Comparison of Two Therapeutic Approaches of Cerebellar Transcranial Direct Current Stimulation in a Sardinian Family Affected by Spinocerebellar Ataxia 38: a Clinical and Computerized 3D Gait Analysis Study.

Spinocerebellar ataxia 38 (SCA 38) is a very rare autosomal dominant inherited disorder caused by a mutation in ELOV5 gene, specifically expressed in cerebellar Purkinje cells, encoding an enzyme involved in the synthesis of fatty acids. Seven symptomatic SCA 38 patients of a Sardinian family were administered 15 sessions of cerebellar anodal transcranial direct current stimulation (tDCS) in a cross-over study, employing deltoid cerebellar-only (C-tDCS) and cerebello-spinal (CS-tDCS) cathodal montage. Clinical evaluation was performed at baseline (T0), after 15 sessions of tDCS (T1) and after 1 month of follow-up (T2). Modified International Cooperative Ataxia Rating Scale (MICARS) and the Robertson dysarthria profile were used to rate ataxic and dysarthric symptoms, respectively. Alertness and split attention tests from Zimmermann test battery for attentional performance were employed to rate attentive functions. Moreover, 3D computerized gait analysis was employed to obtain a quantitative measure of efficacy of tDCS on motor symptoms. While clinical data showed that both CS and C-tDCS improved motor, dysarthric, and cognitive scores, the quantitative analysis of gait revealed significant improvement in spatio-temporal parameters only for C-tDCS treatment. Present findings, yet preliminary and limited by the small size of the tested sample, confirm the therapeutic potential of cerebellar tDCS in improving motor and cognitive symptoms in spinocerebellar ataxias and underline the need to obtain quantitative and objective measures to monitor the efficacy of a therapeutic treatment and to design tailored rehabilitative interventions. ClinicalTrials.gov identifier: NCT05951010.

Perceived Emotional Impact of COVID-19 and Depressive Symptoms among Male Same-Sex Chilean Couples: Direct and Indirect Dyadic Associations through Relationship Satisfaction.

Stressors arising from the COVID-19 pandemic can spill over into the quality of couple relationships, with negative consequences on mental health. The mental health impact of COVID-19 might be particularly pronounced in disadvantaged populations such as LGBT people. This study aimed to examine direct and indirect dyadic associations between emotional impact of COVID-19 and depressive symptoms through relationship satisfaction in male same-sex couples. Using a cross-sectional design, 158 male same-sex Chilean couples completed self-report measures of the emotional impact of COVID-19, relationship satisfaction and depressive symptoms. We used the actor-partner interdependence mediation model for indistinguishable dyads to explore the direct and indirect dyadic associations. Results indicated that each partner's perceived emotional impact of COVID-19 was associated with his own higher depressive symptoms directly and indirectly, through his own lower relationship satisfaction. The other partner's perceived emotional impact of COVID-19 was associated with one's own higher depressive symptoms only directly. Our findings reinforce the notion that satisfactory couple relationships can act as a protective factor against depression in the LGBT population. Programs to promote adaptive coping strategies to deal with the emotional impact of the COVID-19 pandemic may have beneficial effects for the emotional adjustment of male same-sex couples, also by promoting relationship satisfaction.

Development and validation of The Breaking Bad News Attitudes Scale.

BACKGROUND: Communication of bad news plays a critical role in the physician-patient relationship, and a variety of consensus guidelines have been developed to this purpose, including the SPIKES protocol. However, little is known about physicians' attitudes towards breaking bad news and to be trained to deliver it. This study aimed to develop and validate a self-report questionnaire to assess physicians' attitudes towards principles of the SPIKES protocol and training on them. METHODS: The Breaking Bad News Attitudes Scale (BBNAS) was administered to 484 pediatricians and 79 medical students, recruited at two scientific conferences and two medical schools in Brazil. The questionnaire structural validity, reliability, and associations with other variables were tested. RESULTS: The BBNAS showed adequate validity and good reliability, with two factors measuring attitudes towards the SPIKES strategy for braking bad news (α = 0.81) and the possibility to be trained on it (α = 0.77), respectively. CONCLUSION: The novel questionnaire is a psychometrically sound measure that provides information on physicians' agreement with the SPIKES protocol. The BBNAS can provide useful information for planning training and continuing education programs for clinicians on communication of bad news using the SPIKES as a framework.

