Adult attachment security and college student substance use

Exploring Attachment Patterns in Patients With Comorbid Borderline Personality and Substance Use Disorders

Studies exploring attachment patterns in samples of patients with borderline personality disorder (BPD) report a combination of preoccupied and fearful-avoidant patterns. This has been interpreted as reflecting the approach-avoidance dilemma of BPD. Comorbid substance use disorders (SUD) have not been considered in these studies, despite the high proportions of SUD among BPD patients and despite the more avoidant attachment in SUD samples. This cross-sectional, naturalistic study explores attachment patterns in a sample of comorbid (BPD and SUD) patients, comparing them to two samples of patients with either SUD or BPD only. Within-group comparisons replicated findings of both preoccupied and fearful-avoidant attachment in BPD and comorbid groups. But between-group comparisons showed that comorbid patients were significantly less preoccupied (p = 0.018) and more dismissing-avoidant (p = 0.030). Although both groups were similar in several psychiatric measures, attachment patterns of the comorbid group were more similar to substance abusers than to borderline patients.

A transdiagnostic minority stress treatment approach for gay and bisexual men's syndemic health conditions

Developing and deploying separate treatments for separate conditions seems ill-suited to intervening upon the co-occurring, and possibly functionally similar, psychosocial conditions facing gay and bisexual men. This article argues for the need to create transdiagnostic interventions that reduce multiple syndemic conditions facing gay and bisexual men at the level of their shared source in minority stress pathways. This article first reviews psychosocial syndemic conditions affecting gay and bisexual men, then suggests pathways that might link minority stress to psychosocial syndemics based on recent advancements in emotion science, psychiatric nosology, and cognitive-affective neuroscience, and finally suggests cross-cutting psychosocial treatment principles to reduce minority stress-syndemic pathways among gay and bisexual men. Because minority stress serves as a common basis of all psychosocial syndemic conditions reviewed here, locating the pathways through which minority stress generates psychosocial syndemics and employing overarching treatment principles capable of simultaneously alleviating these pathways will ultimately create a transdiagnostic approach to improving gay and bisexual men's health. Clinical research and training approaches are suggested to further validate the pathways suggested here, establish the efficacy of treatment approaches tied to those pathways, and generate effective methods for disseminating a transdiagnostic minority stress treatment approach for gay and bisexual men's psychosocial syndemic health.

The role of sexual expectancies of substance use as a mediator between adult attachment and drug use among gay and bisexual men

BACKGROUND

Research exploring substance use in gay and bisexual men has increasingly paid attention to interpersonal dynamics and relational concerns associated with the use of substances. The current study explored the role of adult attachment style on drug use as well as the potential mediating role of sexual expectancies of substance use among gay and bisexual men.

METHODS

Online survey data were gathered from 122 gay and bisexual men across the U.S., with a mean age of 33 years. All participants were HIV-negative and identified their relationship status as single. Survey measures included attachment style, sexual expectancies of substance use, and recent drug use.

RESULTS

While neither anxious or avoidant attachment were directly associated with the odds of recent drug use, they were positively associated with sexual expectancies of substance use (β=0.27, p<0.01, and β=0.21, p<0.05) which, in turn, were positively associated with the odds of drug use (expB=1.09, p<0.01). Bootstrapping tests of indirect effects revealed a significant indirect relationship between anxious attachment and drug use through sexual expectancies of substance use (β=0.11, p<0.05), but not for avoidant attachment.

CONCLUSIONS

This study highlights the importance of interpersonal expectancies as motivators for drug use among gay and bisexual men. Sexual expectancies of substance use were associated with drug use and anxious adult attachment was associated indirectly with drug use through these sexual expectancies.

Adult attachment style is associated with cerebral μ-opioid receptor availability in humans

Human attachment behavior mediates establishment and maintenance of social relationships. Adult attachment characteristically varies on anxiety and avoidance dimensions, reflecting the tendencies to worry about the partner breaking the social bond (anxiety) and feeling uncomfortable about depending on others (avoidance). In primates and other mammals, the endogenous μ-opioid system is linked to long-term social bonding, but evidence of its role in human adult attachment remains more limited. We used in vivo positron emission tomography to reveal how variability in μ-opioid receptor (MOR) availability is associated with adult attachment in humans. We scanned 49 healthy subjects using a MOR-specific ligand [(11) C]carfentanil and measured their attachment avoidance and anxiety with the Experiences in Close Relationships-Revised scale. The avoidance dimension of attachment correlated negatively with MOR availability in the thalamus and anterior cingulate cortex, as well as the frontal cortex, amygdala, and insula. No associations were observed between MOR availability and the anxiety dimension of attachment. Our results suggest that the endogenous opioid system may underlie interindividual differences in avoidant attachment style in human adults, and that differences in MOR availability are associated with the individuals' social relationships and psychosocial well-being.

