Is attachment style a source of resilience against ... - ResearchGate

Is attachment style a source of resilience against ... - ResearchGate


Social Science & Medicine 64 (2007) 765–775

Is attachment style a source of resilience against health

inequalities at work?

Mel Bartley , Jenny Head, Stephen Stansfeld

University College London, London, UK

Available online 28 November 2006


The argument that ‘indirect selection’ is a contributory factor to health inequality has included ideas about personal

characteristics that may originate in childhood and increase the likelihood of both poor health and disadvantaged social

position in adulthood. The concept of protective resilience makes a similar but converse argument: that positive

characteristics acquired at one phase of life may enable individuals to withstand later adversity. The increasing richness of

data from longitudinal studies now allows us to examine these processes more closely over a longer period of life. In this

paper we show that attachment style, a psychological characteristic thought to be associated with the style of parenting

encountered during early childhood, may act as a source of resilience in the face of educational disadvantage. Men in midlife

who were not burdened with anxious or avoidant attachment styles seem to have been more likely to overcome the

disadvantage of a lower level of educational attainment and progress up the ladder of Civil Service grades in the English

Whitehall II study. As it is not strongly related to parents’ social class, it can be argued that attachment style has acted as a

source of upward social mobility which is also likely to reinforce better health in later life.

r 2006 Elsevier Ltd. All rights reserved.

Keywords: Social inequalities in health; Attachment style; Resilience; Social mobility; Whitehall II study; UK


Recent changes in social policy towards young

children, such as the setting up in Great Britain of

the ‘Sure Start’ schemes to support parents of young

children in deprived areas, have reflected a growing

acceptance of the importance of life-course processes.

Evidence has accumulated that experiences

in early life may, in the words of the Black Report,

‘‘cast long shadows forward’’ onto the health and

Corresponding author. Tel.: +44 207 679 1707;

fax: +44 207 813 0280.

E-mail addresses: (M. Bartley), (J. Head),

(S. Stansfeld).

well-being of adults. Theories regarding the influence

of childhood conditions and experiences for

later health have included ideas about the possible

joint effects of parental care on later personality and

adult social position (Glendinning, Shucksmith, &

Hendry, 1997; Haavet, Saugstad, & Straand, 2005;

Stewart-Brown, Fletcher, & Wadsworth, 2005).

This idea has been termed ‘indirect health selection’,

that is, a process through which early life conditions

may constitute a ‘confounder’ of the relationship

between adult social position and health. In this

model, early experiences, through their effect on

personal characteristics such as coping styles or

locus of control might strongly influence both

educational and career success, and thereby social

0277-9536/$ - see front matter r 2006 Elsevier Ltd. All rights reserved.




M. Bartley et al. / Social Science & Medicine 64 (2007) 765–775

position, as well as health behaviours in adulthood,

and thereby health (Berglund et al., 1996; Mackenbach,

2005; van de Mheen, 1998). The apparent

link between social position and health, the ‘health

gradient’ in adults, would, in this perspective, be

something that had its origins far earlier.

Sweeting and West proposed a mechanism of this

kind by raising the question of ‘‘a role for family

culture in the health inequalities debate’’ (Sweeting

& West, 1995). This paper was based on data from

the West of Scotland 20-07 study’s youngest cohort,

aged 15 in 1997 (West, Macintyre, Annandale, &

Hunt, 1990). It argued that ‘‘the role of the family in

relation to health inequalities has been largely

ignored’’(Sweeting & West, 1995, p. 171). Their

measures of family-centredness and family conflict

when cohort members were aged 15 were found to

be significantly related to measures of physical and

psychological health, self esteem, and to the likelihood

that, by the age of 18, a young person would

be in further or higher education rather than

unemployed or in a government training scheme

or unskilled employment. Equally important was

their finding that material deprivation in the

household was of lesser importance than these

aspects of family relationships for either self esteem

or health as measured at age 15 and 18. In this way,

the study points towards a lifecourse process in

which relationships in childhood may, independently

of material factors, influence both the

development of personal characteristics such as self

esteem, and the attainment of social position in

adulthood. Although a great deal more work in

social epidemiology since that time has been

concerned with the life course, family function and

its consequences for personal characteristics in

adulthood might still be regarded as somewhat

under-investigated. Another Scottish study produced

interesting findings in this respect during the

1990s (Glendinning, Hendry, & Shucksmith, 1995;

Glendinning, Love, Hendry, & Shucksmith, 1992;

Glendinning et al., 1997). More recently, a Norwegian

study found a strong effect of aspects of family

culture on health in adolescents (Haavet et al.,

2005), and several studies have now addressed the

possibility that psychological characteristics emerging

during childhood may play a role in adult

health, and thereby in health inequality (Balkrishnan,

1998; Stewart-Brown et al., 2005; Whalley &

Deary, 2001). However most of these studies regard

‘adverse’ personal characteristics such as hostility or

neuroticism as part of an aetiological pathway in

which socio-economic disadvantage in the family of

origin is associated with both social and health

disadvantage during adult life. Few studies ask

whether there might be characteristics arising from

family relationships, independently of material

circumstances, that may act as sources of resilience

in that they increase the likelihood of both a more

advantaged socioeconomic position and better

health in adulthood.