The awareness, visibility and support for young carers across Europe: a Delphi study.

BACKGROUND: Across Europe, young carers (YCs) and their need for support receive limited attention in the media, policy and empirical research, even though, similar to adult carers, they also provide care to ill family members. The Delphi study, a qualitative research methodology, which provides the focus for this article, had the overall aim of exploring existing successful strategies to support YCs. Compared to YCs, even less is known about adolescent young carers (AYCs), a group that is in a critical life transition phase. The study forms part of an EU Horizon 2020 funded research project on AYCs aged 15-17 years old. METHODS: A two-round Delphi study was conducted with 66 experts on YCs from 10 European countries. Topics included: (i) visibility and awareness-raising of YCs at local, regional, and national levels, (ii) current interventions to support YCs, and (iii) future strategies to support YCs. RESULTS: Experts reported a lack of visibility and awareness about YCs in general, and AYCs in particular. Although awareness is slowly increasing in most countries, with the UK ranked highest, experts acknowledged that it remains challenging to identify YCs in many countries. Furthermore, the level and type of support available for YCs differs, with most countries mainly offering support on a local level. Diverse views were expressed regarding future strategies to support YCs. Experts highlighted the importance of specific legislation to formalise the rights of YCs, and the issue of whether young people should be safeguarded from caregiving or if this should be considered part of regular family life. They also emphasised the relevance of available integrated support services for YCs, including schools, family, health and social care. CONCLUSIONS: In most European countries, there is a lack of awareness and visibility on YCs. Identification of YCs is a crucial first step and there is need for a common definition of YCs, together with greater opportunities for young adults to identify themselves as YCs.

Emotional overeating questionnaire: a validation study in Italian adults with obesity, overweight or normal weight.

PURPOSE: This study aimed at testing the validity and reliability of the Emotional Overeating Questionnaire (EOQ) in a sample of Italian adults with obesity, overweight or normal weight. MATERIALS AND METHODS: Participants were 314 Italian adults (72.6% females, aged 18-76 years) with obesity (27.4%), overweight (21.3%), or normal weight (51.3%), who completed the EOQ and measures of binge eating, mental well-being, and mindful eating. Retesting was performed 4 weeks later in a randomly selected subsample of 60 participants. Factor structure of the EOQ was estimated by confirmatory factor analysis (CFA). Reliability was tested with McDonald's ω and ordinal α coefficients for internal consistency and Cohen's weighted Kappa coefficient (Kw) for test-retest reliability. RESULTS: Based on CFA, the five negative emotional items formed one factor (EOQ-5) with good reliability (ω = 0.89; ordinal α = 0.88; Kw= 0.71), while the item referring to happiness was dropped. EOQ-5 scores were associated with higher binge eating, lower mental well-being, and lower mindful eating. A cut-off point of two identified individuals at risk for binge eating disorders with 75% sensitivity and 67% specificity. Negative emotional overeating was more frequent in women with obesity than women with normal weight and men with obesity. CONCLUSIONS: EOQ-5 is a valid and reliable tool for measuring the frequency of emotional overeating at the Italian community-level. LEVEL OF EVIDENCE: Level V, cross-sectional, descriptive study.

Development and initial validation of the Positive Sexuality Scale for female adults.

AIM AND OBJECTIVES: To develop and initially validate the Positive Sexuality Scale (PSS) to assess adult female-positive sexuality. BACKGROUND: While traditional approaches focus on negative sexual experiences and sexual dysfunctions, within the positive psychology framework positive sexuality is a subjective experience of happiness and fulfilment with one's sexual expression, which contributes to well-being. No measure exists that specifically measures adult female-positive sexuality and can be confidently used with women of any fertility/childlessness status. DESIGN: Two-stage cross-sectional study with a 4-week test-retest, which follows the STROBE guidelines. METHODS: Participants were 912 Italian women aged 18-45 (52.74% mothers, 23.79% voluntarily childless and 23.46% primary infertile), who completed the 5-item PSS and a self-report of psychological well-being. A subsample (n = 61) completed the 4-week test-retest. RESULTS: Factor analyses supported a one-factor model with measurement invariance across adulthood stage and fertility/childlessness status and good reliability. Younger and fertile women showed higher PSS scores, and moderate-to-high variability in infertile women's well-being was accounted for by PSS scores. CONCLUSION: The PSS is a brief self-report with initial evidence of validity and reliability that could be used in sex research, practice and education. RELEVANCE TO CLINICAL PRACTICE: The PSS could assist health professionals to identify a positive resource to which women can draw on to deal with sex-related issues. Implementing the assessment of female-positive sexuality in infertility protocols could help professionals to identify a potential resource within couples facing infertility and its treatment.