Adult Attachment Dimensions and College Student Distress

The present investigation examined dispositional hope as a psychological strength that mediates the associations between adult attachment dimensions and seven commonly assessed college student psychological symptoms, as measured by the Counseling Center Assessment of Psychological Symptoms–62 (CCAPS-62): depression, eating concerns, substance use, generalized anxiety, hostility, social anxiety, and academic distress. Structural equation modeling of data obtained from students at a large Midwestern university ( N = 2,644) revealed that (a) adult attachment dimensions were positively associated with CCAPS-62 domains and negatively associated with hope, (b) hope was negatively associated with all seven CCAPS-62 domains with the exception of substance use, and (c) hope mediated the associations between attachment dimensions and all seven CCAPS-62 psychological symptoms, with the exception of substance use. Findings suggest that addressing adult attachment-driven automatic views of self and others may have important implications for hopeful thinking as well as for counseling intervention and prevention of college student psychological distress.

Insecure attachment styles, relationship-drinking contexts, and marital alcohol problems: Testing the mediating role of relationship-specific drinking-to-cope motives

Research and theory suggest that romantic couple members are motivated to drink to cope with interpersonal distress. Additionally, this behavior and its consequences appear to be differentially associated with insecure attachment styles. However, no research has directly examined drinking to cope that is specific to relationship problems, or with relationship-specific drinking outcomes. Based on alcohol motivation and attachment theories, the current study examines relationship-specific drinking-to-cope processes over the early years of marriage. Specifically, it was hypothesized that drinking to cope with a relationship problem would mediate the associations between insecure attachment styles (i.e., anxious and avoidant) and frequencies of drinking with and apart from one's partner and marital alcohol problems in married couples. Multilevel models were tested via the actor-partner interdependence model using reports of both members of 470 couples over the first nine years of marriage. As expected, relationship-specific drinking-to-cope motives mediated the effects of actor anxious attachment on drinking apart from one's partner and on marital alcohol problems, but, unexpectedly, not on drinking with the partner. No mediated effects were found for attachment avoidance. Results suggest that anxious (but not avoidant) individuals are motivated to use alcohol to cope specifically with relationship problems in certain contexts, which may exacerbate relationship difficulties associated with attachment anxiety. Implications for theory and future research on relationship-motivated drinking are discussed.

Attachment security and problematic substance use in low-income, suicidal, African American women

BACKGROUND AND OBJECTIVES

While secure attachment may buffer the effect of adverse early experiences on the development of behavioral problems in children, whether attachment security may provide resilience against problematic substance use in adulthood is less clear, and addressed by this study.

METHODS

We examined relations between attachment security and problematic substance use in 356 African American women recruited for a suicide prevention/intervention study. Problematic substance use was defined as a positive screen on either the Brief Michigan Alcoholism Screening Test or the Drug Abuse Screening Test-10. Attachment security was assessed using the Secure Subscale of the Relationship Scales Questionnaire. Associations between demographic and psychosocial variables (age, education, unemployment, homelessness, attachment security, past childhood maltreatment, current exposure to intimate partner violence, and depressive symptoms) and problematic substance use were determined using logistic regression analyses.

RESULTS

Participants averaged 35.1 ± 10.0 years of age, and exhibited significant psychosocial challenges. More secure attachment was independently associated with a lower likelihood of problematic drug use (OR = .516, 95% CI (.343-.777), p ≤ .01); and the problematic use of either alcohol or drugs (OR = .563, 95% CI (.374-.849), p ≤ .01). Attachment security, along with childhood maltreatment, age, and homelessness, accounted for 25.5% of the variance in problematic substance use.

DISCUSSION AND CONCLUSIONS

Participants who reported greater attachment security were significantly less likely to engage in problematic substance use.

