The relationship between attachment styles and marital quality in women with breast cancer: The mediating role of death anxiety

Jafarizadeh, Fatemeh; Keshavarz, somayeh; Mirani, Aristotle; abdollahzadeh, Hasan

doi:10.22034/27.3.43

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Volume 27, Issue 3 (10-2025)

EBNESINA 2025, 27(3): 43-54

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The relationship between attachment styles and marital quality in women with breast cancer: The mediating role of death anxiety

Fatemeh Jafarizadeh

, Somayeh Keshavarz ^*

, Aristotle Mirani

, Hasan Abdollahzadeh

Assistant Professor, Department of Psychology, Faculty of Social Sciences, Imam Khomeini International University, Qazvin, Iran. , s.keshavarz@soc.ikiu.ac.ir

Abstract: (178 Views)

Background and aims: Breast cancer, beyond its physical effects, profoundly affects quality of life, mental health, and especially marital satisfaction and functioning for patients and their partners. This study examined the relationship between attachment styles and marital quality in women with breast cancer, considering the mediating role of death anxiety.
Methods: This descriptive-correlational study used path analysis. The statistical population comprised all women with breast cancer who attended the Mehr Golestan Center in Gorgan, Iran, in 2024. A convenience sample of 230 participants was recruited. Measures included the Marital Quality Questionnaire (Busby et al., 1995), the Attachment Styles Questionnaire (Collins & Read, 1990), and the Death Anxiety Scale (Collett–Lester, 1993). Data were analyzed using path analysis in AMOS 24.
Results: Significant direct relationships were found among secure and ambivalent attachment styles, death anxiety, and marital quality. In addition, death anxiety significantly mediated the relationship between attachment styles and marital quality.
Conclusion: Marital quality in women with breast cancer is influenced both directly and indirectly by psychological factors such as attachment styles and death anxiety. Considering these variables in therapeutic and intervention programs may substantially improve marital relationships and overall quality of life in this population.

Keywords: death, anxiety, attachment, marital

Full-Text [PDF 1615 kb] (86 Downloads) | | Extended Abstract (HTML) (69 Views)

Type of Study: Original | Subject: Disaster Medicine
Received: 2025/10/10 | Revised: 2025/11/13 | Accepted: 2025/11/16 | Published: 2025/11/22

References

1. Pieh C, O´Rourke T, Budimir S, Probst T. Relationship quality and mental health during COVID-19 lockdown. PLOS ONE. 2020;15(9):e0238906. doi:10.1371/journal.pone.0238906

2. KavehFarsani Z, Worthington EL, Jr. Direct Effects of Marital Empathy, Body image, and perceived social support on quality of life of married women with breast cancer and the mediating Role of Perceived Marital Quality. Iranian Journal of Psychiatry. 2024;19(1):70-78. doi:10.18502/ijps.v19i1.14340

3. Lee H, Yoon HG. Body change stress, sexual function, and marital intimacy in korean patients with breast cancer receiving adjuvant chemotherapy: A cross-sectional study. Asia-Pacific Journal of Oncology Nursing. 2023;10(5):100228. doi:10.1016/j.apjon.2023.100228

4. Gui G, Yang D, Liu Y, Yao Y, Xie X, Liu R, et al. How family support alleviates death anxiety in breast cancer patients: the mediating role of meaning in life. Frontiers in Public Health. 2025;Volume 13 - 2025. doi:10.3389/fpubh.2025.1567485

5. Li Y, Dong W, Tang H, Guo X, Wu S, Lu G, et al. Correlates of death anxiety for patients with cancer: A systematic review and meta-analysis. Journal of Clinical Nursing. 2024;33(5):1933-1947. doi:10.1111/jocn.17021

6. Bennett A, Sharpe L, Boyse JB. A meta-analysis of death anxiety in people living with or beyond cancer: the important role of culture. Journal of cancer survivorship : research and practice. 2025. doi:10.1007/s11764-025-01856-8

7. Ahmead M, Shehadah F, Abuiram I. Correlation of death anxiety with coping strategies among Palestinian women with breast cancer: a cross-sectional study. Frontiers in Public Health. 2024;Volume 12 - 2024. doi:10.3389/fpubh.2024.1420306

8. Yahya F, Yusoff A, Talib AT, Darshan Singh SS, Mohad AH, Mohd Isa NA, Ahmad Khiri MJ. Attachment styles and marital quality between spouses. Journal of Cognitive Sciences and Human Development. 2021;7(1):57-71. doi:10.33736/jcshd.2876.2021

9. Krok D, Telka E, Moroń M. Dyadic effects of attachment on illness acceptance in patients with breast cancer and spousal caregivers: sense of coherence as a mediator. Journal of Clinical Medicine. 2024;13(21). doi:10.3390/jcm13216425

10. Karveli S, Galanis P, Mitropoulou EM, Karademas E, Markopoulos C. The role of attachment styles on quality of life and distress among early-stage female breast cancer patients: A systematic review. Journal of Clinical Psychology in Medical Settings. 2023;30(4):724-739. doi:10.1007/s10880-023-09940-w

11. Tao L, Lv J, Tan X, Hu X, Fu L, Li J. Relationships between attachment style, emotional self-disclosure, and quality of life among young breast cancer survivors: A cross-sectional study. Seminars in Oncology Nursing. 2024;40(1):151526. doi:10.1016/j.soncn.2023.151526

12. Mardani M, Marashi SA, Abbaspour Z. On the causal relationship between attachment styles and marital satisfaction: Mediating role of Gottman's marital communication model. Iranian Journal of Psychiatry and Behavioral Sciences. 2021;15(2):e108339. doi:10.5812/ijpbs.108339

13. Shafique A, Yousaf K, Irfan A. Marital satisfaction and quality of life among married women: Moderating role of attachment styles. Bahria Journal of Professional Psychology. 2023;22(2):27-42.

