The role of attachment and parental bonding in the psychosocial assessment of transplant candidates: a cross-sectional study.

Background: Kidney transplant involves profound psychological, relational, and social changes for both the patients and their family context. Occasionally, the family or social support can be deemed "dysfunctional" as it fails to fully comprehend the patient's needs and requirements. Attachment style, which pertains to the motivation to seek proximity and care in relationships with caregivers, has a significative role in the social support system for transplant, therapeutic adherence, and maintenance of the transplanted organ. We sought to assess attachment styles among patients awaiting transplantation using psychosocial measures in order to study their impact on psychopathology, quality of life, and transplant eligibility.

Methods: Eighty-five patients with chronic kidney disease awaiting transplantation were recruited at the Italian Transplant Center and were administered the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT), the Attachment Style Questionnaire (ASQ), the Parental Bonding Instrument (PBI), the Short Form Health Survey-36 (SF-36), and the Middlesex Hospital Questionnaire (MHQ). Measures were entered in blocks in a stepwise multiple regression.

Results: The SIPAT score was significantly associated with key psycho-physical constructs. SIPAT was negatively predicted by maternal care (β = -.35, p = .001), secure attachment (i.e., confidence) (β = -.23, p = .029), and general physical health (β = -.25, p = .016) - which could be considered protective factors for transplant suitability. Conversely, anxiety symptoms were positively associated with SIPAT (β = .32, p = .001) and may serve as a risk factor for post-transplant issues.

Conclusions: These findings highlight that in the evaluation of kidney transplant candidates, greater attention should be paid to parental bonding, adult attachment, and psychopathological symptoms, as these factors may play a key role as protective or risk factors for post-transplant issues. A timely assessment of these constructs may improve the evaluation of psychosocial suitability for transplantation, as well as allow the provision of targeted psychotherapeutic interventions to enhance the acceptance and management of illness in patients awaiting kidney transplants.