Spirituality, infertility-related stress, and quality of life in Brazilian infertile couples: Analysis using the actor-partner interdependence mediation model.

Infertility has a stressful impact on both partners, with adverse effects on the quality of life of infertile couples. Spirituality is a meaning-based strategy that can protect couples against infertility's negative impact on quality of life, but analysis of this mediator relationship in infertile couples has not been reported. We adopted a dyadic approach and used the actor-partner interdependence mediation model to examine whether and how women's and men's spirituality was associated with their own and their partners' infertility-related stress and quality of life. In 2014, 152 infertile couples starting their first fertility treatment at a private clinic in Brazil were recruited and completed self-reports of spirituality, infertility-related stress, and quality of life. Results indicated that women's and men's level of spirituality was positively associated with their own quality of life directly and indirectly, by reducing their own infertility-related stress. Their spirituality was associated with an increase in their partners' quality of life only indirectly, by reducing their partners' infertility-related stress. Findings highlight the importance of assessing and promoting spirituality as a coping resource that infertile women and men might use to deal with the stress of infertility and reduce its adverse effects on quality of life.

Sexual satisfaction among involuntarily childless women: A cross-cultural study in Italy and Brazil.

Infertility has been negatively associated with sexual satisfaction. This study aimed to estimate the relation of infertility to sexual satisfaction from a cross-cultural perspective, comparing Italian and Brazilian women. Between June 2012 and January 2013, 528 women seeking assisted reproduction technology (ART) treatment in Italy (39%) or Brazil (61%) completed self-reports of sexual satisfaction (ISS) and infertility-related stress in the marital domain (IRS). IRS was the same across countries. ISS differed, with 34.31% of the Italians and 43.52% of the Brazilians being sexually dissatisfied at a clinical level (ISS score >30). Multiple logistic regression models showed that being sexually dissatisfied at a clinical level was associated with lower education and higher IRS among Italian women, regardless of having a diagnosed cause of infertility. It was instead associated with higher IRS only among the Brazilian women who had a diagnosed cause of infertility. These findings suggest that, regardless of nationality, sexual satisfaction and infertility-related stress need to be addressed in the treatment of infertile women turning to ART. However, as factors associated with these dimensions vary across countries, interventions to promote sexual satisfaction among infertile women should be adapted to their specific socio-cultural context.

Distress and demoralization of hospital nurses as a function of sources of stress and job seniority.

AIM: To explore job-related factors associated with distress and demoralization among hospital nurses, using a cross-sectional mixed-method design. BACKGROUND: Sources of job stress for nurses are mainly organizational or emotional care-related and can result in adverse outcomes such as distress or demoralization, but factors associated with demoralization in nurses still need to be thoroughly explored. METHODS: A convenience sample of 150 nurses from three public hospitals completed an online survey on job stress, distress, demoralization, and feelings of entrapment in the caring profession. RESULTS: Emotional job stress was linked to higher distress and demoralization, compared to no job stress, and to higher feelings of entrapment, compared to both organizational and no job stress, among senior nurses. CONCLUSIONS: This pilot study points to the study of demoralization as a promising line of research in hospital nursing, but further longitudinal studies with larger samples are needed.

Screening for infertility-related stress at the time of initial infertility consultation: psychometric properties of a brief measure.

