The Association between Attachment Avoidance and Quality of Life in Bariatric Surgery Candidates

Objective: Patients presenting for bariatric surgery have high rates of psychiatric co-morbidity and reduced health-related quality of life (HRQOL) compared to the general population. In this study, we aimed to determine the relationship between insecure attachment styles and HRQOL in bariatric surgery candidates. Methods: We assessed depression, social support, attachment avoidance, attachment anxiety, HRQOL (SF-36), and eating disorder psychopathology in 70 consecutive patients assessed for bariatric surgery. SF-36 physical (PCS) and mental component scores (MCS) were compared to a normative sample and analyzed using t-tests. Predictors of HRQOL were analyzed using multiple linear regression analyses. Results: SF-36 PCS and MCS in this pre-bariatric surgery sample were significantly lower than in an age-matched reference population. Depression, attachment anxiety, attachment avoidance and eating disorder psychopathology scores were negatively correlated with SF-36 MCS. Depression was associated with lower SF-36 PCS (p = 0.015). SF-36 MCS were significantly predicted by BDI scores (p < 0.001) and attachment avoidance (p = 0.024) in our multiple regression model. Conclusion: This is the first study to demonstrate an association between attachment avoidance and poor mental HRQOL in bariatric surgery candidates. Future studies are needed to examine the effect of attachment avoidance on post-bariatric surgery outcomes.