
(pg. 347
-362
) Elliott TR, Frank RG. Depression following spinal cord injury. Arch Phys Med Rehabil. 1996;77(8):816–823.
,
Depression following spinal cord injury
, Arch Phys Med Rehabil.
, vol. 77
(pg. 816
-823
) Bombardier CH, Richards JS, Krause JS, Tulsky D, Tate DG. Symptoms of major depression in people with spinal cord injury: Implications for screening. Arch Phys Med Rehabil. 2004;85(11):1749–1756.
,
Symptoms of major depression in people with spinal cord injury: Implications for screening
, Arch Phys Med Rehabil.
, vol. 85
(pg. 1749
-1756
) Dryden DM, Saunders LD, Jacobs P, et al. Direct health care costs after traumatic spinal cord injury. J Trauma. 2005;59(2):443–449.
,
Direct health care costs after traumatic spinal cord injury
, J Trauma.
, vol. 59
(pg. 443
-449
) Fann JR, Bombardier CH, Richards JS, Tate DG, Wilson CS, Temkin N. Depression after spinal cord injury: Comorbidities, mental health service use, and adequacy of treatment. Arch Phys Med Rehabil. 2011;92(3):352–360.
,
Depression after spinal cord injury: Comorbidities, mental health service use, and adequacy of treatment
, Arch Phys Med Rehabil.
, vol. 92
(pg. 352
-360
) Saunders LL, Krause JS, Focht KL. A longitudinal study of depression in survivors of spinal cord injury. Spinal Cord. 2012;50(1):72–77.
,
A longitudinal study of depression in survivors of spinal cord injury
, Spinal Cord.
, vol. 50
(pg. 72
-77
) Krause JS, Saladin LK, Adkins RH. Disparities in subjective well-being, participation, and health after spinal cord injury: A 6-year longitudinal study. NeuroRehabilitation. 2009;24(1):47–56.
,
Disparities in subjective well-being, participation, and health after spinal cord injury: A 6-year longitudinal study
, NeuroRehabilitation.
, vol. 24
(pg. 47
-56
) Bonanno GA, Kennedy P, Galatzer-Levy I, Lude P, Elfström ML. Trajectories of resilience, depression, and anxiety following spinal cord injury. Rehabil Psychol. 2012;57(3):236–247.
,
Trajectories of resilience, depression, and anxiety following spinal cord injury
, Rehabil Psychol.
, vol. 57
(pg. 236
-247
) Catalano D, Chan F, Wilson L, Chiu C, Muller VR. The buffering effect of resilience on depression among individuals with spinal cord injury: A structural equation model. Rehabil Psychol. 2011;56(3):200–211.
,
The buffering effect of resilience on depression among individuals with spinal cord injury: A structural equation model
, Rehabil Psychol.
, vol. 56
(pg. 200
-211
) Kilic SA, Dorstyn DS, Guiver NG. Examining factors that contribute to the process of resilience following spinal cord injury. Spinal Cord. 2013;51(7):553–557.
,
Examining factors that contribute to the process of resilience following spinal cord injury
, Spinal Cord.
, vol. 51
(pg. 553
-557
) Monden KR, Trost Z, Catalano D, et al. Resilience following spinal cord injury: A phenomenological view. Spinal Cord. 2014;52(3)197–201.
,
Resilience following spinal cord injury: A phenomenological view
, Spinal Cord.
, vol. 52
(pg. 197
-201
) Shin J, Chae J, Min J, et al. Resilience as a possible predictor for psychological distress in chronic spinal cord injured patients living in the community. Ann Rehabil Med. 2012;36(6):815–820.
,
Resilience as a possible predictor for psychological distress in chronic spinal cord injured patients living in the community
, Ann Rehabil Med.
, vol. 36
(pg. 815
-820
) White B, Driver S, Warren AM. Resilience and indicators of adjustment during rehabilitation from a spinal cord injury. Rehabil Psychol. 2010;55(1): 23–32.
,
Resilience and indicators of adjustment during rehabilitation from a spinal cord injury
, Rehabil Psychol.
, vol. 55
(pg. 23
-32
) Bonanno G. Loss, trauma, and human resilience: Have we underestimated the human capacity to thrive after extremely adversive events ? Am Psychol. 2004;59(1):20–28.