SCIENTIFIC SIGNIFICANCE

Future research should explore attachment security as a resilience factor against problematic substance use.

Rejection attitudes, poor parental bonding, and stressful life events in heroin addicts' families

BACKGROUND

The influence of family factors on the development and/or on maintenance of heroin addiction still remains unclear.

OBJECTIVES

The aim of this study was to investigate family factors, which might be associated with heroin addiction in a sample of male individuals.

METHODS

A group of 40 heroin addicts' families was compared with a group of 17 families with a member presenting schizophrenia and a group of 27 families with mentally healthy members in regard to (1) parents' rejection attitudes toward their adult child, (2) quality of parental bond, as perceived by the adult child, and (3) stressful life events in the nuclear family.

RESULTS

The main findings showed that the degree of rejection by the fathers in the heroin addicts' families as well as in the subjects with schizophrenia was significantly higher compared to the fathers' degree of rejection in the control group. Moreover, the degree of rejection by mothers in the heroin addicts' families was significantly higher compared to the mothers' degree of rejection in the control group. Heroin addicts reported that they had perceived less care from their fathers than healthy controls. The total number of stressful life events in the nuclear family was higher in the patients with schizophrenia in comparison to the healthy controls. Also, in the heroin addicts' group, a significantly higher number of fathers presented a current or past psychiatric disorder.

CONCLUSIONS

The findings of this study showed the importance of negative family factors in the course of heroin addiction.

Attachment and family functioning in patients with internet addiction

OBJECTIVE

Although the Internet is used effectively in many areas of life, some users experience problems because of over-use due to a lack of control. The diagnostic criteria for Internet addiction include disruptions in family relationships, but adequate data on the attachment styles and family functioning associated with this condition are limited. This study aimed to investigate the attachment styles and family functioning of patients with Internet addiction.

METHOD

The sample included 30 male patients consecutively admitted to the Bakırköy Mental Health and Research Hospital Internet Addiction Outpatient Clinic, who were diagnosed in clinical interviews as having Internet addiction according to Young's (1998) criteria. Thirty healthy males who were matched with the experimental group in terms of sociodemographic characteristics were included as control subjects. Both groups provided sociodemographic data and completed the Beck Depression Inventory (BDI), the Experiences in Close Relationships Questionnaire-r (ECR-r) and the Family Assessment Device (FAD).

RESULTS

Patients with Internet addiction had higher BDI scores (P<.001) and higher attachment anxiety subscores on ECR-r (P<.001) compared with those in the control group. Patients with Internet addiction evaluated their family functioning as more negative and reported problems in every aspect addressed by the FAD. Scores on the FAD behaviour control, affective responsiveness, and problem-solving subscales (P<.05) and on the FAD communication, roles, and general functioning subscales (P<.001) were significantly higher in the patient compared with the control group.

CONCLUSION

Patients with Internet addiction have more anxious attachment styles as well as prominent disruptions in family functioning. Thus, it may be important to evaluate the attachment styles and family functioning of patients with Internet addiction. Indeed, comprehensive treatment approaches including other family members may make important contributions to treatment success.

Attachment and alcohol use amongst athletes: the mediating role of conscientiousness and alexithymia

OBJECTIVE

The present study aims to explore the mediating effects of conscientiousness and alexithymia in the relationship between parental attachment style and alcohol use in a large sample of athletic young people.

METHOD

Participants included 434 French sport sciences students. Alcohol use, parental attachment style, conscientiousness and alexithymia were assessed. The hypotheses were tested by using regression and bootstrapping mediation analyses.

RESULTS

Maternal insecure attachment style is positively associated with alcohol use. The current study highlights a multiple pathway in this relationship. The results reveal the mediating effect of low conscientiousness and alexithymia between maternal insecure attachment and alcohol use.

CONCLUSION

Athletes' alcohol use seems to be the result of a complex association of underlying psychological factors.

An Interpersonal Model of Addiction Relapse

In this article, we review the literature on interpersonal stress and rejection sensitivity and examine how these factors increase the risk of relapse in individuals with alcohol or drug dependence. We begin by considering the constructs of social pain and social threat, examining their evolutionary origins and their neuroanatomical, neuropsychological and neurophysiological dimensions. Together, these perspectives provide insight into the role of interpersonal stress as a powerful and oftentimes destructive factor that affects individuals in recovery from substance dependence. We then review the empirical evidence showing that intrapersonal traits and interpersonal environments interact to increase an addict's risk of relapse. We conclude by proposing that substance-dependent individuals with high trait rejection sensitivity and a critical interpersonal environment are particularly vulnerable to relapse to substance use.

