The origins of cognitive vulnerability in early childhood: mechanisms linking early attachment to later depression

The Development of the Attachment Defenses Questionnaire (ADQ-50): A Preliminary Examination of Reliability, Validity, and Factor Structure

This paper marks the initial phase in the development of the Attachment Defenses Questionnaire (ADQ-50), a self-report tool crafted to assess defense mechanisms associated with attachment processes, catering to both clinical and research contexts. Anchored in the theoretical framework of attachment theory, the ADQ posits that an individual's internalized attachment style plays a influential role in predicting their defense mechanisms. The paper outlines the comprehensive development and refinement process of the ADQ-50. In Study 1 a preliminary 176-item version of the ADQ was examined. Data was collected online drawing from participants sourced from Prolific and undergraduate students (N = 1994). Study 2 further refined the ADQ, evaluating its initial convergent validity with a diverse participant pool (N = 726), including undergraduates, Prolific contributors, general practice medical patients, and individuals from social media. Exploratory factor analysis revealed a robust ten-factor structure, resulting in a 50-item scale aligning with theoretical expectations and demonstrating good psychometric properties. Findings, limitations, strengths and future research directions are discussed. We posit that the ADQ holds great potential to deepen our comprehension of defense mechanisms linked to attachment, with wide-ranging implications for clinical practices.

Children's neural reactivity to maternal praise and criticism: Associations with early depressive symptoms and maternal depression

Caregiving experiences are implicated in children's depression risk; however, children's neural reactivity to positive and negative feedback from mothers, a potential mediator of depression risk, is poorly understood. In a sample of 81 children (Mage = 11.12 years, SDage = 0.63), some of whom were recruited based on a maternal history of depression (n = 29), we used fMRI to characterize children's neural responses to maternal praise and criticism. Maternal history of depression was unrelated to children's brain activity during both the praise and criticism conditions; however, ROI analyses showed that children's self-reported depressive symptoms were negatively associated with functional activity in the left anterior insula and right putamen while hearing maternal criticism. Whole-brain analyses showed that children's depressive symptoms were positively associated with left inferior frontal gyrus activity while listening to maternal praise. These findings complement past work implicating these brain regions in the processing of emotionally salient stimuli, reward processing, and internal speech. Given associations between early depressive symptoms and later disorder, findings suggest that maladaptive neural processing of maternal feedback may contribute to children's early emerging risk for depression.

Resilience to depression: Implication for psychological vaccination

From the vulnerability perspective, we often ask the question "why someone suffers from depression?" Despite outstanding achievements along this line, we still face high occurrence or recurrence and unsatisfied therapeutic efficacy of depression, suggesting that solely focusing on vulnerability perspective is insufficient to prevent and cure depression. Importantly, although experiencing same adversity, most people do not suffer from depression but manifest certain resilience, which could be used to prevent and cure depression, however, the systematic review is still lack. Here, we propose the concept "resilience to depression" to emphasize resilient diathesis against depression, by asking the question "why someone is exempted from depression?" Research evidence of resilience to depression has been reviewed systematically: positive cognitive style (clear purpose in life, hopefulness, et al.), positive emotion (emotional stability, et al.), adaptive behavior (extraversion, internal self-control, et al.), strong social interaction (gratitude and love, et al.), and neural foundation (dopamine circuit, et al.). Inspired by these evidence, "psychological vaccination" could be achieved by well-known real-world natural-stress vaccination (mild, controllable, and adaptive of stress, with help from parents or leaders) or newly developed "clinical vaccination" (positive activity intervention for current depression, preventive cognitive therapy for remitted depression, et al.), both of which aim to enhance the resilient psychological diathesis against depression, through events or training. Potential neural circuit vaccination was further discussed. This review calls for directing attention to resilient diathesis against depression, which offers a new thinking "psychological vaccination" in both prevention and therapy of depression.

