ADULT ATTACHMENT THEORY AND DIABETES MELLITUS : AN EXAMINATION OF HEALTHCARE UTILIZATION AND BIOPSYCHOSOCIAL HEALTH

Abstract

Diabetes mellitus (DM) impacts hundreds of millions of individuals and their families around the globe. To explore the relational aspects of care and healthcare utilization two research articles were written: (a) a systematic literature review synthesized published research articles on diabetes and adult attachment theory; and (b) a descriptive cross-sectional study examined patient depictions consisting of relationship style, mental and physical well-being and healthcare utilization rates. The findings from the systematic literature review supported the need for additional prospective research focused upon diverse populations, and attachment style as the theoretical basis for understanding high utilizers of health care among patients with DM who experience barriers to quality health care. The cross-sectional study with a predominantly rural African American (AA) sample examined demographic, psychosocial (e.g., depression and social support), and behavioral data (e.g., primary care, specialty care, and behavioral health care utilization), by relationship style. There were 55 secure patients (37.2%); 21 fearful (14.2%); 13 preoccupied (8.8%); and 59 dismissing (39.9%). Compared to estimates of the general population as well as previous medical populations, the study sample consisted of slightly fewer secure patients, and slightly more dismissing ones. The findings showed most AAs were in the dismissing relationship category, which had the highest HbA1c values, yet reported the least amount of DM related distress. Preoccupied patients, who in previous studies tended to utilize more healthcare resources than other relationship types, actually utilized the least amount of outpatient primary care and specialty care, but more behavioral health. This study supports the need for: (a) more research on attachment styles among diverse populations with chronic disease; (b) further exploration of the relational aspects of care to assist in the development of behavioral and psychosocial patient profiles; and (c) expansion of studies about attachment styles in rural settings where socioeconomic and access to care issues may be barriers to quality health care. Recommendations based upon findings from both articles are presented for future research, clinical practice, policy awareness and development, and for the field of Medical Family Therapy.