,
Loss, trauma, and human resilience: Have we underestimated the human capacity to thrive after extremely adversive events ?
, Am Psychol.
, vol. 59
(pg. 20
-28
) Driver S, Warren AM, Reynolds M, et al. Identifying predictors of resilience at inpatient and 3-months post spinal cord injury [published online ahead of print October 9, 2014]. J Spinal Cord Med.
,
Identifying predictors of resilience at inpatient and 3-months post spinal cord injury [published online ahead of print October 9, 2014]
, J Spinal Cord Med.
Chronister JA, Johnson EK, Berven NL. Measuring social support in rehabilitation. Disabil Rehabil. 2006;28(2):75–84.
,
Measuring social support in rehabilitation
, Disabil Rehabil.
, vol. 28
(pg. 75
-84
) Chawalisz K, Vaux A. Social support and adjustment to disability. In: Frank R, Elliot T, eds. Handbook of Rehabilitation Psychology. Washington, DC: American Psychological Association; 2000:537– 552.
,
Social support and adjustment to disability. In
, Handbook of Rehabilitation Psychology.
Luthar S. Resilience in development: A synthesis of research across five decades. In: Cicchetti D, Cohen D, eds. Developmental Psychopathology. Volume 3: Risk, Disorder, and Adaptation. 2nd ed. Hoboken, NJ: John Wiley & Sons Inc; 2006:739–795.
,
Resilience in development: A synthesis of research across five decades. In
, Developmental Psychopathology. Volume 3: Risk, Disorder, and Adaptation.
(pg. 739
-795
) Masten AS. Ordinary magic. Resilience processes in development. Am Psychol. 2001;56(3):227–238.
,
Ordinary magic. Resilience processes in development
, Am Psychol.
, vol. 56
(pg. 227
-238
) Rutten M. Resilience concepts and findings: Implications for family therapy. J Fam Ther. 1999;21(2):119–144.
,
Resilience concepts and findings: Implications for family therapy
, J Fam Ther.
, vol. 21
(pg. 119
-144
) Bowlby J. Attachment and Loss: Volume 1. Attachment. New York: Basic Books; 1969.
,
Attachment and Loss: Volume 1. Attachment.
Bowlby J. Attachment and Loss: Volume 2. Separation: Anxiety and Anger. New York: Basic Books; 1973.
,
Attachment and Loss: Volume 2. Separation: Anxiety and Anger.
Waters E, Merrick S, Treboux D, Crowell J, Albersheim L. Attachment security in infancy and early adulthood: A twenty-year longitudinal study. Child Dev. 2000;71(3):684–689.
,
Attachment security in infancy and early adulthood: A twenty-year longitudinal study
, Child Dev.
, vol. 71
(pg. 684
-689
) Weinfield NS, Sroufe LA, Egeland B. Attachment from infancy to early adulthood in a high-risk sample: Continuity, discontinuity, and their correlates. Child Dev. 2000;71(3):695–702.
,
Attachment from infancy to early adulthood in a high-risk sample: Continuity, discontinuity, and their correlates
, Child Dev.
, vol. 71
(pg. 695
-702
) Hamilton C. Continuity and discontinuity of attachment from infancy through adolescence. Child Dev. 2000;71(3):690–694.
,
Continuity and discontinuity of attachment from infancy through adolescence
, Child Dev.
, vol. 71
(pg. 690
-694
) Bartholomew K, Horowitz LM. Attachment styles among young adults: A test of a four-category model. J Pers Soc Psychol. 1991;61(2):226–244.
,
Attachment styles among young adults: A test of a four-category model
, J Pers Soc Psychol.
, vol. 61
(pg. 226
-244
) Shaver PR, Mikulincer M. Attachment-related psychodynamics. Attach Hum Dev. 2002;4(2): 133–161.
,
Attachment-related psychodynamics
, Attach Hum Dev.
, vol. 4
(pg. 133
-161
) Mikulincer M, Florian V. Attachment style and affect regulation: Implications for coping with stress and mental health. In: Fletcher G, Clark M, eds. Blackwell Handbook of Social Psychology: Interpersonal Process. Oxford, UK: Blackwell; 2001:537–557.
,
Attachment style and affect regulation: Implications for coping with stress and mental health.
, Blackwell Handbook of Social Psychology: Interpersonal Process.