Influence of psychological attachment patterns on periodontal disease - a pilot study with 310 compliant patients

OBJECTIVES

Psychosocial variables have received increased attention in periodontology. Attachment theory adds to known risk factors by linking early interactional experiences with adult tendencies of stress-regulation, health behaviour, symptom reporting, and healthcare utilization. The study investigates associations between attachment patterns and periodontal parameters.

METHODS

Within the context of a longitudinal study on periodontal diseases, 310 patients with aggressive (AgP) and chronic periodontitis (CP) filled out questionnaires on psychological attachment patterns. The influence of attachment style on health behaviour, treatment attendance and utilization, and periodontal variables was tested.

RESULTS

We found associations between psychological attachment anxiety on smoking and higher number of session use, independent of disease severity, which was more pronounced for women. Patients with higher attachment avoidance attended periodontal treatment later when diagnosed with CP and earlier with AgP. For men, we found differential associations for attachment avoidance and anxiety and number of teeth at beginning of treatment.

CONCLUSION

Psychological attachment patterns are a promising target for understanding periodontal disease in addition to known psychosocial risk factors.

A comparative study of self-regulation in substance dependent and non-dependent individuals

BACKGROUND

Several factors influence the beginning and maintenance of substance use. The purpose of this study was to examine as well as to compare 'self-regulation' in both substance dependent and non-substance dependent individuals.

METHOD

In a cross-sectional study 228 (118 substance dependent and 110 with no history of using substance) participants aged 16-55 were recruited. All of the participants were asked to complete the Self-Regulation Inventory (SRI-25) and a demographic characteristics data checklist. Data was analyzed using descriptive statistics (frequency, mean and standard deviation) and the t-test.

RESULTS

The results showed significant differences between substance dependent and non- substance dependent groups in all the scales of the self-regulation inventory including positive actions, controllability, expression of feelings and needs, assertiveness, and well-being seeking (p<0.01).

CONCLUSION

Self-regulation and self-control skills in drug dependent individuals are lower than those without substance dependence individuals. It is concluded that substance use may related to a deficiency in self-control and regulation of feelings. Therefore, for prevention and treatment of substance dependence disorder, it is necessary to work out and exploit strategies that include the improvement of self-regulation.

[Self-esteem, coping, perceived social support and substance use in young adults with a cannabis dependence disorder]

INTRODUCTION

Self-esteem, coping strategies and perceived social support play a role in the adaptive functioning of the human being: they allow the adjustment of the subject to his/her environment. These dimensions could be protective factors regarding multiple risks associated with adolescent development, and particularly substance use. Thus our objective was twofold: to evaluate self-esteem, coping strategies and perceived social support in adolescents and young adults with a cannabis dependence in comparison with subjects from the general population; to establish the correspondence between these psychological dimensions and the patients' substance use pattern.

METHOD

Data from 43 young patients (36 males; mean age=19.6±3), consulting for their cannabis dependence, and 50 young adults from the general population (39 males; mean age=19.7±3.4) were included. Participants completed the Rosenberg Self-Esteem Inventory, the Social Self-Esteem Inventory of Lawson, the Coping Inventory for Stressful Situation of Endler & Parker, and the Perceived Social Support Questionnaire of Sarason. The MINI was administered to evaluate cannabis abuse or dependence; a semi-structured clinical interview was given to determine psychoactive substance use.

RESULTS

Between-group comparisons (two independent sample t-tests) showed that the patients had significantly lower scores on global (P=0.002) and social (P=0.035) self-esteem, task-oriented coping (P<0.001) and both availability and satisfaction regarding perceived social support (respectively P=0.029 and P<0.001). Conversely, patients had significantly higher scores on emotion-focused coping subscale (P=0.003). Logistic regressions showed that the satisfaction regarding social support and task-oriented coping scores were the more powerful to distinguish the patients from the controls (respectively β=1.16, P=0.043 and β=1.06, P=0.015). Unvaried linear regression analyses revealed a negative association between the age of first cannabis use and the avoidant-social coping score (P=0.025), and positive associations between the length of daily cannabis use and emotion-focused coping score (P=0.028), and frequency of cannabis use and global self-esteem scores (P=0.028). Moreover, polysubstance misuse is associated with low distraction-avoidant coping scores. No association was found between clinical scores and tobacco and alcohol uses variables.

