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

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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.

Methods

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-IV (SCID) administered at first and follow-up interview. Major depression and clinical level anxiety disorders (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 explaining 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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Notes

  1. Compliance with original interview was 61%, with 22% refusal. The remaining 25% proved unsuitable in a paired sister-group subset because the sister proved unobtainable.

  2. A proportion of the original sample were not contacted for follow-up, these included (a) the sisters of a subgroup recruited for validating the childhood information who lived outside the area (n = 98), and (b) a small group of the women with adult vulnerability (21) who did not have relatives suitable for study in the parallel inter-generational investigation. The numbers selected for follow-up therefore represented around half of the original series.

  3. Withdrawn style had a modest association with depression, but this disappeared when controls were applied for disorder at interview 1.

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Acknowledgements

The research was supported by the Medical Research Council (programme grant G9827201). Professor Kwon was released on sabbatical from Korea University, Seoul, South Korea to work in the team and conduct analyses. We acknowledge the important contribution of Professor George Brown and Tirril Harris to the research programme. We would like to thank Rebecca Baines, Bronwen Ball, Kate Benaim, Joanne Cavagin, Lucie Reader, Helen Rickard, Katherine Stanford and Lisa Steinberg for data collection. Thanks are also due to Dr. Soumitra Pathare for checking reliability of psychiatric ratings and to Laurence Letchford for computer analyses. Finally, we are grateful to the Islington families who generously, and patiently, participated in this research over the two waves of study.

Author information

Authors and Affiliations

  1. Lifespan Research Group, Royal Holloway, University of Lzondon , 11, Bedford Square, London, WC1B 3RF, UK

    Antonia Bifulco PhD, Catherine Jacobs BSc, Patricia M. Moran PhD & Amanda Bunn BA

  2. Dept. of Psychology, Korea University, Seoul, Korea

    Junghye Kwon PhD

  3. Dept. of Psychology, London Metropolitan University, London, UK

    Nils Beer MSc

Authors
  1. Antonia Bifulco PhD
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  2. Junghye Kwon PhD
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  3. Catherine Jacobs BSc
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  4. Patricia M. Moran PhD
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  5. Amanda Bunn BA
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  6. Nils Beer MSc
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Corresponding author

Correspondence to Antonia Bifulco PhD.

Appendix

Appendix

Logistic regression test of mediation: Highly Fearful or Angry-dismissive attachment style mediating the relationship between childhood neglect/ abuse and adult disorder.

Regression analyses

Predictor (IV)

Criterion (DV)

Exp(B)/SE

P

1

Childhood Neglect/abuse

Anxiety or depression at follow-up interview

2.09 (0.33)

0.02

2

Childhood Neglect/abuse

Highly Fearful or Angry-dismissive attachment style at interview 1

4.34 (0.40)

0.0003

3

Childhood Neglect/abuse

Anxiety or Depression at follow-up interview

1.42 (0.36)

NS

Highly Fearful or Angry-Dismissive attachment style

4.95 (0.41)

0.0001

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Bifulco, A., Kwon, J., Jacobs, C. et al. Adult attachment style as mediator between childhood neglect/abuse and adult depression and anxiety. Soc Psychiat Epidemiol 41, 796–805 (2006). https://doi.org/10.1007/s00127-006-0101-z

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