One psychological theory relevant to the processes

at work behind observed associations between

family relationships in childhood and later

life health and well-being that has received more

attention in the years since Sweeting and West’s

study is known as attachment theory (Ainsworth,

Blehar, Waters, & Wall, 1978; Fonagy, 2001; Gil &

Rupprecht, 2003). These ideas have their foundation

in the work of Bowlby, a psychoanalyst who

studied the consequences of children having been

separated from their parents, for example during

spells in hospital and during the World War II

evacuations (Bowlby, 1982; Main, 1996). One

consequence of his work, as is well known, was a

complete change of policy regarding parental

visiting rights in the children’s wards of hospitals.

Before Bowlby’s work, it had been thought that

parental visits caused distress to children, and that it

was better for young patients to become resigned to

their separation from their families. Bowlby’s

research showed, however, that the passive resignation

often seen in children during spells in hospital

(which, in that period of epidemiological history,

the 1940s and 1950s, were often prolonged), was

more likely to be a sign of serious psychological

damage than of children’s philosophical acceptance

of the situation.

More generally, Bowlby regarded family functioning

as having great importance for the eventual

adult, as did other psychoanalysts. He was the

founder of the idea that a developing person needs a

‘secure base’ from which to venture forth into the

wider world (Waters, Crowell, Elliott, Corcoran, &

Treboux, 2002). The concept of attachment was

later explored by Ainsworth and her colleagues in

the form of the ‘strange situation’ test. In these

experiments, very young children were briefly

separated from their caretakers (usually their

mothers), and their behaviour on being re-united

was carefully observed. Behaviour seemed to fall

into three major types. Children who were securely

attached ran back happily into the caretaker’s arms.

Other children showed patterns of behaviour in


M. Bartley et al. / Social Science & Medicine 64 (2007) 765–775 767

which some would resist being picked up and

cuddled at first, or avoid looking at the caretaker,

appear totally indifferent, or show in quick succession

an apparently disorganised combination of

these three types of reaction. In longitudinal

research, these different patterns of attachment

behaviour have been found to be associated with

later adult behaviour, including ways of relating to

children of one’s own (Green & Goldwyn, 2002;

Hesse & Main, 1999; Main, 1996; Massie &

Szajnberg, 2002).

Research on patterns of infant attachment and

their adult sequelae form just one part of the field of

developmental psychopathology, which has been

described as ‘‘the consideration of the abnormal and

healthy together, with particular attention to risk

and resilience factors influencing the course of

development’’ (Main, 1996, p. 241). This research

programme fits into the emerging field of life-course

social epidemiology in a number of important ways

(Hertzman & Power, 2003; Tremblay, 1999). The

most significant of these, for the purposes of the

present analysis, is the way in which developmental

psychopathology (despite its name) considers ‘resilience

as well as ‘risk’ (Main, 1996; Fergus &

Zimmerman, 2005; Schoon, 2006; Werner, 2004). In

this way it differs from much life-course epidemiology

which has tended to focus on accumulating

patterns of risk (Bartley & Plewis, 2002; Brunner,

Shipley, Blane, Smith, & Marmot, 1999; Galobardes,

Lynch, & Davey Smith, 2004; Power &

Matthews, 1997; Singh-Manoux, Ferrie, Chandola,

& Marmot, 2004).

Theoretically it is expected that styles of attachment

develop from early relationships with mother

and father and are maintained into adult life.

Attachment styles developed in childhood have

been shown to be associated in adults with a range

of outcomes (Droomers, Schrijvers, Casswell, &

Mackenbach, 2003; Scharf, Mayseles, & Kivenson-

Baron, 2004; Schmidt, Nachtigall, Wuethrich Martone,

& Strauss, 2002; Waller, Scheidt, & Hartmann,

2004). In general, this research has

concentrated on relationships between attachment

styles and adult mental health (Bifulco, Moran,

Ball, & Bernazzini, 2002; Irons & Gilbert, 2005) or

relationships (Bifulco, Moran, Ball, & Lillie, 2002),

for example with spouses, children (Priel & Besser,

2001) and caretakers of those who are ill ( Maunder

et al., 2006; Waller et al., 2004). Secure attachment

is seen in this perspective as a possible ‘resilience

factor’, emerging early in life, which may protect

individual wellbeing in the face of risk and

adversity, because it is regarded as reflecting the

ability to effectively regulate and mitigate the

strength of emotional responses to adverse personal

or health events.

The inclusion of a short validated questionnaire

on attachment style in the Whitehall II study gives

data on a relatively large sample of the adult

working population, which also includes extensive

information on education, health, and career

attainment within the civil service over a 20-year

period. Because attention in the developmental

literature has been on psychological risk, less

attention has been paid to the possibility that

attachment style might function as a source of

resilience that would come into play in the face of

social adversities encountered during schooling, or

as part of the transition to adulthood or the work

career. Sweeting and West do not set their study

within the attachment or resilience perspectives. But

they show it is plausible that positive family

function might have been associated with more

favourable later outcomes independently of socioeconomic

circumstances, in part, by conferring

resilience to less materially advantaged children.