CONCLUSION

These results suggest that cannabis dependent patients may present a lack in individual and interpersonal resources. This clinical study underscores the potential contribution of maladaptive coping to the development or maintenance of substance use in young adulthood.

Contributions of family environment and parenting processes to sexual risk and substance use of rural African American males: a 4-year longitudinal analysis

This study sought to identify factors that forecast sexual risk and alcohol or other substance use patterns among 411 rural African American males as they transitioned from middle childhood to late adolescence. In addition, an exploration was undertaken to examine the contribution of both risk and protective factors in distinguishing rural African American males at highest risk for engaging in risky sexual behavior and elevated substance use from those with relatively low risk of engaging in these behaviors. Findings revealed that exposure to negative life events during middle childhood has prognostic significance for rural African American males' susceptibility to engaging in HIV-related risk behaviors as they transition into adolescence and young adulthood. High-risk engaging males had significantly higher means on susceptibility to risk and marginally significantly higher means on substance-using peer affiliation. High-risk rural African American males also reported lower means on involved-vigilant parent than the normative group (low-risk group). However, economic hardship, family stress, parental psychological functioning, and harsh and inconsistent parenting did not emerge as significant predictors of high- or low-risk group membership. The implication for future research and preventive interventions is discussed.

Psychological differences between smokers who spontaneously quit during pregnancy and those who do not: a review of observational studies and directions for future research

INTRODUCTION

Although remarkable interindividual differences among pregnant smokers' decision/ability to quit have been documented, the psychological factors that may account for these differences have received less attention and comprised the primary aim of this review.

METHODS

We searched the medical and behavioral sciences literature from 1996 to November 2011 using PubMed and PsycINFO(®). Fifty-one articles were identified based on titles or abstracts. These articles were reviewed in full and searched for quantitative observational studies of population-based or clinical samples, with the main topic of comparing smokers who quit spontaneously during pregnancy with those who did not, utilizing multivariable analyses.

RESULTS

The eight pertinent studies reviewed herein included four longitudinal studies and four cross-sectional analyses. Amidst significant variability among measures used, social support, depressive symptoms, and anxiety appeared unrelated to smoking cessation during pregnancy. Furthermore, when severity of nicotine dependence was controlled, maternal history of attention-deficit/hyperactivity disorder, depression, bipolar disorder, and schizophrenia all showed no independent relationship with smoking cessation during pregnancy, whereas maternal history of conduct disorder did. Secure attachment, prosocial personality, self-esteem, and perceived parenting competence were additional predictors of cessation during pregnancy.

CONCLUSIONS

A greater understanding of psychological factors that differentiate smokers who spontaneously quit during pregnancy from those who do not is crucial to the design of more effective prenatal smoking cessation interventions and also may elucidate causal mechanisms that underlie the well-established link between maternal smoking during pregnancy and offspring behavioral problems. Directions for future research and public health and policy implications are discussed.

Associations between adult attachment style and health risk behaviors in an adult female primary care population

OBJECTIVE

To examine the relationship between adult attachment style and health risk behaviors among adult women in a primary care setting.

METHODS

In this analysis of a population of women enrolled in a large health maintenance organization (N=701), we examined the relationship between anxious and avoidant dimensions of adult attachment style and a variety of sexual, substance-related, and other health risk behaviors. After conducting descriptive statistics of the entire population, we determined the relationships between the two attachment dimensions and health behaviors using multiple regression analyses in which we controlled for demographic and socioeconomic factors.

RESULTS

After adjustment for covariates, the anxious dimension of attachment style was significantly associated with increased odds of self-report of having sex without knowing a partner's history, having multiple (≥2) male partners in the past year, and history of having a sexually transmitted infection (ORs [95% CIs]=1.11 [1.03, 1.20], 1.23 [1.04, 1.45]; and 1.17 [1.05, 1.30], respectively). The avoidant attachment dimension was associated with increased odds of being a smoker and not reporting regular seatbelt use (ORs [95% CIs]=1.15 [1.01, 1.30] and 1.16 [1.01, 1.33], respectively).