AIM: To develop and psychometrically test a brief self-report to assess the amount of infertility-related stress; to investigate how infertility-related stress was associated to socio-demographics, causes of infertility and emotional distress. BACKGROUND: Infertility exerts a stress effect on both personal and interpersonal areas. Due to the burden of multiple assessments in fertility clinics, there is the need for very brief and easy to administer measures of the stressful impact of infertility on the intrapersonal and interpersonal life domains. DESIGN: The study had a psychometric, cross-sectional design. METHOD: Between January - December 2013, a total of 597 Italian infertile patients (58·6% women), recruited at the time of initial infertility consultation, completed the Infertility-Related Stress Scale. A subsample of 200 participants (50% women) also completed self-reports of anxiety and depression. A subsample of 40 patients completed again the Infertility-Related Stress Scale at a 4-week follow-up visit. RESULTS: Confirmatory factor analyses supported the proposed two-factor model of infertility stress affecting intrapersonal and interpersonal life domains. Both dimensions showed good reliability and were associated in expected ways with emotional distress. Patients with above-threshold levels of anxiety and depression showed higher infertility stress in both domains and particularly in the intrapersonal area. Infertility stress was significantly higher in women than in men in the intrapersonal domain. CONCLUSION: The Infertility-Related Stress Scale showed evidence of validity and reliability. This new, brief self-report can assist fertility clinic staff in identifying those patients who need support to overcome the stressful impact of infertility on intrapersonal and interpersonal domains.

Positive sexuality, relationship satisfaction, and health: a network analysis.

Introduction: Positive sexuality, defined as the happiness and fulfillment individuals derive from their sexual experiences, expressions, and behaviors, has been linked to relationship satisfaction and health. However, the intricate associations between positive sexuality and relationship functioning and health indicators have rarely been explored from a network perspective. This approach, by analyzing the interconnections among these factors within a broader system, can offer insights into complex dynamics and identify key variables for targeted interventions. Methods: The present study applied network analysis to uncover interconnections between positive sexuality, relationship satisfaction, and health indicators, highlight the most relevant variables and explore potential gender-based differences in a sample of 992 partnered individuals (51% women, aged 18-71 years). Networks were estimated via Gaussian Graphical Models, and network comparison test was used to compare men and women. Results: Results indicated that variables related to positive sexuality were more highly interconnected than the rest of the network. There were small-to-negligible connections between positive sexuality and relationship satisfaction variables, both of which had negligible or no connections with health. The network was globally invariant across gender, though a few connections were gender-specific. The most important variables, regardless of gender, related to pleasurable feelings during sexual intercourse. Discussion: The findings underscore the importance of enhancing positive sexual experiences within intimate relationships and have implications for research and clinical practice in positive sexuality.

Cybersickness in People with Multiple Sclerosis Exposed to Immersive Virtual Reality.

Together with the wide range of possible benefits for the rehabilitation/training of people with multiple sclerosis (pwMS) and other neurologic conditions, exposure to immersive virtual reality (VR) has often been associated with unpleasant symptoms, such as transient dizziness, headache, nausea, disorientation and impaired postural control (i.e., cybersickness). Since these symptoms can significantly impact the safety and tolerability of the treatment, it appears important to correctly estimate their presence and magnitude. Given the existing data scarcity, this study aims to assess the existence and severity of possible adverse effects associated with exposure to immersive VR in a cohort of pwMS using both objective measurements of postural control effectiveness and subjective evaluations of perceived symptoms. To this aim, postural sway under upright quiet posture (in the presence and absence of visual input) of 56 pwMS with an Expanded Disability Status Scale score (EDSS) in the range of 0-6.5 (mean EDSS 2.3) and 33 unaffected individuals was measured before and after a 10-min immersive VR session and at 10 min follow-up on the basis of center of pressure (COP) trajectories. The severity of cybersickness symptoms associated with VR exposure was also self-rated by the participants using the Italian version of the Simulator Sickness Questionnaire (SSQ). Temporary impairments of postural control in terms of significantly increased sway area were observed after the VR session only in pwMS with mild-moderate disability (i.e., EDSS in the range of 2.5-6.5) in the presence of visual input. No changes were observed in pwMS with low disability (EDSS 0-2) and unaffected individuals. In contrast, when the visual input was removed, there was a decrease in sway area (pwMS with mild-moderate disability) and COP path length relating to the use of VR (pwMS with mild-moderate disability and unaffected individuals), thus suggesting a sort of "balance training effect". Even in this case, the baseline values were restored at follow-up. All participants, regardless of their status, experienced significant post-VR side effects, especially in terms of blurred vision and nausea. Taken together, the findings of the present study suggest that a short immersive VR session negatively (eyes open) and positively (eyes closed) impacts the postural control of pwMS and causes significant disorientation. However, such effects are of limited duration. While it is reasonable to state that immersive VR is sufficiently safe and tolerable to not be contraindicated in the rehabilitation/training of pwMS, in order to reduce possible negative effects and maximize the efficacy, safety and comfort of the treatment, it appears necessary to develop specific guidelines that consider important factors like individual susceptibility, maximum exposure time according to the specific features of the simulation, posture to adopt and protocols to assess objective and perceived effects on participants.

