Traumatic Stress, Attachment Style, and Health Outcomes in Cardiac Rehabilitation Patients

Adam Heenan; Paul S Greenman; Vanessa Tassé; Fotini Zachariades; Heather Tulloch

doi:10.3389/fpsyg.2020.00075

Traumatic Stress, Attachment Style, and Health Outcomes in Cardiac Rehabilitation Patients

Front Psychol. 2020 Jan 28:11:75. doi: 10.3389/fpsyg.2020.00075. eCollection 2020.

Authors

Adam Heenan¹, Paul S Greenman^{2

3}, Vanessa Tassé², Fotini Zachariades⁴, Heather Tulloch^{1

5

6}

Affiliations

¹ Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada.
² Département de Psychoéducation et de Psychologie, Universite du Québec en Outaouais, Gatineau, QC, Canada.
³ Institut du Savoir Montfort, Ottawa, ON, Canada.
⁴ Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.
⁵ Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
⁶ School of Psychology, University of Ottawa, Ottawa, ON, Canada.

Abstract

Objective: Research on psychosocial risk factors in cardiovascular disease (CVD) has identified traumatic stress and attachment style as independent risk factors for the development of CVD and poor prognosis for those with established CVD. Exploring the interrelationships between these variables will inform psychosocial risk factor modeling and potential avenues for intervention. Therefore, the hypothesis that attachment style is related to health outcomes among CR patients and that traumatic stress mediates this relationship was tested.

Methods: Patients in a cardiac rehabilitation program (n = 201) completed validated self-report measures of traumatic stress and attachment style at baseline (program intake). Health outcomes were assessed at baseline and 3 months, including anxiety, depression, quality of life, fasting blood glucose, glycated hemoglobin (HbA1c), and cholesterol (HDL ratio). Multivariate structural equation modeling was used to fit the data.

Results: Of the 201 participants, 42 (21%) had trauma scores indicating the probable presence of posttraumatic stress disorder. Via greater levels of traumatic stress, greater attachment anxiety at baseline was indirectly related to greater anxiety, depression, fasting blood glucose, and HbA1c, and poorer physical and mental quality of life. There were no significant indirect effects on HDL ratios.

Conclusion: Greater attachment anxiety predicted greater traumatic stress; this, in turn, predicted poorer health outcomes. Screening and treatment for these constructs in CVD patients is warranted.

Keywords: attachment anxiety; attachment avoidance; cardiovascular disease; health outcomes; traumatic stress.