According to the literature on resilience, a

protective resilience factor is one whose importance

is greatest in the face of adversity. If attachment

style is acting as a source of resilience, it will not

necessarily be related to Civil Service grade in any

simple fashion, but rather will have greater importance

for career mobility in the Civil Service for

those who entered the service with some degree of

relative educational disadvantage. The reasoning

behind the hypothesis is that for those following a

‘straight road’ through life with an accumulation of

advantages, the aspects of psychological functioning

measured by the attachment scale may not be

significant factors for career success. For those with

a less privileged life course, however, advancement

in a complex organisation may be more dependent

on the kind of personal and social skills thought to

be prominent in those who are ‘securely attached’.

These have been enumerated to include being

comfortable exploring new situations, having low

levels of hostility, and being able to ask for and

make use of help from others (Shaver & Mikulincer,

2002), and ‘‘able to maximize the opportunities

presented to them by the environment’’ (Fonagy,

2005). In this paper, we examine whether attachment

style in adults is more importantly associated

with occupational attainment in adults with less



M. Bartley et al. / Social Science & Medicine 64 (2007) 765–775

advantaged earlier life histories, as reflected in their

educational attainment.

Data and methods

Study population

The Whitehall II Study was set up in England to

investigate the degree and causes of the social

gradient in morbidity and mortality

A cohort of civil servants was

established between 1985 and 1988 (Phase 1). All

male and female civil servants aged between 35 and

55 years, in 20 London-based civil service departments,

were sent an introductory letter and a

screening questionnaire and attended a screening

examination. The overall response rate was 73%

(74% for men and 71% for women). The true

response rates are likely to be higher, however,

because around 4% of those on the list of employees

had moved before the study and were not eligible

for inclusion. Altogether 10,308 civil servants were

examined—6,895 men and 3413 women. After the

initial participation of Phase 1 there have been an

additional seven phases of data collection. This

paper deals with data collected at Phase 1 which

took place during 1985–1987 (education) and Phase

5 which took place between 1997 and 1999

(attachment and Civil Service grade) when study

participants were aged 47–67.


Three styles of attachment are usually described:

secure, anxious/ambivalent (also called preoccupied

or fearful) and avoidant (also called dismissing).

There is, however, evidence of important differences

between avoidant and dismissing styles: Bartholomew

(1990) found a distinction between dismissing

individuals who avoid attachment because they do

not value it and fearful individuals who long for

attachment but avoid intimacy for fear of rejection.

For inclusion in the Whitehall II study, a reliable

self-report measure of attachment style that was

feasible for use in large epidemiological studies and

had some track record of being used in large-scale

studies was needed. An adapted version of the

Hazan and Shaver attachment style measure,

distinguishing four attachment styles, was therefore

included at Phase 5 of the study in 1997–1999

(Hazan & Shaver, 1987). This measure, drawing on

the concept of individual differences in infant

attachment patterns, comprises four groups of

statements measuring secure attachment style,

anxious/ambivalent attachment style, avoidant attachment

style, and dismissing attachment style.

The statements are:

It is easy for me to become emotionally close to

others. I am comfortable depending on them and

having them depend on me. I don’t worry about

being alone or having others not accept me


I am uncomfortable getting close to others. I

want emotionally close relationships, but I find it

difficult to trust others completely, or to depend

on them. I worry that I will be hurt if I allow

myself to become too close to others [avoidant]

I want to be completely emotionally intimate

with others, but I often find others are reluctant

to get as close as I would like. I am uncomfortable

being without close relationships, but I

sometimes worry that others don’t value me as

much as I value them. [anxious/ambivalent]

I am comfortable without close emotional

relationships. It is very important to me to feel

independent and self-sufficient, and I prefer not

to depend on others or have others depend on me


For each group of statements, participants were

asked to score the statements between 0 and 100

where 100 meant that ‘‘the statement describes me

exactly’’ and 0 describes ‘‘the complete opposite to

me’’. Attachment style is conceptualised to have

quite a high degree of stability. In earlier studies

70% of individuals identified the same attachment

style across a 4-year interval (Hazan & Shaver,

1987). In another study using the same adapted

scale, the kappa was 0.48 for agreement with the

Revised Adult Attachment Scale (Stein et al, 2002).

In terms of validity the attachment groups were

related in a predicted fashion with marital status:

the proportion with a secure attachment style was

lower in single men and women compared to

married, divorced, separated and widowed groups.

Anxious attachment was more frequent in single

and divorced men and women, while avoidant

attachment was more frequent in divorced, separated

men and women. Dismissing style was more

frequent in single men and single, divorced separated

and widowed women (Stansfeld, Head,

Bartley, & Fonagy, 2006).


M. Bartley et al. / Social Science & Medicine 64 (2007) 765–775 769


Education was included in the Phase 1 questionnaire

when participants were aged 35–55. The

variable used here combines two questions: on the

age at which the participant finished full time

education and on the last type of educational

establishment they attended. This was coded 1

(lowest) for those who left full time education at

age 18 or before, 2 for those who stayed in

education beyond age 18 but did not acquire a

degree, and 3 (highest) for those who left full time

education later than age 18 having gained a degree,

or a nursing or teaching qualification.

Parental social class

Social class of the parents was classified according

to the Registrar-General’s schema (RGSC). This

classification was used in British official statistics up

to the time of the Census of 2001. It was based in

part on prestige (‘general standing in the community’)

and in part on the approximate skill level

thought to be required for the occupations in each

class. Because social class defined in this way is

known to be strongly associated with income, in this

analysis it is included as a measure of the material

living standards experienced by study participants

during their childhood.