A Serial Mediation Model of Insecure Attachment and Psychological Distress: The Role of Dispositional Shame and Shame-Coping Styles.

Shame is an intense, difficult to regulate, self-conscious emotion that predicts aspects of poor psychological functioning and is also strongly related to early relationships. Attachment insecurities, which constitute non-specific risk factors for psychological maladjustment, have been associated with an individual's tendency to experience shame. In this study, we sought to examine the serial mediating roles of dispositional shame and shame-coping styles (i.e., attack other, attack self, withdrawal and avoidance) in the association between anxious and avoidant attachment, and psychological distress. Using a cross-sectional design, self-reported data were collected. The study sample included 978 respondents (57% female) with a mean age of 32.17 ± 13.48 years. The results of the path analysis indicated that both attachment dimensions were sequentially associated with dispositional shame and then with the attack self shame-coping style, which was, in turn, positively related to psychological distress. Further, attachment insecurities were sequentially associated with dispositional shame and then with the avoidance shame-coping style, which was, in turn, negatively related to psychological distress. The model was gender invariant, suggesting that the serial mediation worked in a similar way for men and women. The practical implications of these findings are discussed.

A Psychometric Study of the Perinatal Assessment of Maternal Affectivity (PAMA) for the Screening of Perinatal Affective Disorders in Mothers.

Recently, empirical evidence from perinatal studies has led researchers to pay more attention to fathers. The need to evaluate male suffering led at first to using the same screening tools developed for mothers. However, these instruments present validity concerns with fathers, and today the need to assume a gender-based perspective is clear. The Perinatal Assessment of Paternal Affectivity (PAPA) is a self-reported questionnaire for the screening of a variety of psychological and behavioral dimensions related to affectivity as experienced by fathers during the perinatal period. In the present study, the psychometric properties of the maternal version of the scale (Perinatal Assessment of Maternal Affectivity; PAMA) were examined. The study, based on 225 mothers and their partners (n = 215), used a cross-sectional design with a single assessment at the third trimester of pregnancy. Results indicated a one-factor structure for a seven-item version of the PAMA, which showed adequate internal consistency reliability and was associated in the expected direction with other clinically relevant variables (depression, psychological distress, perceived stress and dyadic adjustment). The findings suggest the usefulness of developing gender sensitive screening tools for the detection of perinatal affective disorders.

Breast/ovarian cancer genetic counseling: Do anxiety, depression, and health care-related fears influence cancer worry and risk perception?

BACKGROUND: The impact of family and personal cancer history and emotional factors, such as depression and anxiety, on disease representation has received limited attention in studies investigating the development of cancer-related worry and risk perception within the context of genetic counseling. The current study endeavors to fill this gap by exploring the extent to which depression and anxiety influence cancer worry and risk perception, and the role of health care-related fear as potential mediator in this relationship. METHODS: A sample of 178 women who underwent their first genetic counseling for breast/ovarian cancer, 52% of whom had previous cancer diagnoses, completed questionnaires assessing sociodemographic and clinical information, emotional distress in terms of anxiety and depression, cancer-related worry, risk perception, and health care-related fears. RESULTS: Results of mediation analyses showed that cancer-related worry and risk perception increased with rising levels of depression and anxiety, with health care-related fears acting as a mediator in the relationship of depression and anxiety with cancer worry and risk perception. Covariate analysis revealed that previous cancer diagnosis increases cancer-related worry but not risk perception, while the number of family members affected by cancer increases both outcomes. CONCLUSION: These findings emphasize the need for a holistic approach in genetic counseling and have implications for the clinical practice.

An Immersive Virtual Kitchen Training System for People with Multiple Sclerosis: A Development and Validation Study.

