Coping Style as a Mediator between Attachment and Mental and Physical Health in Patients Suffering from Morbid Obesity

Abstract

Objective:

The presence of mental health problems and limitations in physical functioning is high in patients suffering from morbid obesity. The purpose of the current study was to examine the mediating role of coping style in the relationship between attachment representations and mental health and physical functioning in a morbidly obese population.

Method:

A total of 299 morbidly obese patients who were referred to the Slotervaart bariatric surgery unit in Amsterdam, the Netherlands, completed self-report questionnaires assessing adult attachment style (Experiences in Close Relationship—Revised Questionnaire), coping style (Utrecht Coping List), and patients physical functioning and mental health (Short Form-36).

Results:

Attachment anxiety (β = –.490, p < .001) and attachment avoidance (β = –.387, p < .001) were both found to be related to mental health. In addition, attachment anxiety was also found to be related to physical functioning (β = –.188, p < .001). Coping style partly mediated these associations.

Conclusions:

Findings suggest that coping mediates the association between attachment anxiety and attachment avoidance on the one hand and mental health and physical functioning in patients with morbid obesity on the other hand.

Keywords

obesity attachment coping mental health physical functioning bariatric surgery

Get full access to this article

View all access options for this article.

References

van Hout

van Oudheusden

van Heck

. Psychological profile of the morbidly obese. Obesity Surgery 2004; 14: 579–588.

Guh

Zhang

Bansback

Amarsi

Birmingham

Anis

. The incidence of co-morbidities related to obesity and overweight: A systematic review and meta-analysis. BMC Public Health 2009; 9: 88.

Alciati

Gesuele

Rizzi

Sarzi-Puttini

Foschi

. Childhood parental loss and bipolar spectrum in obese bariatric surgery candidates. International Journal of Psychiatry in Medicine 2011; 41: 155–171.

Carpiniello

Pinna

Pillai

Nonnoi

Pisano

Corrias

. Psychiatric comorbidity and quality of life in obese patients. Results from a case-control study. International Journal of Psychiatry in Medicine 2009; 39: 63–78.

Campos

Ciovica

Rogers

Posselt

Vittinghoff

Takata

. Spectrum and risk factors of complications after gastric bypass. Archives Surgery 2007; 142: 969–975.

Halmi

Long

Stunkard

Mason

. Psychiatric diagnosis of morbidly obese gastric bypass patients. American Journal of Psychiatry 1980; 137: 470–472.

Bond

Unick

Jakicic

Vithiananthan

Trautvetter

Co'leary

. Physical activity and quality of life in severely obese individuals seeking bariatric surgery or lifestyle intervention. Health Related Quality of Life Outcomes 2012; 10: 86.

Stewart

Brook

. Effects of being overweight. American Journal of Public Health 1983; 73: 171–178.

Bowlby

. Attachment and loss, Vol. 1, Attachment. New York, NY: Basic Books, 1969.

10.

Bartholomew

Horowitz

. Attachment styles among young adults: A test of a four-category model. Journal of Personality and Social Psychology 1991; 61: 226–244.

11.

Brennan

KACCSP

. Self-report measurement of adult attachment: An integrative overview. Attachment theory and close relationships. In Simpson

Rholes

, Editors, Attachment theory and close relationships. New York, NY: Guilford Press, 1998: 46–76.

12.

Cooper

Shaver

Collins

. Attachment styles, emotion regulation, and adjustment in adolescence. Journal of Personality and Social Psychology 1998; 74: 1380–1397.

13.

Kotler

Buzwell

Romeo

Bowland

. Avoidant attachment as a risk factor for health. British Journal of Medical Psychology 1994; 67(Pt 3): 237–245.

14.

Hunter

Maunder

. Using attachment theory to understand illness behavior. General Hospital Psychiatry 2001; 23: 177–182.

15.

Martin

Vosvick

Riggs

. Attachment, forgiveness, and physical health quality of life in HIV + adults. AIDS Care 2012; 24: 1333–1340.

16.

Sockalingam

Wnuk

Strimas

Hawa

Okrainec

. The association between attachment avoidance and quality of life in bariatric surgery candidates. Obesity Facts 2011; 4: 456–460.

17.

Ciechanowski

Katon

. The interpersonal experience of health care through the eyes of patients with diabetes. Social Science and Medicine 2006; 63: 3067–3079.

18.

Maunder

Hunter

. Assessing patterns of adult attachment in medical patients. General Hospital Psychiatry 2009; 31: 123–130.

19.

Stuart

Noyes

Jr . Attachment and interpersonal communication in somatization. Psychosomatics 1999; 40: 34–43.

20.

Ciechanowski

Katon

Russo

Dwight-Johnson

. Association of attachment style to lifetime medically unexplained symptoms in patients with hepatitis C. Psychosomatics 2002; 43: 206–212.

21.

Wei

Heppner

Mallinckrodt

. Perceived coping as a mediator between attachment and psychological distress: A structural equation modeling approach. Journal of Counseling Psychology 2003; 50(4): 438–447.

22.

Lazarus

Folkman

. Stress, appraisal and coping. New York, NY: Springer, 1984.

23.