Grade of employment

The Civil Service identifies 12 non-industrial

grades on the basis of salary and the type of work

carried out. To investigate the distribution of

attachment style by grade we used a broader

categorisation of employment grade: administrative,

professional/executive, clerical/support.

Four thousand eight hundred and thirty-six men

and 2013 women participants gave usable data in

response to the attachment questionnaire. There

were no missing data on Civil Service grade in these

participants; data on parental social class were

missing in1484 men and 695 women, and data on

educational level were missing in 1223 men and 540



Table 1 shows the distribution of attachment style

according to gender, social origins (paternal social

class), present social position at Phase 5 of the

Whitehall II study, measured as Civil Service

employment grade, and educational level in this

sample of employed adults. There is perhaps

surprisingly little difference between men and

women: a slightly higher prevalence of secure or

dismissive styles in men and slightly more anxious

attachment in women. The relationship between

attachment styles and parental social class was

examined, in order to test for a relationship between

material circumstances in childhood and adult

attachment, but this relationship was found to be

weak and non-significant. The relationship between

attachment style and current Civil Service grade was

also examined, and was found to be weak in both

men and women. Childhood material circumstances

in themselves did not therefore appear to be

strongly related to attachment style in middle age

in this cohort, and are not further considered.

Although the relationship between parental social

class and attachment was weak parental social class

was strongly related to educational attainment in

Whitehall II study participants, as it is in all other

studies. Material circumstances in childhood are

therefore seen to have far more importance for

educational success than for adult attachment style,

and any relationship of attachment style to later

career attainment will not act directly through this

pathway (Table 2).

Table 3 shows the relationship of educational

attainment to Civil Service grade attained by Phase

5 of the study. It can be seen that taking participants

as a whole, it was unusual for a man (17.6%) and

even more unusual for a woman (0.5%) to reach the

higher grades of the Civil Service. The very small

numbers of women in the highest employment

grades makes it impossible to investigate the role

of attachment style as a source of resilience in the

work career any further.

Table 4 addresses the question of whether

attachment style may act as a source of ‘protective

resilience’ in the work career of male participants in

the Whitehall II study. The small number of

women, especially in the higher grades, means that

there is not sufficient power to replicate these

models in women. The table shows four separate

logistic regression models. In Model 1, the relationship

of education to the likelihood of being in the

higher Civil Service grades is shown, adjusted

only for age. Model 2 shows that the relationship

of attachment style to Civil Service grade in

men is no longer significant after adjustment for

age. These models replicate Tables 2 and 3, but have



M. Bartley et al. / Social Science & Medicine 64 (2007) 765–775

Table 1

Attachment style by social origins (father’s social class), education and gender

Attachment style

Secure (%) Dismissive (%) Avoidant (%) Anxious (%) N

Father’s social class


Men 45.8 33.4 8.0 12.9 1394

Women 42.8 34.1 7.7 15.4 505


Men 47.3 35.0 6.5 11.1 1620

Women 43.5 34.0 7.3 15.1 641

Semi or unskilled

Men 45.9 37.9 5.3 10.9 338

Women 48.8 29.7 7.6 14.0 172


Men 1484

Women 695

Men, women n.s.



Men 49.7 33.4 5.3 11.6 958

Women 47.5 32.8 6.7 13.0 640


Men 47.5 33.8 7.5 11.3 924

Women 42.7 36.6 7.3 13.4 358


Men 44.3 35.3 7.5 12.9 1731

Women 41.1 31.2 8.0 19.8 475


Men 1223

Women 540

Men p ¼ 0.08, women p ¼ 0.02

Civil service grade


Men 47.8 34.5 6.6 11.1 2017

Women 42.5 35.7 7.5 14.3 294


Men 46.1 33.5 7.3 13.1 2520

Women 44.4 32.3 6.8 16.4 900


Men 40.1 37.8 9.4 12.7 299

Women 45.5 33.0 6.8 14.7 819

Men p ¼ 0.06, women p ¼ 0.86

All with valid attachment scores

Men 56 34 7 12 4836

Women 45 33 7 15 2013

Men, women p ¼ 0.006


M. Bartley et al. / Social Science & Medicine 64 (2007) 765–775 771

Table 2

Relationship between paternal social class and educational

attainment level

Educational attainment

Low Inter-mediate High N

Paternal social class

Professional or management

Men 14.1 23.9 62.0 1393

Women 21.4 22.8 55.8 504

Skilled intermediate non manual or manual

Men 33.4 27.0 39.6 1618

Women 53.6 25.3 21.1 640

Semi or unskilled manual

Men 45.6 21.9 32.5 338

Women 66.9 21.5 11.6 172


Men 1487

Women 697

Relationship in men and women significant po0.001.

Table 3

Relationship between educational attainment level and Civil

Service grade

Civil service grade (grouped)

High Middle Low

Educational level


Men 19.6 65.6 14.8 958

Women 0.6 34.1 65.3 640


Men 30.6 64.7 4.7 924

Women 7.5 57.0 35.5 358


Men 55.1 41.2 3.8 1731

Women 29.7 50.5 19.8 475


Men 1223

Women 540

Relationships significant in men and women po0.001.

the advantage that any confounding effect of age is

taken into account. In the third model, education

and attachment style are entered together, giving

little improvement to the fit of the model over

Model 1, which included age and education only.

