Attachment Style, Depression, and Health Outcomes among Antepartum Patients

Clear evidence of the impact of psychosocial factors on healthcare utilization continues to grow. An individual's attachment style is hypothesized to be one such important psychosocial factor related to healthcare utilization. Women with high-risk pregnancies treated in antepartum units have been shown to experience higher levels of stress than the general population, which has been hypothesized to activate adaptive and maladaptive patterns of interpersonal relationships. Therefore, the present study investigated the relationship among attachment style, stress, depression, and healthcare utilization in a sample of women with high-risk pregnancies. Stress and depressive symptoms were hypothesized to serve as moderating variables between patients' attachment styles and their healthcare utilization. To the author's knowledge, this was the first study to examine the role of stress in this manner. One hundred seventeen participants from the antepartum unit of Baylor University Medical Center were enrolled. Participants were administered a demographic questionnaire, the Edinburgh Postpartum Depression Scale, the Experiences in Close Relationships Scale - Short Form, the Attachment Style Questionnaire, the Crowne-Marlowe Social Desirability Scale, and the Perceived Stress Scale. Healthcare utilization data was then collected from participants' electronic medical records. Regression analyses determined that while an insecure attachment style was associated with increased depressive symptoms, the strongest association with depressive symptomatology was subjective stress levels (b = .813, t = 11.54, p < .001). Thus, while the moderator analysis was significant overall, stress was most closely associated with depressive symptoms. With regard to healthcare utilization, a MANOVA revealed no association between attachment style and healthcare utilization, although it did reveal that stress scores were significantly associated with emergency room visits in the past twelve months (F(1, 103) = 11.48, p < .001, partial η2 = .093) as well as with pain scores (F(1, 103) = 5.19, p = .025, partial η2 = .044). Thus, although attachment style is related to depression, stress was found to be more strongly associated with depression and several healthcare variables. Further research is warranted to examine the role that attachment style may play in depressive symptoms and healthcare utilization.