Rehabilitation via virtual reality (VR) training tools allows repetitive, intensive, and task-specific practice in a controlled and safe environment. Our goal was to develop and validate a novel immersive VR system based on the practice of real-life activities in a kitchen environment in people with multiple sclerosis (pwMS) with upper-limb dysfunction. The novel immersive VR kitchen application includes several tasks, i.e., tidying up the kitchen, preparing a hamburger and soup meal, and dish washing. Following the development phase, the system was tested for an 8-week intervention period on a small sample of pwMS suffering from upper-limb dysfunction. The Suitability Evaluation Questionnaire for VR systems served as the primary outcome. The scores for enjoyment, sense of comfort with the system, feelings of success and control, realism, easy-to-understand instructions, assists in rehabilitation therapy, were between 4.0 and 4.6, indicating a high satisfaction. The scores for eye discomfort, dizziness, nausea, and disorientation during practice were between 2.8 and 1.3, indicating a low-to-moderate interference of the system. The virtual kitchen training system is feasible and safe for upper-limb training in pwMS and paves the way for future RCTs to examine the benefits of the system compared with standard care, thus improving the functionality of the upper limbs in pwMS.

Characterization of upper limb use in health care workers during regular shifts: A quantitative approach based on wrist-worn accelerometers.

Despite the high prevalence of upper limb (UL) work-related musculoskeletal disorders (WRMSD) among health care workers (HCWs), little is known about their relationship with exposure to biomechanical risk factors. This study aimed to assess UL activity features under actual working conditions using two wrist-worn accelerometers. Accelerometric data were processed to obtain duration, intensity, and asymmetry of UL use in 32 HCWs during the execution of commonly performed tasks (e.g., patient hygiene, transfer, and meal distribution) within a regular shift. The results show that such tasks are characterized by significantly different patterns of UL use, in particular, higher intensities and larger asymmetries were observed respectively for patient hygiene and meal distribution. The proposed approach appears, thus, suitable to discriminate tasks characterized by different UL motion patterns. Future studies could benefit from the integration of such measures with self-reported workers' perception to elucidate the relationship between dynamic UL movements and WRMSD.

Smoothness of Gait in Overweight (But Not Obese) Children Aged 6-10.

Excessive body mass represents a serious threat to the optimal psychophysical development of children, and it is known to be able to significantly affect their locomotor capabilities, making them more prone to the development of musculoskeletal disorders. However, despite the relevant number of existing studies, a clear gait pattern of overweight children has not been defined yet, particularly in the case of a mass excess that is relatively small (i.e., in those not obese). In the present study, we employed a wearable inertial measurement unit placed on the low back to derive spatio-temporal parameters and quantify the smoothness of gait (by means of harmonic ratio) from trunk accelerations acquired during gait trials carried out by 108 children aged 6-10 (46% males), stratified into two groups according to their body mass index (normal weight, n = 69 and overweight, n = 39). The results show that while gait speed, stride length, cadence and double support duration were found to be almost identical in the two groups, significant differences were observed in terms of harmonic ratio. In particular, overweight children exhibited a reduced harmonic ratio in the antero-posterior direction and higher harmonic ratio in the medio-lateral direction. While the significantly lower harmonic ratio in the antero-posterior direction is likely to be indicative of a loss of smoothness in the walking direction, probably due to a combination of factors associated with the altered movement biomechanics, the higher harmonic ratio in the medio-lateral direction might be associated with specific strategies adopted to increase lateral stability. Although further studies are necessary to elucidate the specific mechanisms that influence the smoothness of gait, it is noteworthy that harmonic ratios appear sensitive even to subtle change in locomotor control in overweight children characterized by apparently regular spatio-temporal parameters of gait and might be employed to assess the effectiveness of interventions designed to improve mobility functions.

Internalized homonegativity moderates the association between attachment avoidance and emotional intimacy among same-sex male couples.

Introduction: The present study aimed to examine dyadic associations between attachment insecurity and emotional intimacy in same-sex male couples, and to investigate whether and how each partner's internalized homonegativity (IH) moderated these associations. Methods: The sample included 138 same-sex male couples. Both dyad members completed self-report measures of attachment insecurity, emotional intimacy, and IH. The actor-partner interdependence model with moderation analysis was applied. Results: Indicated that higher levels of actor's and partner's attachment anxiety and attachment avoidance were associated with lower actor's emotional intimacy. IH moderated the partner effects of attachment avoidance on emotional intimacy. The partner's higher attachment avoidance was associated with one's own lower emotional intimacy at low (but not high) levels of one's own IH and at high (but not low) levels of the partner's IH. Discussion: Findings suggest that the partner's attachment avoidance may differently affect one's own emotional intimacy depending on the IH levels of both dyad members. Helping partnered sexual minority men decrease attachment insecurity while recognizing their own and their partners' IH may promote relationship quality.