This means that considered by itself, with or

without adjustment for education, attachment style

does not predict membership of a high civil service

grade. Model 3 also shows that adjustment for


attachment style can be seen to make very little

difference to the relationship between education and

career success (in fact the relationship becomes

somewhat stronger).

Model 4 also contains education and attachment

style, but here an additional term is added for the

interaction between attachment style and education.

This allows us to see whether the relationship of

education and career success is significantly different

in those with different attachment styles. That is,

model 4 asks whether attachment is a source of

‘protective resilience’, which plays a more important

role in relation to career success in the presence of

lower levels of educational attainment. The addition

of the interaction term results in a significant

improvement to the model (improvement in

w 2 ¼ 18:25, 6 df, p ¼ 0:006), showing that we more

accurately predict career success if we allow education

to have a different relationship to Civil Service

grade in those with different attachment styles. In

men with the highest levels of education, the

probability of membership of higher civil services

grades is high irrespective of attachment style.

However, in those with only basic education,

securely attached men are well over twice as likely

(O.R. 2.34, 95% C.I. 1.20–4.55) to be in higher civil

service grades than those (the baseline group) with

both low educational level and anxious attachment

style. The effect of attachment style is also greater in

those with intermediate levels of education than in

those with the highest level.


Attachment style is beginning to be more widely

discussed as a factor in adult social and psychological

adjustment, and in coping with illness. However

less attention has been paid to its possible effect

as a source of resilience in the life-course of

the individual. One reason for this may be that

there are few studies which have included measures

of attachment style in a large number of adults

(Belsky, 2002; Mickelson, Kessler, & Shaver, 1997).

The inclusion of such measures in the Whitehall II

study now makes it possible to look more closely at

relationships between attachment style and adult

social and occupational, as well as psychological

functioning. Encouragingly, the distribution of

attachment styles is similar in this cohort to what

has been found in other studies (Mickelson et al.,

1997) with around 45% of all respondents having a



M. Bartley et al. / Social Science & Medicine 64 (2007) 765–775

Table 4

Relationship of educational attainment to high Civil Service grade in men with different attachment styles

Odds of high civil service grade

Model 1 a Model 3 c Model 4 d


Anxious Avoidant Dismissive Secure


Basic 1 1 1 (baseline) 1.41 (0.52–3.83) 1.47 (0.73–2.96) 2.34 (1.20–4.55)

Intermediate 2.08 (1.67–2.59) 2.09 (1.70–2.60) 2.53 (1.14–5.62) 1.78 (0.73–4.36) 3.98 (2.02–7.83) 4.38 (2.26–8.50)

Higher 6.75 (5.53–8.24) 6.82 (5.59–8.32) 13.15 (6.61–26.18) 13.24 (6.41–27.36) 12.32 (6.41––23.67) 11.88 (6.21–22.72)

Model 2 b

Attachment style

Secure 1 1

Dismissive 0.95 (0.84–1.08) 0.90 (0.77–1.06)

Avoidant 0.87 (0.68–1.10) 0.79 (0.59–1.06)

Anxious 0.90 (0.75–1.09) 0.81 (0.64–1.03)

a Model 1 adjusted for age only, w 2 improvement over model with age alone ¼ 469.83, 2 df, po0:001.

b Model 2 adjusted for age only, w 2 improvement over model with age alone ¼ 2.26, 3 df, p40:1.

c Model 3 includes age, education and attachment style. w 2 ¼ 471.18. Improvement over Model 1 (age+education) w 2 ¼ 1.35, 4 df,


d Model 4 includes age, attachment style, education and interaction education attachment. Model w 2 ¼ 597.38. Improvement over

Model 3 (main effects only) w 2 ¼ 18:25, 6 df, p ¼ 0:006.

secure attachment style, 12% anxious, 7% avoidant

and 34% dismissive.

Reflecting other work (Mickelson et al., 1997),

the measures of socio-economic status used in this

paper were not closely related, in themselves, to

attachment style. Previous work has shown that

there was no significant relationship to parental

social class in this sample (Stansfeld et al., 2006).

Here we have shown that attachment style is not

related to present socio-economic position as

measured by Civil Service grade in women and a

borderline relationship in men. Rather, the data

indicate that attachment style appears to be

associated with greater occupational attainment in

those with a less favourable educational history. A

factor which is not associated with a favourable

outcome overall, but acts specifically among those

with some kind of adversity, is known as a source of

‘protective resilience’ (Schoon, 2006).

Bernier and Dozier have concluded that ‘‘There is

no doubt that what is tapped by self-reports of

attachment style’ is a very significant component of

adult personality that plays a major role not only in

close relationships but in a wide range of spheres of

functioning.’’ (Bernier & Dozier, 2002). We have

examined the possibility that attachment style may

have, in this cohort of civil servants, acted as a

moderator to the disadvantages of lower levels of

educational attainment for career progression. It is

striking that, in study participants with the highest

educational level, there appeared to be no benefit at

all from a secure attachment style. In the large

group with only intermediate educational attainment,

as in the smaller numbers with low attainment

however, attachment style significantly affected the

likelihood of civil service career success. In those

with degrees and other tertiary qualifications, there

was no such effect of attachment.

