Work

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

Year: 2026

Type: article

Abstract: OBJECTIVE: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.

Source: Psychosomatic Medicine

DOI: 10.1097/psy.0000000000001466