Attachment style and posttraumatic stress disorder after cardiac surgery

Introduction: Cardiac surgery with cardiopulmonary bypass represents a severe source of stress and has been reported to be associated to the development of Posttraumatic Stress Disorder (PTSD). This disorder leads to a significant disability that might greatly decrease the benefits of surgery. Research rarely focused on the role of attachment styles in the development of PTSD, and no studies addressed this issue in patients undergoing cardiac surgery. Objectives: To assess the influence of attachment styles on the development of PTSD. Aims: The identification of specific personological traits predictive of the development of PTSD. Methods: Participants were recruited among patients scheduled for elective cardiac surgery with cardiopulmonary bypass and evaluated through a) Experiences in Close Relationships (ECR) b) Post-traumatic 10 Stress Symptom Inventory - Modified (PTSS-10) c) Perceived Stress Scale (PSS). Six months after surgery, participants were mailed the PTSS-10 and the PSS. Multiple logistic regression analysis was performed with PTSD as dependent variable, and attachment-related avoidance and anxiety, sex, age and perceived stress as independent variables. Results: One hundred twenty-one patients (94% of candidates for elective cardiac surgery who met study inclusion criteria) underwent surgery; 61(59%) were assessed after 6 months. Fourteen subjects (19.7%) scored 􀂕35 on the PTSS-10 at followup and were considered as having a probable diagnosis of PTSD. Attachment related avoidance at baseline predicted the development of PTSD at follow-up (p< 0.017), after controlling for age, sex and perceived stress. Conclusions: Subjects endorsing the avoidant attachment style are more likely to develop PTSD after cardiac surgery.