International Journal of Behavioral Sciences

International Journal of Behavioral Sciences

Investigating the Effect of Attachment Styles on the Level of Perceived Anxiety and Stress in Women with Polycystic Ovary Syndrome with the Moderating Role of Defense Mechanisms

Document Type : Original Article

Authors
1 Department of Psychology, Faculty of Medicine, Shiraz Branch, Islamic Azad University, Shiraz, Fars, Iran
2 Department of Psychology, Mohaghegh Ardebili University, Ardebil, Iran
3 Training and Counseling Department, Central Tehran Branch, Islamic Azad University, Tehran, Iran
4 Department of Psychology, Exceptional Children Education, University of Tehran, Tehran, Iran
5 Department of Psychology, Quchan Branch, Islamic Azad University, Quchan, Iran
Abstract
Introduction: This study investigates the influence of attachment styles on perceived anxiety and stress levels in women with Polycystic Ovary Syndrome (PCOS), considering the moderating effect of defense mechanisms. PCOS, a hormonal imbalance, can cause physical changes and other complications, potentially affecting the mental health of women.
Method: This cross-sectional, descriptive-correlational study used structural equation modeling and path analysis to examine female patients with PCOS attending women's treatment clinics in Tehran in 2022. A sample of 152 women was selected using purposive sampling. Research instruments included the Revised Adult Attachment Scale (RAAS), Beck Anxiety Inventory (BAI), Perceived Stress Questionnaire (PSQ), and Defense Style Questionnaire (DSQ-40). Descriptive statistics and moderation analysis were carried out with Jamovi software version 2.4, while SmartPLS software version 4 was used for path analysis. The p-value of 0.05 was established for this study.
Results: Findings revealed that avoidant attachment style significantly reduced stress (β=0.19, P=0.012) but not anxiety (β=0.18, P=0.057). Immature defensive style significantly reduced stress (β=0.50, P=0.0001) and moderated the relationship between both avoidant (β=0.32, P=0.013) and secure (β=-0.25, P=0.036) attachment styles and anxiety.
Conclusion: This research suggests that women with PCOS experience higher stress levels when displaying avoidant attachment and immature defense mechanisms. Conversely, secure attachment can mitigate anxiety, even with inadequate defense mechanisms. These findings may inform the development of psychological interventions to reduce stress and anxiety in this population.
Keywords