(pg. 537
-557
) Mikulincer M, Shaver PR, Pereg D. Attachment theory and affect regulation: The dynamics, development, and cognitive consequences of attachment-related strategies. Motiv Emotion. 2003;27(2):77–102.
,
Attachment theory and affect regulation: The dynamics, development, and cognitive consequences of attachment-related strategies
, Motiv Emotion.
, vol. 27
(pg. 77
-102
) Lopez FG, Gormley B. Stability and change in adult attachment style over the first-year college transition: Relations to self-confidence, coping, and distress patterns. J Couns Psychol. 2002;49(3):355–364.
,
Stability and change in adult attachment style over the first-year college transition: Relations to self-confidence, coping, and distress patterns
, J Couns Psychol.
, vol. 49
(pg. 355
-364
) Collins NL, Feeney BC. Working models of attachment shape perceptions of social support: Evidence from experimental and observational studies. J Pers Soc Psychol. 2004;87(3):363–383.
,
Working models of attachment shape perceptions of social support: Evidence from experimental and observational studies
, J Pers Soc Psychol.
, vol. 87
(pg. 363
-383
) Declercq F, Palmans V. Two subjective factors as moderators between critical incidents and the occurrence of post traumatic stress disorders: Adult attachment and perception of social support. Psychol Psychother. 2006;79:323–337.
,
Two subjective factors as moderators between critical incidents and the occurrence of post traumatic stress disorders: Adult attachment and perception of social support
, Psychol Psychother.
, vol. 79
(pg. 323
-337
) Florian V, Mikulincer M, Bucholtz I. Effects of adult attachment style on the perception and search for social support. J Psychol. 1995;129(6):665–676.
,
Effects of adult attachment style on the perception and search for social support
, J Psychol.
, vol. 129
(pg. 665
-676
) Moreira JM, de Fátima Silva M, Moleiro C, et al. Perceived social support as an offshoot of attachment style. Pers Individ Dif. 2003;34(3):485–501.
,
Perceived social support as an offshoot of attachment style
, Pers Individ Dif.
, vol. 34
(pg. 485
-501
) Rodin G, Walsh A, Zimmerman C, et al. The contribution of attachment security and social support to depressive symptoms in patients with metastatic cancer. Psychooncology. 2007;16(12):1080–1091.
,
The contribution of attachment security and social support to depressive symptoms in patients with metastatic cancer
, Psychooncology.
, vol. 16
(pg. 1080
-1091
) Vogel DL, Wei M. Adult attachment and help-seeking intent: The mediating roles of psychological distress and perceived social support. J Couns Psychol. 2005;52(3):347–357.
,
Adult attachment and help-seeking intent: The mediating roles of psychological distress and perceived social support
, J Couns Psychol.
, vol. 52
(pg. 347
-357
) Shaver PR, Mikulincer M. Attachment theory and research: Core concepts, basic principles, conceptual bridges. In: Kruglanski AW, Higgins ET, eds. Social Psychology: Handbook of Basic Principles. 2nd ed. New York,: Guilford Press; 2007:650–677.
,
Attachment theory and research: Core concepts, basic principles, conceptual bridges.
, Social Psychology: Handbook of Basic Principles.
(pg. 650
-677
) Brennan KA, Shaver PR. Dimensions of adult attachment, affect regulation, and romantic relationship functioning. Pers Soc Psychol Bull. 1995;21(3):267–283.
,
Dimensions of adult attachment, affect regulation, and romantic relationship functioning
, Pers Soc Psychol Bull.
, vol. 21
(pg. 267
-283
) Wei M, Russell DW, Mallinckrodt B, Zakalik RA. Cultural equivalence of adult attachment across four ethnic groups: Factor structure, structured means, and associations with negative mood. J Couns Psychol. 2004;51(4):408–417.
,
Cultural equivalence of adult attachment across four ethnic groups: Factor structure, structured means, and associations with negative mood
, J Couns Psychol.
, vol. 51
(pg. 408
-417
) Cutrona CE, Russell DW. The provisions of social relationships and adaptation to stress. In: Jones W, Perlman D, eds. Advances in Personal Relationships. Greenwich, CT: JAI Press; 1987:37–67.
,
The provisions of social relationships and adaptation to stress. In
, Advances in Personal Relationships.