Belsky (2002, p. 167) reports that ‘‘Secure

individuals appraise stressful events as less threatening

than do less secure persons’’ and that such

individuals ‘‘are more likely to seek help from others

and to resolve conflicts rather than repress them.’’ It

is plausible that those with anxious or avoidant

attachment styles may be less able to respond in

positive ways to the more complex demands placed

on the individual who must make his way up the

occupational ladder in an organisation from a

lower starting point, rather than having been

predestined for high position by educational success.

Several studies have concluded that a feature

of the anxious or avoidant attachment styles is


M. Bartley et al. / Social Science & Medicine 64 (2007) 765–775 773

difficulty in managing relationships to others

(Bifulco, 2002; Park & Waters, 1989; Shaver &

Mikulincer, 2002). The anxiously attached may be

excessively dependent, and the avoidant may be less

successful in managing ongoing relationships over

time. Neither of these behavioural styles is likely to

help in the negotiation of a work career in a

complex organisation. In women, attachment style

may work in rather different ways which would

need more complex explanations. For example, in

this cohort of employed middle aged persons,

securely attached persons are more likely to be

married, and women in the highest employment

grade are less likely to be married and have children

than those in the lower grades (Bartley, Martikainen,

Shipley, & Marmot, 2004). Secure attachment

and career success may be inter-related in quite a

different manner in women than in men.

The attachment literature regards attachment

style as arising from the relationships between

parents and children early in life. One problem in

research in this area has been that child development

research has used longer interviews to establish

the relationship between childhood experiences

and attachment style. Social psychology research on

adults has, in contrast, used survey questions similar

to those reported here. This has led to difficulties in

making inferences about any relationship between

childhood experiences, attachment style as measured

by short questionnaire, and adult social and

emotional functioning (Bernier & Dozier, 2002;

Main, 1996). The Whitehall II study has included

measures of childhood experience as well as

measures of attachment style, finding that attachment

style in adulthood was related to parental

warmth in childhood (Stansfeld et al., 2006), but

not, as has been shown here, to the more material

aspects of the childhood environment indicated by

social class. It is therefore a reasonable inference

that attachment style in this case has acted as a

pathway through which early experiences of

family functioning, similar to Sweeting and West’s

‘family culture’ may influence social outcomes in

later life in the presence of relative socio-economic


There could be an alternative explanation of the

relationships seen in Table 4. It is possible that the

group of Whitehall II participants who attained the

higher occupational grades despite lower levels of

education were more likely to report ‘secure’

attachment ideation because their life trajectory

produced a generally more positive frame of mind.

This possibility was tested by examining participants’

mental health score according to Goldberg’s

General Health Questionnaire (GHQ) (Goldberg &

Williams, 1988). There was no tendency for higher

grade civil servants to report better mood according

to this measure of psychological well-being if they

also had lower levels of educational qualification.

We also tested for the possibility that Whitehall II

participants in the higher grades might be more

likely to recall greater parental warmth if they had

not attained the highest level of education, and

found that this was not the case.

Our data are therefore consistent with the

possibility that attachment style may be an intermediating

factor between early life emotional

experiences and later health, in a manner not

dissimilar to that which seems to be suggested in

the work of Sweeting and West, as well as of others

(McCarron, Gunnell, Harrison, Okasha, & Davey

Smith, 2002; Neeleman, Sytema, & Wadsworth,

2002; van de Mheen, Stronks, Looman, & Mackenbach,

1998a, b). The difference between what we

(and Sweeting and West) argue and some other

studies of ‘cumulative disadvantage’ is that attachment

style does not seem to be part of a simple

pathway between childhood socio-economic advantage

and adult social attainments (or between earlier

and later socio-economic disadvantage). Rather, we

have shown one example of the way in which earlier

life experiences may confer resilience that allows

high levels of occupational attainment in the face of

some degree of socio-cultural disadvantage.

Although social origins, through their link to

educational attainment, had a powerful effect on

occupational success in the Civil Service during the

1980s and 1990s, participants in the Whitehall II

study whose educational trajectory had been less

favourable seemed to be helped up the career ladder

from their lower starting points if they did not suffer

from the more anxious or avoidant attachment

styles. In the light of our own and others’ findings

relating the quality of family relationships to the

formation of these personal characteristics, our

study seems to add to the evidence that the quality

of family relationships may provide a source of

resilience in the face of social or economic



We are grateful to Peter Fonagy for his help in the

development and interpretation of the attachment



M. Bartley et al. / Social Science & Medicine 64 (2007) 765–775

measures. Work for this paper was carried out as

part of the ESRC Research Priority Network ‘‘Human

Capability and Resilience in their Social and

Geographical Contexts’’ Grant no. L326253061.


Ainsworth, M. D. S., Blehar, M. C., Waters, E., & Wall, S.

(1978). Patterns of attachment: A psychological study of the

strange situation. Hillsdale, NJ: Erlbaum.

Balkrishnan, R. (1998). Predictors of medication adherence in the

elderly—Commentary. Clinical Therapeutics, 20, 764–771.

Bartholomew, K. (1990). Avoidance of intimacy: An attachment

perspective. Journal of Social and Personal Relationships, 7,


Bartley, M., Martikainen, P., Shipley, M., & Marmot, M. (2004).

