Bindungsdiagnostik mittels Adult Attachment Projective bei Patienten mit Herzinsuffizienz oder Herzinsuffizienz-Risikofaktoren

Cardiovascular diseases as coronary heart disease and heart failure are the most common cause of death in Germany. This is why the identification of risk factors plays an important role in investigating the problem. Merely somatic aspects of these diseases turned out to be insufficient, so the attention meanwhile centers also on psychic and social factors. The criterions for inclusion contained arterial hypertension, diabetes mellitus, sleep apnea or coronary heart disease. 45 patients were examined, partly in the university hospital of Marburg and partly in the university hospital of Göttingen. This cross-sectional study focuses on Adult Attachment, anxiety and depression in patients with an apparent heart disease or risk factors for such a disease. In detail, we documented the cardiac history, the Adult Attachment Projective (AAP), and the quality of life questionnaires Relationship Scales Questionnaire (RSQ) and the Hospital Axiety and Depression Scale (HADS). We found a low prevalence of secure (15,6%) and a high prevalence of unresolved attached persons (62.2%) in the AAP, which could indicate a high level of traumatic experiences in this sample. In RSQ, the focus was on the secure attachment style (68,4%). This is in accord with other non-clinical samples. By comparing the two measures to assess attachment, AAP and RSQ, we revealed that 60% of the “unresolved/disorganized” patients in the AAP were rated “secure” in RSQ. We assume that we measured different things: AAP accentuates on unconscious defensive processes, while RSQ measures conscious emotions on the persons’ relationships. Regrettably, we were unable to resolve which of these two instruments to assess attachment is more likely associated with clinical findings and mental health. With respects to risk- versus heart patients neither AAP nor RSQ led to significant results. Solely serum cholesterol shows significantly higher rates in AAP disorganized (median 208 mg/dl) than in AAP organized persons (median 181 mg/dl). Referring to psychic factors, we found significantly higher depression rates both in disorganized patients in AAP (contrary to organized attached persons; median 5.5 versus 3.0) and in insecure patients in RSQ (compared to securely attached beings; median 6.5 versus 3.5). Furthermore, we were able to exhibit a highly significant difference in axiety rates (median 8.5 in the insecure versus 3.0 in the secure). Altogether, this leads to the conclusion that attachment behavior has a strong impact on the patients’ psychic mood. In turn, this may affect health behavior, which reflects a trend towards a higher level of depression in cardiac patients. Adult Attachment may be evaluated by different measures, concerning somatic and psychic factors non of the instruments is clearly superior to the other one yet. Basically, it is both reasonable and exciting to further investigate the interaction of attachment, psyche and somatic factors.