Attachment and Clinical Outcomes in Treatment-Seeking Adults with Persistent Symptoms Following Concussion

Research Objectives: To investigate whether insecure attachment strategies are associated with worse clinical outcomes following concussion, including persistent post-concussion symptoms (PPCS), lower health-related quality of life (HRQOL), higher depression and anxiety symptoms, and worse treatment responses.

Design: The study used data from a randomized controlled trial of behavioral interventions for PPCS. Outcome measures were administered at clinic intake (M=18.1 weeks post-injury) and at follow-up (M=32.2 weeks post-injury), except for the measure of attachment strategies, which was only administered at follow-up.

Setting: Outpatient concussion clinics.

Participants: A total of 83 treatment-seeking adults with PPCS were recruited. Participants were 66% female with a mean age of 41.3 years (SD=11.8).

Interventions: Not applicable.

Main Outcome Measures: Insecure attachment dimensions were measured using the Relationship Scales Questionnaire. PPCS were assessed using the Rivermead Post Concussion Symptoms Questionnaire; depression and anxiety were measured using the Patient Health Questionnaire-9 and the Generalized Anxiety Disorder-7 scale, respectively. HRQOL was assessed with the Quality of Life after Brain Injury-Overall Scale.

Results: Higher attachment anxiety was associated with greater PPCS (B=3.42, 95% CI [0.46, 6.38], p=.02), greater depression and anxiety symptoms (B=0.33, 95% CI [0.10, 0.57], p=.006; B=0.37, 95% CI [0.08,0.65], p=.01), and worse HRQOL (B=-6.80, 95% CI [-10.66, -2.95], p<.001) at follow-up. Higher attachment anxiety was also associated with less improvement in depression (B=-1.20, 95% CI [-2.29, -0.12], p=.03) and HRQOL (B=-4.08, 95% CI [-7.21, -0.93], p=.01) over time. In contrast, attachment avoidance was unrelated to any of the clinical outcomes.

Conclusions: Our results suggest that attachment anxiety, the fear that a significant other will not be available in stressful circumstances, may be a particularly important social determinant of health in adults with PPCS. Greater consideration of the attachment system is warranted in post-concussion care and research.

Author(s) Disclosures: The authors have no conflict of interest to disclose.