Gender differences in the relationship of partner’s social class

to behavioural risk factors and social support in the Whitehall

II study. Social Science & Medicine, 59, 1925–1936.

Bartley, M., & Plewis, I. (2002). Accumulated labour market

disadvantage and limiting long-term illness: Data from the

1971–1991 Office for National Statistics’ Longitudinal Study.

International Journal of Epidemiology, 31, 336–341.

Belsky, J. (2002). Developmental origins of attachment styles.

Attachment and Human Development, 4, 166–170.

Berglund, G., Eriksson, K. F., Israelsson, B., Kjellstrom, T.,

Lindgarde, F., Mattiasson, I., et al. (1996). Cardiovascular

risk groups and mortality in an urban Swedish male

population: The Malmo Preventive Project. Journal of

Internal Medicine, 239, 489–497.

Bernier, A., & Dozier, M. (2002). Assessing adult attachment:

Empirical sophistication and conceptual bases. Attachment &

Human Development, 4, 171–179.

Bifulco, A. (2002). Attachment style measurement: A clinical and

epidemiiological perspective. Attachment and Human Development,

4, 180–188.

Bifulco, A., Moran, P. M., Ball, C., & Bernazzini, O. (2002).

Adult attachment style. II: Its relationship to clinical

depression. Social Psychiatry and Psychiatric Epidemiology,

37, 50–59.

Bifulco, A., Moran, P. M., Ball, C., & Lillie, A. (2002). Adult

attachment style: Its relationship to psychosocial depressivevulnerability.

Social Psychiatry and Psychiatric Epidemiology,

37, 60–67.

Bowlby, J. (1982). Attachment and Loss. New York: Basic Books.

Brunner, E., Shipley, M. J., Blane, D., Smith, G. D., & Marmot,

M. G. (1999). When does cardiovascular risk start? Past and

present socioeconomic circumstances and risk factors in

adulthood. Journal of Epidemiology and Community Health,

53, 757–764.

Droomers, M., Schrijvers, C. T., Casswell, S., & Mackenbach, J.

P. (2003). Occupational level of the father and alcohol

consumption during adolescence; patterns and predictors.

Journal of Epidemiology and Community Health, 57, 704–710.

Fergus, S., & Zimmerman, M. A. (2005). Adolescent resilience: A

framework for understanding healthy development in the face

of risk. Annual Review of Public Health, 26, 399–419.

Fonagy, P. (2001). Introduction to attachment theory. Ch 1.

Attachment theory and psychoanalysis. London: Karnac (pp.


Fonagy, P. (2005). Attachment, the development of self, andits

pathology in personality disorders. Psychomedia Telematic

Review. /http:///

(accessed 1 Feb 2005))

Galobardes, B., Lynch, J. W., & Davey Smith, G. (2004).

Childhood socioeconomic circumstances and cause-specific

mortality in adulthood: Systematic review and interpretation.

Epidemiologic Reviews, 26, 7–21.

Gil, F. P., & Rupprecht, R. (2003). Attachment research. Current

aspects of attachment theory and development psychology as

well as neurobiological aspects in psychiatric and psychosomatic

disorders. Nervenarzt, 74, 965–971.

Glendinning, A., Hendry, L. B., & Shucksmith, J. (1995).

Lifestyle, health and social class in adolescence. Social Science

& Medicine, 41, 234–248.

Glendinning, A., Love, J. G., Hendry, L. B., & Shucksmith, J.

(1992). Adolescence and health inequalities. Extension to

Macintyre and West. Social Science & Medicine, 35, 79–87.

Glendinning, A., Shucksmith, J., & Hendry, L. (1997). Family life

and smoking in adolescence. Social Science & Medicine, 44,


Goldberg, D. P., & Williams, P. (1988). The user’s guide to the

general health questionnaire. Slough: NFER-Nelson.

Green, J., & Goldwyn, R. (2002). Annotation: Attachment

disorganisation and psychotherapy: New findings in attachment

research and their potential implications for developmental

psychopathology in childhood. Journal of Child

Psychology and Psychiatry and Allied Disciplines, 43, 835–846.

Haavet, O. R., Saugstad, O. D., & Straand, J. (2005). Positive

factors associated with promoting health in low-risk and highrisk

populations of 15-and 16-year-old pupils in Oslo,

Norway. Acta Paediatrica, 94, 345–351.

Hazan, C., & Shaver, P. (1987). Romantic love conceptualised as

an attachment process. Journal of Personality and Social

Psychology, 52, 511–524.

Hertzman, C., & Power, C. (2003). Health and human development:

Understandings from life-course research. Developmental

Neuropsychology, 24, 719–744.

Hesse, E., & Main, M. (1999). Second generation effects of

unresolved trauma in nonmaltreating parents: Dissociated,

frightening and threatening parental behaviour. Psychoanalytic

Inquiry, 10, 481–540.

Irons, C., & Gilbert, P. (2005). Evolved mechanisms in adolescent

anxiety and depression symptoms: The role of the attachment

and social rank systems. Journal of Adolescence, 28, 325–341.

Mackenbach, J. P. (2005). Genetics and health inequalities:

Hypotheses and controversies. Journal of Epidemiology and

Community Health, 59, 268–273.

