Changes in distress of psychiatric in-patients after the changeover of junior psychiatric trainees as a function of attachment style: A pilot study

Background and Objectives: Therapists, including psychiatrists, may act as attachment figures. Rotational training schemes necessitate the regular and frequent ending of therapeutic relationships. The effects on patients are rarely studied. This is a pilot prospective study to evaluate whether relative distress in adult psychiatric in-patients follows change in trainee psychiatrists; whether differences in distress are mediated by patient attachment style; and to provide data for power calculation. Methods: Twenty adult in-patients were assessed using the Mental Health Inventory 5 (MHI-5) scale before and after changeover of psychiatric trainees; attachment style was assessed prior to the changeover. Qualitative data were also collected. Results: The average MHI-5 scores improved with time (p = 0.021). Less improvement correlated with higher score on preoccupied attachment (rho = 0.41, p(1-tail) < 0.05). A non-significantly stronger improvement was seen with secure/dismissing styles compared to preoccupied/fearful styles (p(1-tail) = 0.08). Based on these results, a study of at least 87 patients is likely to produce a statistically significant result. Most patients were not aware a staff change was due and would like to be informed by their clinical team. Conclusions: Relative distress following junior trainee changeover may have a link with patients' attachment styles.