(pg. 37
-67
) Baron RS, Cutrona CE, Hicklin D, Russell DW, Lubaroff DM. Social support and immune function among spouses of cancer patients. J Pers Soc Psychol. 1990;59(2):344–352.
,
Social support and immune function among spouses of cancer patients
, J Pers Soc Psychol.
, vol. 59
(pg. 344
-352
) Campbell-Sills L, Stein MB. Psychometric analysis and refinement of the Connor-Davidson Resilience Scale (CD-RISC): Validation of a 10-item measure of resilience. J Trauma Stress. 2007;20(6):1019–1028.
,
Psychometric analysis and refinement of the Connor-Davidson Resilience Scale (CD-RISC): Validation of a 10-item measure of resilience
, J Trauma Stress.
, vol. 20
(pg. 1019
-1028
) Kroenke K, Spitzer RL, Williams JB. The PHQ-9: Validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–613.
,
The PHQ-9: Validity of a brief depression severity measure
, J Gen Intern Med.
, vol. 16
(pg. 606
-613
) Su Y, Gelman A, Hill J, Yajima M. Multiple imputations with diagnostics (mi) in R: Opening windows into the black box. J Stat Softw. 2011;45(2):1–31.
,
Multiple imputations with diagnostics (mi) in R: Opening windows into the black box
, J Stat Softw.
, vol. 45
(pg. 1
-31
) Baraldi AN, Enders CK. An introduction to modern missing data analyses. J Sch Psychol. 2010;48(1): 5–37.
,
An introduction to modern missing data analyses
, J Sch Psychol.
, vol. 48
(pg. 5
-37
) Muthén LK, Muthén BO. Mplus User’s Guide. 6th ed. Los Angeles, CA: Muthén & Muthén; 1998–2010.
,
Mplus User’s Guide.
Cole-Detke H, Kobak R. Attachment processes in eating disorder and depression. J Consult Clin Psychol. 1996;64(2):282–290.
,
Attachment processes in eating disorder and depression
, J Consult Clin Psychol.
, vol. 64
(pg. 282
-290
) Fonagy P, Leigh T, Steele M, et al. The relation of attachment status, psychiatric classification, and response to psychotherapy. J Consult Clin Psychol. 1996;64(1):22–31.
,
The relation of attachment status, psychiatric classification, and response to psychotherapy
, J Consult Clin Psychol.
, vol. 64
(pg. 22
-31
) Mikulincer M. Adult attachment style and individual differences in functional versus dysfunctional experiences of anger. J Pers Soc Psychol. 1998;74(2):513–524.
,
Adult attachment style and individual differences in functional versus dysfunctional experiences of anger
, J Pers Soc Psychol.
, vol. 74
(pg. 513
-524
) Riggs SA, Sahl G, Greenwald E, Atkison H, Paulson A, Ross CA. Family environment and adult attachment as predictors of psychopathology and personality dysfunction among inpatient abuse survivors. Violence Vict. 2007;22(5):577–600.
,
Family environment and adult attachment as predictors of psychopathology and personality dysfunction among inpatient abuse survivors
, Violence Vict.
, vol. 22
(pg. 577
-600
) Zuroff DC, Fitzpatrick DK. Depressive personality styles: Implications for adult attachment. Pers Individ Dif. 1995;18(2):253–365.
,
Depressive personality styles: Implications for adult attachment
, Pers Individ Dif.
, vol. 18
(pg. 253
-365
) Dozier M, Stovall-McClough KC, Albus KE. Attachment and psychopathology in adulthood. In: Cassidy J, Shaver PR, eds. Handbook of Attachment: Theory, Research, and Clinical Applications. 2nd ed. New York: Guilford Press; 2008:718–744.
,
Attachment and psychopathology in adulthood.
, Handbook of Attachment: Theory, Research, and Clinical Applications.
(pg. 718
-744
) Williams NL, Risking JH. Adult romantic attachment and cognitive vulnerabilities to anxiety and depression: Examining the interpersonal basis of vulnerability models. J Cogn Psychother. 2004;18(1):7–24.
,
Adult romantic attachment and cognitive vulnerabilities to anxiety and depression: Examining the interpersonal basis of vulnerability models
, J Cogn Psychother.
, vol. 18
(pg. 7
-24
)
This content is only available as a PDF.