Main, M. (1996). Introduction to the special section on

attachment and psychopathology: 2. Overview of the field

of attachment. Journal of Consulting and Clinical Psychology,

64, 237–243.

Massie, H., & Szajnberg, N. (2002). The relationship between

mothering in infancy, childhood experience and adult mental

health: Results of the brody prospective longitudinal study

from birth to age 30. International Journal of Psychoanalysis,

83, 35–55.

Maunder, R. G., Panzer, A., Viljoen, M., Owen, J., Schalk, H., &

Hunter, J. J. (2006). Physicians’ difficulty with emergency

department patients is related to patients’ attachment style.

Social Science & Medicine, 63, 552–562.


M. Bartley et al. / Social Science & Medicine 64 (2007) 765–775 775

McCarron, P., Gunnell, D., Harrison, G. L., Okasha, M., &

Davey Smith, G. (2002). Temperament in young adulthood

and later mortality: Prospective observational study. Journal

of Epidemiology and Community Health, 25, 888–892.

Mickelson, K. D., Kessler, R. C., & Shaver, P. R. (1997). Adult

attachment in a nationally representative sample. Journal of

Personality and Social Psychology, 73, 1092–1106.

Neeleman, J., Sytema, S., & Wadsworth, M. (2002). Propensity to

psychiatric and somatic ill-health: Evidence from a birth

cohort. Psychological Medicine, 32, 793–803.

Park, K. A., & Waters, E. (1989). Security of attachment and

preschool friendships. Child Development, 60, 1076–1081.

Power, C., & Matthews, S. (1997). Origins of health inequalities

in a national population sample. Lancet, 350, 1584–1589.

Priel, B., & Besser, A. (2001). Bridging the gap between

attachment and object relations theories: A study of the

transition to motherhood. British Journal of Medical Psychology,

74, 85–100.

Scharf, M., Mayseles, O., & Kivenson-Baron, I. (2004).

Adolescents’ attachment representations and developmental

tasks in emerging adulthood. Developmental Psychology, 40,


Schmidt, S., Nachtigall, C., Wuethrich Martone, O., & Strauss,

B. (2002). Attachment and coping with chronic disease.

Journal of Psychosomatic Research, 53, 763–773.

Schoon, I. (2006). Risk and Resilience: Adaptations in changing

times. Cambridge: Cambridge University Press.

Shaver, P. R., & Mikulincer, M. (2002). Attachment-related

psychodynamics. Attachment and Human Development, 4,


Singh-Manoux, A., Ferrie, J., Chandola, T., & Marmot, M.

(2004). Socioeconomic trajectories across the life course and

health outcomes in midlife: Evidence for the accumulation

hypothesis? International Journal of Epidemiology, 33,


Stansfeld, S.A., Head, J., Bartley, M., & Fonagy, P. (2006). Social

position, early deprivation and the development of attachment.

Social Science & Medicine (forthcoming).

Stein, H., Koontz, A. D., Fongay, P., Allen, J. G., Fultz, J.,

Brethour, J. R., et al. (2002). Adult attachment: What are the

underlying dimensions? Psychology and Psychotherapy, 75,


Stewart-Brown, S. L., Fletcher, L., & Wadsworth, M. E. J.

(2005). Parent-child relationships and health problems in

adulthood in three UK national birth cohort studies.

European Journal of Public Health, 15, 640–646.

Sweeting, H., & West, P. (1995). Family life and health in

adolescence: A role for culture in the health debate? Social

Science & Medicine, 40, 163–175.

Tremblay, R. E. (1999). When children’s social development fails.

In D. P. Keating, & C. Hertzman (Eds.), Developmental

Health and the Wealth of Nations (pp. 55–71). New York: The

Guildford Press.

van de Mheen, D. (1998). Is there indirect selection? Determinants

of interngenerational social mobility. Findings from the

Dutch GLOBE study. PhD thesis, Erasmus University

Rotterdam, Rotterdam.

van de Mheen, H., Stronks, K., Looman, C. W., & Mackenbach,

J. P. (1998a). Does childhood socioeconomic status influence

adult health through behavioural factors? International

Journal of Epidemiology, 27, 431–437.

van de Mheen, H., Stronks, K., Looman, C. W. N., &

Mackenbach, J. P. (1998b). Role of childhood health in the

explanation of socioeconomic inequalities in early adult

health. Journal of Epidemiology and Community Health, 52,


Waller, E., Scheidt, C. E., & Hartmann, A. (2004). Attachment

representation and illness behaviour in somatoform disorders.

Journal of Nervous and Mental Disease, 192, 200–209.

Waters, E., Crowell, J., Elliott, M., Corcoran, D., & Treboux, D.

(2002). Bowlby’s secure base theory and the social/personality

psychology of attachment styles: Work(s) in progress.

Attachment and Human Development, 4, 230–242.

Werner, E. E. (2004). Journeys from childhood to midlife: Risk,

resilience, and recovery. Pediatrics, 114, 492.

West, P., Macintyre, S., Annandale, E., & Hunt, K. (1990).

Social-class and health in youth—findings from the west of

scotland 20-07 study. Social Science & Medicine, 30, 665–673.

Whalley, L. J., & Deary, I. J. (2001). Longitudinal cohort study

of childhood IQ and survival up to age 76. British Medical

Journal, 322, 819.

More magazines by this user
Similar magazines