Attachment--and loss.

Supportive relationships are health protective (e.g., Berkman, Glass, Brissette, & Seeman, 2000; Cohen, 2004; Uchino, 2009). People who lack social ties or social integration experience higher mortality rates especially from cardiovascular disease but also from other diseases such as cancer (see Holt-Lunstad, Smith, & Layton, 2010). Although the connections between relationships and health are well-established, less is known about the interpersonal processes through which relationships influence health outcomes, despite a call for this type of research more than 20 years ago (e.g., House, Landis, & Umberson, 1988). Progress has been made on the biological mediators (e.g. Miller, Chen, & Cole, 2009), but cutting edge research in relationship science typically has not been integrated into health psychology. In this article, we draw on recent theory and research from the study of adult attachment theory in relationship science to develop an integrative framework for investigating how relationship constructs and processes influence health-related outcomes.

The field of relationship science has expanded considerably in the past three decades, and it has yielded a number of rich theories of close relationships that have generated multiple innovative lines of research (for reviews, see Clark & Lemay, 2010 and Reis, in press). During approximately the same time period, health psychology also emerged as a distinct and rapidly expanding and developing subfield of psychology. Although many theories and empirical findings from relationship science are relevant for understanding a range of health-related issues, relationship science and health psychology have often progressed in parallel or independently with a few exceptions (e.g., Belcher et al., 2011; Kim, Carver, Deci, & Kasser, 2008; Manne et al., 2004a). Many specific ideas drawn from the social and personality literature on close relationships appear in the health literature, but overall, health psychology generally has not incorporated relationship science theories to generate hypotheses or integrated relationship science paradigms into research design and methodology. The goals of this article are threefold: To present one example of a theoretical model that integrates key relationship constructs and processes with biopsychosocial processes and health outcomes, to illustrate how the model can be applied to several specific health areas, and to offer recommendations to guide future relationship research designed to understand and promote health and well-being.

Three major theoretical frameworks have guided most contemporary social and personality research on close personal relationships: attachment theory, interdependence theory, and theories based in evolutionary approaches (Reis, in press). In addition, relationships research has been informed by a variety of more specific theories such as the communal-exchange framework (Clark & Mills, 1979) and the intimacy process model (Reis & Shaver, 1988), and more recent approaches include the self-expansion model (Aron & Aron, 2001), the risk regulation model (Murray, Holmes, & Collins, 2006), and relationship goal approaches (Canevello & Crocker, 2011; Gable & Impett, in press). In this article, we selectively focus on one major theoretical perspective, adult attachment theory, because it is has driven a disproportionately large segment of research on relationship processes and outcomes over the past 25 years, has been shown to have wide explanatory power, and has clear relevance for health-related behavior and outcomes (see Mikulincer & Shaver, 2007).

In the following sections, we first provide a brief overview of adult attachment theory. Second, we present a theoretical model incorporating components of attachment theory to specify how key relationship variables may predict health behavior and outcomes and highlight how this attachment-based model can generate novel lines of research to understand and promote health and well-being. Third, we discuss specific applications of the model to investigate connections between relationship processes and health (e.g., health behavior, coping with pain) in adults. Fourth, we offer examples of how the model might inform interventions. Finally, we provide a roadmap for future research. We focus on connections between close relationships and health and, because of space constraints as well as the centrality of close connections to our lives, we do not discuss other types of potentially relevant relationships such as broader social networks, buddy systems, or social connectivity (e.g., see Kawachi & Subramanian, 2008 and Smith & Christakis, 2008, all worthy of relationship science and health psychology integration as well.

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Close Relationship Processes and Health: Implications of Attachment Theory for Health and Disease

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The Oxford Handbook of Stress, Health and Coping

Much research on children in military families has taken a deficit approach--that is, it has portrayed these children as a population susceptible to psychological damage from the hardships of military life, such as frequent moves and separation from their parents during deployment. But M. Ann Easterbrooks, Kenneth Ginsburg, and Richard M. Lerner observe that most military children turn out just fine. They argue that, to better serve military children, we must understand the sources of strength that help them cope with adversity and thrive. In other words, we must understand their resilience. The authors stress that resilience is not a personal trait but a product of the relationships between children and the people and resources around them. In this sense, military life, along with its hardships, offers many sources for resilience--for example, a strong sense of belonging to a supportive community with a shared mission and values. Similarly, children whose parents are deployed may build their self-confidence by taking on new responsibilities in the family, and moving offers opportunities for adventure and personal growth. As the wars in Iraq and Afghanistan drew more and more service members into combat, the military and civilian groups alike rolled out dozens of programs aimed at boosting military children's resilience. Although the authors applaud this effort, they also note that few of these programs have been based on scientific evidence of what works, and few have been rigorously evaluated for their effectiveness. They call for a program of sustained research to boost our understanding of military children's resilience.

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Resilience among Military Youth.

In this study, we examined estimates of internal consistency reliability, measurement invariance, and differential correlates of the Multidimensional Scale of Perceived Social Support (MSPSS; Zimet, Dahlem, Zimet, & Farley, 1988) in samples of undergraduate men (n = 270) and women (n = 340). The MSPSS is designed to assess 3 sources of perceived social support: family, friends, and significant others. The participants ranged in age from 18 to 24 years (M age = 19.60, SD = 1.4 years). First, composite scale reliability and coefficient omega methods provided adequate estimates of internal consistency reliability for the original MSPSS total and subscale scores. Second, results of multiple-groups invariance confirmatory factor analysis provided support for configural and metric invariance. Partial measurement invariance was attained for scalar and strict measurement invariance across men and women. Additionally, given the high correlations among the first-order factors, we conducted multiple-groups bifactor ...

