Attachment Insecurity and Well-Being in Dementia Spousal Caregivers: The Moderating Role of Marital Satisfaction

Caregivers for spouses with Alzheimer disease and related dementias (AD/ADRD) who exhibit insecure attachment orientations-specifically, greater attachment anxiety and/or avoidance-are at risk for poorer physical and mental well-being. Marital satisfaction, or caregivers' general evaluations of their relationship with their spouses, may buffer this risk. We tested marital satisfaction as a potential buffer of the associations between attachment orientation and psychological and physiological indices of well-being.

A cross-sectional sample of 264 AD/ADRD spousal caregivers completed self-report measures of attachment orientation, marital satisfaction, and depressive symptoms and provided blood samples. We conducted multiple regression models to test study hypotheses.

Greater attachment avoidance was associated with more depressive symptoms ( P = .002) and higher lipopolysaccharide (LPS)-stimulated cytokine production ( P = .001). The associations between attachment avoidance and depressive symptoms ( P = .045) or LPS-stimulated cytokine production ( P = .028) were weaker at higher levels of marital satisfaction. Greater attachment anxiety was associated with more depressive symptoms ( P < .001), and, unexpectedly, this association was stronger as caregivers reported higher levels of marital satisfaction ( P = .028). Marital satisfaction did not moderate the association between attachment anxiety and LPS-stimulated cytokine production ( P = .20).

Our work contributes to the body of research examining psychosocial factors that shape well-being among caregivers. Our findings may inform future interventions focusing on the marital relationship to improve caregiver well-being; although these interventions may benefit avoidantly attached caregivers, anxiously attached caregivers may benefit most from intervention approaches tailored to their specific attachment orientation.