Attachment style and anxiety in carers of people with Alzheimer's disease: results from the LASER-AD study

Background: Preliminary evidence indicates that the quality of the carer-care recipient relationship predicts those carets most at risk from anxiety. Attachment style is related to higher carer burden, psychological morbidity and increased care recipient institutionalization. We tested, for the first time, the hypothesis that carer burden and the coping strategies used mediate a relationship between attachment style and anxiety. Methods: We interviewed 83 people with Alzheimer's disease and their family carets, originally recruited for a larger community study. Caters filled in a validated measure about their attachment style, the Hospital Anxiety and Depression Scale, the COPE to measure coping strategies, and the Zarit-Burden interview. Results: More avoidant attachment (beta = 0.28) and less secure attachment (beta = -0.32) predicted anxiety. After adding coping strategies to the equation, the relationship with avoidant attachment (beta = 0.15) was no longer significant, and that with less secure attachment was reduced (beta = -0.23). A well-fitting structural equation model supported our finding that dysfunctional coping mediated the relationship between attachment style and anxiety. Conclusion: Carets who were less secure or more avoidantly attached reported higher anxiety. Interventions that aim to modify coping strategies have shown promise in reducing carer anxiety. Our finding that coping strategies also appear partially to explain the excess of anxiety among less securely attached carets suggests they are likely to benefit from such interventions.