Adult attachment style as mediator between childhood neglect/abuse and adult depression and anxiety

Bifulco, Antonia ORCID: https://orcid.org/0000-0001-8316-9706, Kwon, Junghye, Jacobs, Catherine, Moran, Patricia M., Bunn, Amanda and Beer, Nils (2006) Adult attachment style as mediator between childhood neglect/abuse and adult depression and anxiety. Social Psychiatry and Psychiatric Epidemiology, 41 (10) . pp. 796-805. ISSN 0933-7954 [Article] (doi:10.1007/s00127-006-0101-z)

Abstract

Background
There has been little prospective investigation of the relationship between adult attachment style and clinical levels of anxiety and major depression. This paper seeks to address this, as well as examining the potentially mediating role of adult insecure attachment styles in the relationship between childhood adverse experience and adult disorder.

Method
154 high-risk community women studied in 1990-1995 were followed up in 1995-1999 to test the role of insecure attachment style in predicting new episodes of anxiety and/or major depressive disorder. The Childhood Experience of Care and Abuse (CECA) and the Attachment Style Interview (ASI) were administered at first interview and the Structured Clinical Interview for DSM-1V (SCID) administered at first and follow-up interview. Major depression and clinical level anxiety disorder (GAD, Social Phobia or Panic and /or Agoraphobia) were assessed at first contact and for the intervening follow-up period.

Results
55% (85/154) of the women had at least one case level disorder in the follow-up period. Only markedly or moderately (but not mildly) insecure attachment styles predicted both major depression and case anxiety in follow-up. Some specificity was determined with Fearful style significantly associated both with depression and Social Phobia, and Angry-Dismissive style only with GAD. Attachment style was unrelated to Panic Disorder and/or Agoraphobia. In addition, Fearful and Angry-dismissive styles were shown to partially mediate the relationship between childhood adversity and depression or anxiety.

Conclusion
In order to correctly interpret lifespan models of adult psychiatric disorder, it is necessary to test for mediating factors. Attachment theory provides a framework for determining how dysfunctional interpersonal style arising from early childhood perpetuates vulnerability to affective disorders. This has implications for intervention and treatment to break cycles of risk.

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