This research investigates physiological and behavioral processes through which insecure attachment in marriage may serve as a risk factor for depression and anxiety disorders. Insecure attachment is associated with depression and anxiety, but little is known about the processes underlying this link. From a cancer perspective, it is important to understand the biobehavioral mechanisms underlying the link between attachment and depression because depression is prevalent among cancer patients, associated with more rapid cancer progression, and contributes to adjustment throughout the course of cancer. It also is critical to investigate these processes in a marital context because social support in marriage has been linked repeatedly to mental and physical health outcomes, including adjustment to cancer. The long term goals of this work are to understand the biobehavioral mechanisms through which attachment processes in marriage play a role in the etiology and risk for depression and anxiety disorders as well as other health outcomes, and to apply this basic knowledge in future work designed to develop and test new interventions to reduce the burden of cancer. The proposed research tests a theoretical model that builds on our prior work by integrating multiple variables into a theoretically meaningful framework to predict depression and anxiety symptoms in a marital context. The model incorporates individual and situational vulnerability factors (attachment, personality variables, life events) as well as biological (HPA activation patterns), cognitive, and behavioral mediating mechanisms to predict depression and anxiety. The specific objectives are to test (1) whether insecure attachment increases risks for depression and anxiety through physiological and behavioral processes, and whether genetically- based personality predispositions and life event changes further raise or lower this risk, (2) whether one spouse's characteristics predict the other partner's responses and symptoms, (3) whether the processes differ for husbands and wives, and (4) whether the quality of one spouse's responses over time leads to changes in the other partner's patterns of HPA activation, which in turn, may increase or decrease vulnerability to depression and anxiety. A sample of 225 recently married, healthy couples will be tested 3 times at 15-18 month intervals. Spouses will provide saliva samples to index cortisol at times before, during, and after a conflict discussion. Interactions will be videotaped, and partners'behaviors will be coded along theoretically important dimensions (e.g., withdrawal, support-seeking). Participants will complete self-report measures to assess adult attachment, personality, life events, depression, anxiety, and variables potentially related to cortisol patterns or to other central constructs in the model. Basic knowledge derived from this work with non- patient couples will provide a strong foundation for examining these processes in couples in which one partner is at high risk for cancer or has been diagnosed with cancer and for building and testing new intervention strategies to enhance adjustment in these couples. Public Health Relevance: Depression and anxiety are prevalent among cancer patients, and depression predicts faster tumor growth and poorer adjustment to cancer diagnosis, treatment, and survivorship. Furthermore, poor marital quality is associated with an increased risk of depression and anxiety, whereas support from a spouse predicts better mental and physical health outcomes, including adjustment to cancer. The proposed project will follow healthy married couples over time to discover how personality factors together with specific physiological stress reactions and behavior patterns that arise during discussions of conflict may increase the risk of depression and anxiety, and knowledge from this basic research will be applied in future work to develop new interventions to enhance adjustment in couples coping with one partner's cancer risk, diagnosis, treatment, or survivorship.