CONCLUSIONS

Both anxious and avoidant dimensions of attachment were associated with health risk behaviors in this study. This framework may be a useful tool to allow primary care clinicians to guide screening and intervention efforts.

Suicide proneness in college students: relationships with gender, procrastination, and achievement motivation

This study examined the relationships between 2 academic dispositions (i.e., procrastination and achievement motivation) and 2 indices of suicidal proneness in college women and men. The degree these 2 academic dispositions could predict unique variance in suicide proneness scores, above and beyond the influence of depression and self-esteem was also examined for each gender. Participants included 475 (336 women, 139 men) undergraduates from a southeastern university. For both genders, procrastination and achievement motivation were significantly correlated at the univarate level with the suicide proneness indices. However, for college women, but not men, procrastination significantly accounted for unique amounts of variance in both suicide indices above and beyond the influence of depression and self-esteem. Implications for suicide intervention efforts directed toward college women and men are offered.

Transfer of attachment functions and adjustment among young adults in China

This study was designed to examine the process of attachment transfer from parents to peers, as well as factors related to this transfer process among Mainland Chinese. A total of 147 Chinese college students (with a mean age of 21.44) completed questionnaires that measured attachment style, attachment transfer, attachment support from various figures, loneliness, positive/negative affects, and self-esteem. Major findings of the current study include the following: (a) Hazan and Shaver's sequential model of attachment transfer was generalized to the Chinese sample; (b) the extent of attachment transfer was found to be associated with participants' emotional states (loneliness and positive affect) and was a significant predictor of these emotional states beyond the effects of attachment style and attachment support. As one of the first studies exploring the phenomenon of attachment transfer among young Chinese adults, conceptual and applied implications of these findings are discussed.

Attachment relationships and physical activity motivation of college students

This study was designed to assess the link of attachment relationships with physical activity motivation. Potential mediators of this link were examined in a cross-sectional study targeting college student physical activity motivation and behaviour. Participants completed self-reports of attachment relationships (with mother, father and best friend), self-determined motivation for physical activity, physical activity behaviour and the hypothesised mediator variables of perceived competence, autonomy and relatedness. The results provide support for the mediating role of these variables in the association of father attachment with self-determined motivation. Meaningful variance in self-determined motivation for physical activity and physical activity behaviour was explained. Overall, attachment relationships appear to be relevant, albeit modestly, to physical activity motivation of college students. The findings support continued efforts to integrate attachment and motivational perspectives in the study of college student health behaviour.

Correlates of heavy drinking behaviors of Latino mothers and their adult daughters

This study explored associations between adult Latina heavy drinking behaviors and potential psychosocial and demographic correlates. It used mother-daughter dyads and a cross-sectional design. Data were drawn from a community-based sample of 158 dyads of adult Latinas (n=316), age 18 years or older, recruited between 2004 and 2006. Bivariate and multivariate statistical methods, including logistic regression and pathway models, were used to analyze data. The study found that protective factors for heavy drinking behaviors for the mother included daughter's social support and mother's age, while for the daughter, they were mother's attachment and daughter's country of birth. Risk factors for daughter's heavy drinking behaviors were mother's social support and daughter's education. For both mother and daughter, chronic stress and drinking behavior associations were mediated by attachment and social support. Preventive interventions should target increasing levels of mother-daughter attachment and daughter's social support while decreasing stress levels for mothers and daughters.

Adult Attachment, Social Support, and Depression Level of Poststroke Patients

This study investigated the relationship between adult attachment, social support, and depression of post-stroke patients. A total of 100 post-stroke patients were recruited to complete 4 questionnaires, which include 2 widely used measurements of adult attachment – the Relationship Questionnaire (Bartholomew & Horowitz, 1991) and the Experiences of Close Relationships Inventory (Brennan, Clark, & Shaver, 1998) – to measure patients' attachment style, the Social Support Inventory (Xiao, 1994) measuring four aspects of social support, and the Beck Depression Inventory (Beck, 1967) measuring their depression level. The results suggested that patients differ in adult attachment styles and varied significantly in all indices of social support and depression. Secure subjects got higher scores in social support and lower scores of depression. Their depression level had significant positive correlations with attachment avoidance and attachment anxiety, and was negatively correlated to all indices of social support. Furthermore, both attachment-anxiety and subjective social support can predicate the depression level of poststroke patients.