The Multidimensional Scale of Perceived Social Support: Analyses of Internal Reliability, Measurement Invariance, and Correlates Across Gender

Objective The current prospective study explored how male cardiac patients' perceptions of received support (i.e., active engagement, protective buffering, and overprotection) moderated the associations between female partners' perceptions of provided support and patients' recovery outcomes: psychological well-being, cholesterol levels, and smoking cessation. Methods Couples (N = 86) completed surveys at the initial hospitalization after patients' Acute Coronary Syndrome (ACS), and 1 and 6 months later. Partners' ways of providing support and patients' concurrent perceptions of these ways were measured using the Ways of Giving Support Questionnaire; patients' depressive and anxiety symptoms were measured using the Brief Symptom Inventory (BSI). Patients' cholesterol levels were assessed during hospitalization and 6 months later, and smoking habits were reported by the patients. Results Female partners' protective buffering was positively associated with male patients' depressive symptoms at follow-up only when male patients' own perceptions of partners' protective buffering were low. Female partners' active engagement was positively associated with better odds for male patients' cessation of smoking only when patients' own perceptions of partners' active engagement were high. Finally, female partners' overprotection was associated with higher levels of male patients' harmful blood lipids at follow-up, but only when patients' own perceptions of partners' overprotection were high. Conclusions As hypothesized, the effect of partners' perceptions of support provided on patients' recovery was moderated by patients' own perceptions of the support received. The effect of this interaction was determined by the specific types of support provided or received and by the specific recovery outcome that was measured. The clinical and theoretical implications of the findings are discussed.

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Dynamics of Support Perceptions Among Couples Coping With Cardiac Illness: The Effect on Recovery Outcomes

Based on the Person-Environment Fit Model, the current prospective study explored the contribution of the interaction between spouses' ways of providing support and patients' attachment orientations to the patients' levels of psychological distress 6 months after experiencing a first Acute Coronary Syndrome (ACS). One hundred and eleven patients completed a measure of attachment orientations during hospitalization, while their spouses completed a measure of ways of providing support 1 month later. The outcome measures were patients' depressive and anxiety symptoms 6 months after their ACS. Whereas active engagement was associated with lower levels of anxiety symptoms among patients high in attachment anxiety, it was also associated with higher levels of anxiety symptoms among patients low on this orientation. In addition, none of the ways of providing support moderated the association between avoidance and distress. These results shed light on the possible interplay between providers' support and recipients' personalities.

Spousal support and cardiac patients' distress: the moderating role of attachment orientation.

Background Cardiovascular fitness is associated with cognition in advanced age. Cardiovascular disease (CVD) is a risk factor for cognitive decline beyond the normal aging process, thus we investigated this association in CVD patients. Method Patients in phase III of cardiac rehabilitation were divided into high and low cardiovascular fitness groups based on their predicted peak VO2. Cognition was assessed by a battery of neuropsychological tests examining memory, attention, visual spatial function, executive function and global cognitive score. Results The two groups were similar on reported physical activity and on the Mini-Mental State Examination (MMSE). However, the high fitness group had significantly higher scores than the lower fitness group on attention and on the global cognitive score, and marginally significant scores on executive functioning. Limitation Due to the small sample size no differentiation was made among the various CVD conditions. Conclusion Higher cardiovascular fitness of CVD patients is associated with superior cognition - predominantly in attention and executive functioning.

Cardiovascular Fitness and Neurocognitive Performance among Older Adults in the Maintenance Stage of Cardiac Rehabilitation

There are limited data on the prevalence and treatment of familial hypercholesterolemia (FH) among Israeli adults who experience premature acute coronary syndrome (ACS). This study aimed to assess the prevalence of FH among young Israeli adults with ACS, examine the rates of lipid-lowering therapy administration, and determine low-density lipoprotein-cholesterol (LDL-C) levels 1 year after ACS. Patients aged ≤55 years hospitalized for ACS at Meir Medical Center between 2018 and 2019 were included. Probable/definite FH was defined using the Dutch Lipid Clinic criteria. Outcomes included the proportion of patients with probable or definite FH, rate of use of lipid-lowering medications, LDL-C levels 1 year postadmission, and major adverse cardiovascular and cerebrovascular events during 30 months of follow-up. The study population comprised 687 young adults with a median age of 48.5 years. Definite/probable FH was present in 61 patients (8.9%). At 1 year of follow-up, the proportions of patients without FH who had LDL-C levels <70 and <55 mg/100 ml were higher than those of patients with FH (55.9% vs 18%, p <0.001 and 35.8% vs 11.5%, p <0.001, respectively). At 1 year of follow-up, only 47.5% and 22% of patients with FH were treated with ezetimibe and proprotein convertase subtilisin/kexin type 9 inhibitor than were those without FH. The incidence of major adverse cardiovascular and cerebrovascular events was significantly higher among patients with FH. In conclusion, clinically defined FH was present in nearly 1 of 11 patients with premature ACS. There is a necessity for more aggressive lipid-lowering therapies in patients with FH after experiencing ACS. 

Abid Khaskia

Papers

Dynamics of Support Perceptions Among Couples Coping With Cardiac Illness: The Effect on Recovery Outcomes

Spousal support and cardiac patients' distress: the moderating role of attachment orientation.

Cardiovascular Fitness and Neurocognitive Performance among Older Adults in the Maintenance Stage of Cardiac Rehabilitation

Familial Hypercholesterolemia Among Young Adults With Acute Coronary Syndrome.

Lipid treatment status and goal attainment among patients with premature acute coronary syndrome in Israel.