  1. Mondal, S., A. Chakraborty, and K. Pramanick, Natural Compounds and Biogenic Nanoparticles in Treatment of Polycystic Ovarian Syndrome, in Plant Derived Bioactive Compounds in Human Health and Disease. 2025, CRC Press. p. 206-222.
  2. Joham, A.E., et al., Polycystic ovary syndrome. The lancet Diabetes & endocrinology, 2022. 10(9): 668-680. 10.1016/S2213-8587(22)00163-2.
  3. Hadipour, S., et al., The Effects of Cinnamon on Metabolic and Hormonal Status of Women With Polycystic Ovary Syndrome: A Randomized Controlled Trial. Journal of Client-Centered Nursing Care, 2025. 11(1): 55-66. https://doi.org/10.32598/JCCNC.11.1.626.
  4. Yadav, S., et al., Direct economic burden of mental health disorders associated with polycystic ovary syndrome: Systematic review and meta-analysis. Elife, 2023. 12: e85338. https://doi.org/10.7554/eLife.85338.
  5. Ott, J. and M. Hager, Scientific Progress in Polycystic Ovary Syndrome: Little by Little. 2025, MDPI. 200. https://doi.org/10.3390/jcm14010200.
  6. Floyd, R., et al., A prospective study of antenatal anxiety and depression in pregnant women with polycystic ovary syndrome. Irish Journal of Psychological Medicine, 2024: 1-5. https://doi.org/10.1017/ipm.2024.56.
  7. Lin, H., et al., The prevalence and factors associated with anxiety-like and depression-like behaviors in women with polycystic ovary syndrome. Frontiers in psychiatry, 2021. 12: 709674. https://doi.org/10.3389/fpsyt.2021.709674.
  8. Nasiri-Amiri, F., et al., Depression and anxiety in adolescents and young women with polycystic ovary syndrome: a systematic review and meta-analysis. International Journal of Adolescent Medicine and Health, 2023. 35(3): 233-242. https://doi.org/10.1515/ijamh-2022-0065.
  9. Salajegheh, Z., et al., Mindfulness-based stress reduction (MBSR) effects on the worries of women with poly cystic ovary syndrome (PCOS). BMC psychiatry, 2023. 23(1): 185. https://doi.org/10.1186/s12888-023-04671-6.
  10. Balikci, A., et al., Depression, anxiety, and anger in patients with polycystic ovary syndrome. Nöro Psikiyatri Arşivi, 2014. 51(4). 328. 10.5152/npa.2014.6898.
  11. Solskyy, V., et al., SPECIFICS OF AUTONOMIC REGULATION, PERCEIVED STRESS, AND ANXIETY IN INTERNALLY DISPLACED WOMEN WITH POLYCYSTIC OVARY SYNDROME (PCOS) WITHOUT OBESITY. Fertility and Sterility, 2023. 120(4): e80. https://www.fertstert.org/article/S0015-0282(23)01512-1/fulltext.
  12. Simon, S., et al., Psychological distress in women with polycystic ovary syndrome: The role of attachment and coping. Psychology, health & medicine, 2021. 26(6): 735-744. https://doi.org/10.1080/13548506.2020.1754436.
  13. Blake, J.A., et al., Does attachment anxiety mediate the persistence of anxiety and depressive symptoms from adolescence to early adulthood? Social psychiatry and psychiatric epidemiology, 2025. 60(2): 453-461. https://doi.org/10.1007/s00127-024-02737-8.
  14. Nickol, L., Ambulatory Measurements of the Relation between Insecure Attachment Style and Stress: A Systematic Literature Review. 2024: . http://gmwpublic.studenttheses.ub.rug.nl/id/eprint/4385.
  15. Gallistl, M., et al., Relationship as resource or burden? Associations of attachment style, relationship quality and dyadic coping with acute psychosocial stress in the presence of the romantic partner. bioRxiv, 2024: 2024-10. https://doi.org/10.1101/2024.10.21.618832.
  16. Shikanai, N., The Relationships between Adolescent Attachment Style, Anxiety, and Psychological Competitive Ability in Japanese Ballet Students. Anxiety, and Psychological Competitive Ability in Japanese Ballet Students, 2024: http://dx.doi.org/10.2139/ssrn.5042723.
  17. Tang, Q. and J. Peng, Research on the Influence of Different Psychological Defense Mechanisms on the Psychology of Students. Journal of Contemporary Educational Research, 2022. 6(5): p. 14-20. 10.26689/jcer.v6i5.3902.
  18. Mirmabini, S.B., et al., Relationship between Attachment Styles in Childhood and Emotional Disorders in Adolescence: A Structural Model for the Mediating Role of Identity and Defense Mechanisms. Journal of health research in community, 2021. 7(3): p. 65-77. http://jhc.mazums.ac.ir/article-1-588-fa.html.
  19. Di Giuseppe, M., et al., Stress, burnout, and resilience among healthcare workers during the COVID-19 emergency: the role of defense mechanisms. International journal of environmental research and public health, 2021. 18(10): 5258. https://doi.org/10.3390/ijerph18105258.
  20. Mohammadi, M., S. Sodagar, and M. Bahrami Hidchi, The mediating role of defense mechanisms in predicting perceived stress based on attachment styles in patients with COVID-19. Journal of Psychological Studies, 2022. 18(1): 69-81. 10.22051/PSY.2022.36951.2486.
  21. Cohen, J., Statistical power analysis for the behavioral sciences. 2013: routledge.
  22. Collins, N.L., Revised adult attachment scale. Behavior therapy, 1996: p. https://psycnet.apa.org/doi/10.1037/t19162-000.
  23. Mehmannavazan, A., M. Aliakbaridehkordi, and A. Kakojoybari, Impact of attachment styles, family cohesion and adaptability on the level of resiliency as it relates to the feeling of homesickness among freshman students living in dormitories of alZahra university. Women's Studies Sociological and Psychological, 2015. 12(4): 173-204. https://doi.org/10.22051/jwsps.2015.1499.
  24. Beck, A.T., G.K. Brown, and R.A. Steer, Psychometric characteristics of the Scale for Suicide Ideation with psychiatric outpatients. Behaviour research and therapy, 1997. 35(11): 1039-1046. https://doi.org/10.1016/S0005-7967(97)00073-9.
  25. Balouch, V., et al., Stress, Anxiety and Depression Status in the Population of Southern Sistan and Baluchestan Province (Coastal Area) in the COVID-19 Epidemic in. Journal of Marine Medicine, 2021. 2(4): 226-36. https://sid.ir/paper/383402/fa.
  26. Cohen, S., T. Kamarck, and R. Mermelstein, A global measure of perceived stress. Journal of health and social behavior, 1983: p. 385-396. https://www.jstor.org/stable/2136404.
  27. Khalili, R., et al., Validity and reliability of the Cohen 10-item Perceived Stress Scale in patients with chronic headache: Persian version. Asian journal of psychiatry, 2017. 26: 136-140. https://doi.org/10.1016/j.ajp.2017.01.010.
  28. Andrews, G., M. Singh, and M. Bond, Defense Style Questionnaire--40. Journal of Nervous and Mental Disease, 1993: https://doi.org/10.1037/t20765-000.
  29. Bita, M. and R. Jafariharandi, Predicting of life satisfaction in terms of personality traits and defense mechanisms. Women's Studies Sociological and Psychological, 2018. 16(1): 111-150. https://doi.org/10.22051/jwsps.2018.20570.1752.
  30. Khorrami, M., et al., Prediction of Coronavirus anxiety based on attachment styles, resilience, and life expectancy in drug users. Modern Care J, 2022. 19(1): https://doi.org/10.5812/modernc-121174.
  31. El-Ashry, A.M., N.K. Abd El Fatah, and E.A. Abdelhamid, Harmony found: Serenity's crucial role in alleviating death anxiety through attachment styles among community-dwelling older adults. Geriatric Nursing, 2024. 58: 247-254. https://doi.org/10.1016/j.gerinurse.2024.05.035.
  32. Khakpoor S, K.K.A., Hassanzadeh R, Asadi J. , The mediating role of early maladaptive schemas in the relationship between attachment styles and defense mechanisms with a positive response to stress in flooded married women in Aq Qala. psychological science, 2023. 21(119): 2249-68. 10.52547/JPS.21.119.2249.