14. Bretaña I, Alonso-Arbiol I, Kittel K, Ubillos-Landa S. “I can't escape!”: Avoidantly attached individuals' conflict resolution and relationship satisfaction before and during the COVID-19 lockdown. PsyCh Journal. 2023;12(3):430-442. doi:10.1002/pchj.646

15. Chen X, Dong C, Zhuang Y, Lu L, Lu P, Li Y, et al. The role of empathy and emotional regulation self-efficacy in adult attachment type and marital adjustment in breast cancer patients-a moderated mediation model. Psychology, Health & Medicine. 2025;30(5):897-913. doi:10.1080/13548506.2024.2430860

16. Philipp R, Mehnert-Theuerkauf A, Koranyi S, Härter M, Vehling S. The role of attachment avoidance: A longitudinal mediation model predicting existential distress in patients with advanced cancer. Psycho-Oncology. 2021;30(7):1059-1067. doi:10.1002/pon.5640

17. Vasquez-Salcedo MZB, Natividad MJ. Emotional intelligence, attachment style, and marital satisfaction among married employees. Journal of Interdisciplinary Perspectives. 2025;3(2):56-73. doi:10.69569/jip.2024.0474

18. Bacık Yaman G, Kayıkçıoğlu E, Hocaoğlu Ç. Cancer patients' attachment styles in the first year after diagnosis: The impact of perceived stress and emotion regulation skills. Psychiatry and Clinical Psychopharmacology. 2025;35(1):22-30. doi:10.5152/pcp.2025.24948

19. Kline RB. Principles and practice of structural equation modeling: Guilford publications. 2023.

20. Busby DM, Crane DR, Larson JH, Christensen C. A revision of the Dyadic Adjustment Scale for use with distressed and nondistressed couples: Construct hierarchy and multidimensional scales. Journal of Marital and Family Therapy. 1995;21(3):289-308. doi:10.1111/j.1752-0606.1995.tb00163.x

21. Yoosefi N. Investigation of Psychometric Properties of the Revised Dyadic Adjustment Scales (RDAS). Research in Clinical Psychology and Counseling. 2012;1(2):183-200. [Persian] doi:10.22067/ijap.v1i2.9534

22. Collins NL, Read SJ. Revised Adult Attachment Scale (Collins, 1996). Available from: https://labs.psych.ucsb.edu/collins/nancy/UCSB_Close_Relationships_Lab/Resources_files/Adult%20‎Attachment%20Scale.doc

23. Pakdaman Sh. Examining the relationship between attachment and sociability in adolescents. Journal of Psychological Science. 2007;3(9):25-47. [Persian]

24. Lester D. The collett-lester fear of death scale: The original version and a revision. Death Studies. 1990;14(5):451-468. doi:10.1080/07481189008252385

25. Naderi F, Esmaili E. Collet-Lester fear of death scale validation and gender-based comparison of death anxiety, suicide ideation and life satisfaction in university students. Journal of Applied Sciences. 2009;9(18):3308-3316. doi:10.3923/jas.2009.3308.3316

26. Luz Patricia DH, Luz Stella BR, Julita S, Martha Patricia BB, Myriam Patricia PT, Mildred RO, Myriam EM. Marital adjustment, depression and quality of life of women with breast cancer and their intimate partners. European journal of oncology nursing : the official journal of European Oncology Nursing Society. 2025;74:102765. doi:10.1016/j.ejon.2024.102765

27. McPherson CJ, Devereaux A. A dyadic examination of patients' and caregivers' attachment orientations and mutually supportive care in cancer caregiving. Psychooncology. 2024;33(1):e6256. doi:10.1002/pon.6256

28. Suleimanian Z, Tamannaeifar MR. The relationship between attachment styles with psychological distress women with breast cancer with mediating role of self-efficacy and resilience. Women's Studies Sociological and Psychological. 2024;22(3):146-179. [Persian] doi:10.22051/jwsps.2024.46873.2865

29. Abadian K, Tavassoli A. The impact of death anxiety on the quality of life of iranian women with breast cancer, mediated by life expectancy. Illness, Crisis & Loss. 2025;0(0). doi:10.1177/10541373251330009

30. Bulut MB. Relationship Between attachment and fear of death: The mediating role of religious coping. Omega (Westport). 2025;91(3):1437-1457. doi:10.1177/00302228231157133

31. Eilert DW, Buchheim A. Attachment-Related Differences in Emotion Regulation in Adults: A Systematic Review on Attachment Representations. Brain sciences. 2023;13(6). doi:10.3390/brainsci13060884

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Jafarizadeh F, Keshavarz S, Mirani A, abdollahzadeh H. The relationship between attachment styles and marital quality in women with breast cancer: The mediating role of death anxiety. EBNESINA 2025; 27 (3) :43-54
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