وابستگی سازگارانه و ناسازگارانه در داغداری: تشخیص خط سیر طولانی مدت و سوگ

Abstract Interpersonal dependency is typically viewed as a risk factor for prolonged grief among conjugally bereaved adults. However, emerging empirical evidence and theoretical advances suggest that one manifestation of interpersonal dependency – adaptive dependency – may serve as a protective factor in coping with loss. This study compared adaptive and maladaptive dependency across three matched groups: prolonged grievers, asymptomatically bereaved adults, and a married comparison group. Results suggest a link between adaptive dependency and asymptomatic bereavement, and between maladaptive dependency and prolonged grief.

Introduction Of the many risk and resilience factors predicting individual response to loss of a loved one, studies have focused on qualities of the conjugal relationship to better understand the behavioral, affective, and cognitive correlates that determine resilient outcomes (Mancini and Bonanno, 2009 and Stroebe et al., 2007). In particular, interpersonal dependency (the tendency to look to others for nurturance, guidance and support, even in situations where autonomous functioning is warranted) is frequently examined. Though dependency has traditionally been identified as a risk factor for prolonged grief, empirical findings have been mixed: While some studies identify interpersonal dependency as a risk factor (Bonanno et al., 2002, Prigerson et al., 2000 and Stroebe et al., 1988), others suggest that interpersonal dependency may be a protective factor, associated with a more adaptive grief trajectory (Blake-Mortimer, Koopman, Spiegel, Field, & Horowitz, 2003). Given the complexity of coping with loss and the multidimensional nature of dependency, it may be that the construct of interpersonal dependency encompasses both risk and resilience factors in the context of bereavement.

3. Results Table 1 shows demographic data across all three groups. Chi-square tests and one way ANOVAs confirmed that the three study groups did not differ along the following demographic variables: age, length of marriage, gender, education, and race. However, there were between group differences in income, where a one way ANOVA confirmed significant differences between the married, prolonged and asymptomatic group F(2, 99) = 9.82, p < .001. Post-hoc analyses with Bonferroni corrections indicated that income for the married group was significantly higher than that for both bereaved groups, with no differences in income between the prolonged and the asymptomatic bereaved groups. Although it is plausible that reported income of the married participants was higher than that for the bereaved group since married participants were likely to report joint income, it is equally likely that the difference between groups occurred due to selection bias. Table 2 shows the intercorrelations among subscales of the RPT, with rows above the diagonal representing correlations within the prolonged grief group and rows below the diagonal representing those for the pooled married and asymptomatic sample. Because there were no differences in RPT-assessed dependency between the married and asymptomatic sample, they were combined in the correlation table. As expected, HD was negatively correlated with DD and DO for the pooled/asymptomatic group (respectively r = −.21, ns; r = −.33, p < .05); although correlation coefficients were in the expected direction for the prolonged grief group (respectively r = −.08, ns; r = −.35, ns), the HD-DO correlation was nonsignificant. Correlations between DO and DD were also nonsignificant for both groups (r = −.05, ns for the prolonged group and r = .14, ns for the pooled group). Table 2. RPT subscale intercorrelations. Subscale HD DD DO Healthy dependency (HD) – −.08 −.35 Dysfunctional detachment (DD) −.21 – −.05 Destructive overdependence (DO) −.33⁎ .14 – Note. Rows above the diagonal are correlations for the prolonged grief group (n = 25), and rows below diagonal are for pooled married and asymptomatic grief sample (n = 77). ⁎ p < .05. Table options Table 3 and Fig. 1 show data for between group comparisons along each of the three RPT subscales: HD, DD, and DO. One way ANOVA’s comparing means of the three RPT subscales revealed significant differences between groups for DD, F(2, 99) = 5.43, p = .006 and HD, F(2, 99) = 5.12, p = .008. Bonferroni corrected post hoc comparisons, also shown in Table 3, revealed that mean DD score for the prolonged grief group was significantly higher in comparison to the resolved group (MD = 5.26, p = .01), and the married group (MD = 5.16, p = .015). Similar comparisons showed that HD was significantly lower for the prolonged group in comparison to both the resolved group (MD = −4.73, p = .015) and the married group (MD = −4.83, p = .015). Table 3. Means, standard deviations, and univariate F-tests for RPT assessed dependency. Scale Married Prolonged Resolved F p Post hoc comparisons M (SD) M (SD) M (SD) Healthy dependency (HD) 35.83 (6.53) 31.00 (6.52) 35.73 (6.44) 5.12 .008 1 < 2, 3⁎ Dysfunctional detachment (DD) 32.08 (7.06) 37.24 (6.28) 31.98 (7.06) 5.43 .006 1 > 2⁎, 3⁎ Destructive overdependence (DO) 26.67 (9.34) 27.36 (9.39) 26.22 (8.46) 0.12 .883 1 > 2, 3 Note. 1 = prolonged group, 2 = resolved group, 3 = married comparison group. ⁎ p < .05. Table options Mean scores on RPT-assessed dysfunctional detachment (DD), destructive ... Fig. 1. Mean scores on RPT-assessed dysfunctional detachment (DD), destructive overdependence (DO), and healthy dependency (HD) across three study groups. Error bars represent 95% confidence interval.