Attachment Styles as Protective and Amplifying Factors in Caregiver Psychological Distress: A Multicenter Cross-Sectional Study in Oncology and Chronic Disease Caregiving

Abstract

Background/Objectives: Caregiving for patients with advanced cancer or chronic illness imposes substantial psychological burden, yet the role of caregiver attachment style in moderating this distress is underexplored. This multicenter, cross-sectional study investigates how attachment styles influence the relationship between psychological distress and caregiver burden in two populations: family caregivers of palliative-stage cancer patients and those supporting patients with chronic diseases. Methods: Across Turkey, 819 caregivers (412 cancer, 407 chronic disease) completed the Zarit Caregiver Burden Scale, DASS-21, and Relationship Scale Questionnaire. Hayes' PROCESS macro was used to test the moderating role of attachment styles. Results: Cancer caregivers reported higher caregiver burden (Cohen's d = 0.35, 95% CI [0.21, 0.49]) and stress than chronic disease caregivers, but lower depression. Secure attachment was negatively associated with burden, while preoccupied attachment was positively associated. For cancer caregivers, secure attachment buffered the impact of depression on burden (interaction B = -0.611, 95% CI [-0.861, -0.361]), whereas preoccupied attachment amplified it in both groups (cancer caregivers: B = 0.292, 95% CI [0.064, 0.520]; chronic disease caregivers B = 0.505, 95% CI [0.174, 0.836]). The final regression models explained 43.1% of variance in burden for the cancer group and 10.9% for the chronic disease group. Conclusions: Attachment styles are significant moderators of the relationship between psychological distress and caregiver burden. Secure attachment is a protective factor, while preoccupied attachment is a vulnerability factor. These findings underscore the need for attachment-informed psychosocial interventions tailored to specific caregiver profiles to mitigate distress.