Attachment styles and clinical rehabilitation: stroke patients and their caregivers

In the practice of clinical rehabilitation, the caregiver plays an active and participating role in the patient’s mental processes. Moreover, the attachment style of the caregiver is associated with a particular type of care (Feeney, 1996). Caregivers with a secure style tend to be empathic and to actively offer assistance, while those with an insecure style exhibit different types of non-responsive caregiving, depending on their particular type of insecurity. We hypothesise that subjects with a secure attachment style will exhibit lower levels of psychological distress and higher levels of functional independence compared to those with an insecure style. We further expect that a relationship between patient and caregiver characterised by secure attachment strategies will be correlated with a more positive outcome of recovery compared to relationships based on an insecure style. Finally, differences may be found between patients with lesions of the right hemisphere, those with lesions of the left hemisphere and orthopaedic patients. Description of the sample: The study excludes patients with severe cognitive deficits. The sample consists of 35 stroke patients (M = 66%, F = 34%; average age = 69 with SD = 9.7; married = 66%) and 30 patients with fractures (M = 27%, F = 73%; average age = 75 with SD = 9.3; married = 50%), as well as the patients’ caregivers. In the neurological patients, the cerebral lesion is located in the right hemisphere in 60% of the cases, while most of the strokes are ischaemic in nature (66%). A share of 70% of the patients with right-hemisphere lesions exhibits modifications in cognitive functioning (neglect: 38%). Among the patients with lesions of the left hemisphere, around 60% show alterations in the cognitive profile (aphasia: 43%). A share of 50% of the orthopaedic patients (74% of the cases with femoral fractures) exhibits modifications of the cognitive profile. The caregivers of the post-stroke patients (spouse: 43%, son or daughter: 46%) are more frequently women (57%) with an average age of 53; 74% are married. Men and women are equally represented among the caregivers of the orthopaedic patients (spouse: 47%, son or daughter 50%); these caregivers have an average age of 61, and 80% are married. Tools and methodology: The HAD (Hospital Anxiety and Depression scale by Zigmond and Snaith, 1983), with separate subscales for anxiety and depression, was used to assess the psychological distress of the patients on admission and on discharge. The patients’ level of functional independence was also tested on admission and discharge by means of the FIM scale (Functional Independence Measurement, by Dodds et al., 1993). The CES-D scale (Center of Epidemiologic Studies Depression scale, by Radloff, 1977 in the Italian form validated by Fava, 1982) was used to measure the presence and degree of depression in the caregivers, likewise on admission and discharge. The attachment style of both patients and caregivers was identified using RQ (Relationship Questionnaire by Bartholomew and Horowitz, 1991) and ASQ (Attachment Style Questionnaire by Feeney, 1996 in the Italian version validated by Fossati et al., 2003). The ASQ evaluates attachment style according to five key factors: “confidence discomfort with closeness”, “need for approval”, preoccupation with relationships” and “relationships as secondary”. The preliminary findings appear to confirm most of the hypotheses formulated above.