Schreurs

van de Willige

Tellegen

Brosschot

. Handleiding Utrechtse Coping Lijst: UCL. Swets & Zeitlinger, Lisse, 1988.

24.

Folkman

. Lifespan developmental psychology: Perspectives on stress and coping. In Cummings

Greene

Karraker

, Editors, Coping across the lifespan: Theoretical issues. Hillsdale, NJ: Erlbaum, 1991: 3–19.

25.

Folkman

. Personal coping: Theory, research, and application. In Carpenter

, Editor, Making the case for coping. Westport, CT: Praeger, 1992: 31–46.

26.

Hopman-Rock

Kraaimaat

Bijlsma

. Quality of life in elderly subjects with pain in the hip or knee. Quality of Life Research 1997; 6: 67–76.

27.

Scharloo

Kaptein

Weinman

Bergman

Vermeer

Rooijmans

. Patients' illness perceptions and coping as predictors of functional status in psoriasis: A 1-year follow-up. British Journal of Dermatology 2000; 142: 899–907.

28.

van der Have

Minderhoud

Kaptein

Leenders

Siersema

Fidder

. Substantial impact of illness perceptions on quality of life in patients with Crohn's disease. Journal of Crohns and Colitis 2012; 7(12): 460–466.

29.

Simpson

Rholes

Nelligan

. Support seeking and support giving within couples in an anxiety-provoking situation: The role of attachment styles. Journal of Personality and Social Psychology 1992; 62: 434–446.

30.

Mikulincer

Florian

Weller

. Attachment styles, coping strategies, and posttraumatic psychological distress: The impact of the Gulf War in Israel. Journal of Personality and Social Psychology 1993; 64: 817–826.

31.

Ciechanowski

Russo

Katon

Korff

Ludman

Lin

. Influence of patient attachment style on self-care and outcome in diabetes. Psychosomatic Medicine 2004; 66: 720–728.

32.

Maunder

Hunter

. Attachment and psychosomatic medicine: Developmental contributions to stress and disease. Psychosomatic Medicine 2001; 63: 556–567.

33.

Mikulincer

Florian

Tolmacz

. Attachment styles and fear of personal death: A case study of affect regulation. Journal of Personality and Social Psychology 1990; 58: 273–280.

34.

Mikulincer

Orbach

. Attachment style and repressive defensiveness: The accessibility and architecture of affective memories. Journal of Personality and Social Psychology 1995; 68: 917–925.

35.

Turan

Osar

Turan

Ilkova

Damci

. Dismissing attachment and outcome in diabetes: The mediating role of coping. Journal of Social and Clinical Psychology 2003; 22: 607–626.

36.

Fraley

Shaver

. Adult attachment and the suppression of unwanted thoughts. Journal of Personality and Social Psychology 1997; 73: 1080–1091.

37.

Vetere

Myers

. Repressive coping style and adult romantic attachment style: Is there a relationship. Personality and Individual Differences 2002; 32: 799–807.

38.

Mikail

Henderson

Tasca

. An interpersonally based model of chronic pain: An application of attachment theory. Clinical Psychology Review 1994; 14: 1–16.

39.

Mikulincer

. Adult attachment style and affect regulation: Strategic variations in self-appraisals. Journal of Personality and Social Psychology 1998; 75: 420–435.

40.

Florian

Mikulincer

Bucholtz

. Effects of adult attachment style on the perception and search for social support. The Journal of Psychology 1995; 129: 665–676.

41.

Priel

Shamai

. Attachment style and perceived social support: Effects on affect regulation. Personality and Individual Differences 1995; 19: 235–241.

42.

Melissas

. IFSO guidelines for safety, quality, and excellence in bariatric surgery. Obesity Surgery 2008; 18: 497–500.

43.

Fraley

Waller

Brennan

. An item response theory analysis of self-report measures of adult attachment. Journal of Personality and Social Psychology 2000; 78: 350–365.

44.

Aaronson

Muller

Cohen

Essink-Bot

Fekkes

Sanderman

. Translation, validation, and norming of the Dutch language version of the SF-36 Health Survey in community and chronic disease populations. Journal of Clinical Epidemiology 1998; 51: 1055–1068.

45.

Baron

Kenny

. The moderator mediator variable distinction in social psychological-research—Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology 1986; 51: 1173–1182.

46.

Sobel

. Effect analysis and causation in linear structural equation models. Psychometrika 1990; 55(3): 495–515.

47.

Maunder

Hunter

. A prototype-based model of adult attachment for clinicians. Psychodynamica Psychiatry 2012; 40: 549–573.

48.

Maunder

Hunter

Lancee

. The impact of attachment insecurity and sleep disturbance on symptoms and sick days in hospital-based health-care workers. Journal of Psychosomatic Research 2011; 70: 11–17.

49.

Algul

Ates

Semiz

Basoglu

Ebrinc

Gecici

. Evaluation of general psychopathology, subjective sleep quality, and health-related quality of life in patients with obesity. International Journal of Psychiatry Medicine 2009; 39: 297–312.

50.

Lier

Biringer

Hove

Stubhaug

Tangen

. Quality of life among patients undergoing bariatric surgery: Associations with mental health—A 1 year follow-up study of bariatric surgery patients. Health Related Quality of Life Outcomes 2011; 9: 79.