The Mediating Role of Affective Empathy in the Relationship Between Insecure Attachment and Depressive Symptoms Among Emerging Adult

Insecure attachment is regarded as a risk factor for depressive symptoms. However, insecure attachment can be divided into attachment avoidance and anxiety, so a better understanding of the relationship between attachment avoidance, attachment anxiety, and depressive symptoms is needed. The current study applied a structural equation model to verify our hypothesis that different facets of affective empathy mediate the relationship between attachment avoidance, attachment anxiety, and depressive symptoms. The participants of this study included four hundred and sixty-four undergraduate students who completed the Experiences in Close Relationships-Relationship Structures Questionnaire, Interpersonal Reactivity Index, and Center for Epidemiologic Studies Depression Scale. The results indicated that the correlation between attachment avoidance and depressive symptoms was mediated by empathic concern, while the correlation between attachment anxiety and depressive symptoms was mediated by personal distress. These results implied that attachment avoidance and attachment anxiety work on depressive symptoms through different pathways.

Mediational Effect of Fairburn's Transdiagnostic Mechanisms Between Attachment to the Mother and Eating Disorder Symptoms in a Clinical Sample

Objective

Research has supported a link between insecure attachment and eating disorders (EDs); however, little is known about how this influence is exerted in young female EDs patients. This study tested, for the first time, a multiple mediational model, wherein the four Fairburn’s transdiagnostic mechanisms mediated the relationship between attachment to the mother and ED symptoms.

Methods

A total of 101 female young EDs patients aged 15–24 were administered the Inventory of Parent and Peer Attachment, Eating Disorder Inventory-3 and Eating Attitudes Test-26 to assess attachment, the four transdiagnostic maintaining mechanisms and ED symptoms, respectively.

Results

Comparison analyses showed that there were no significant differences between the diagnostic groups in terms of attachment and the transdiagnostic variables. Multiple mediational analyses indicated that low self-esteem and clinical perfectionism were significant mediators between insecure attachment to the mother and ED symptoms, while controlling for depressive symptoms.

Conclusion

These findings suggest that the distal risk influence of insecure attachment to the mother in the development of ED symptoms might be explained by low self-esteem and high clinical perfectionism, controlling for depressive symptoms. Further investigation into the efficacy of cognitive-behavioral treatments targeting insecure attachment representations for young EDs patients is recommended.

The role of insecure attachment and psychological mechanisms in paranoid and depressive symptoms: An exploratory model

Attachment theory is considered an important theoretical framework for understanding the ontogenesis of psychopathology. In this regard, insecure attachment styles have been associated with the development and maintenance of paranoid and depressive symptoms. Furthermore, different psychological processes (i.e., self-esteem and experiential avoidance) have been identified as mediating mechanisms between the relationship of insecure attachment and these symptoms. Nowadays, there is a more positive view in psychology focusing on factors that contribute to well-being, although little is known about the role of these psychological well-being variables as mediators between insecure attachment and psychopathology. For thus, the aim of this study was to test one explorative structural equation model of insecure attachment on paranoid and depressive symptoms through psychological mediating mechanisms to elucidate the processes involved in each of them. To evaluate the model, 141 individuals with severe psychiatric conditions participated in the study. The results revealed good model fit, highlighting that avoidant attachment has a direct and indirect effect on the symptoms, while anxious attachment has only an indirect effect through mediating mechanisms. On the other hand, lower levels of self-acceptance and environmental mastery have been identified as important processes associated with paranoid and depressive symptoms. However, less positive relationships were a significant mediating mechanism only for paranoid ideation symptoms. These results have important clinical implications by shedding light on the relationship between insecure attachment, paranoid and depressive symptoms, and the psychological mediating mechanisms involved in this relationship, which may be considered key variables in clinical treatments.

Attachment and the Development of Depressive Symptoms in Adolescence: The Role of Regulating Positive and Negative Affect

Although widely accepted, attachment theory's hypothesis that insecure attachment is associated with the development of depressive symptoms through emotion regulation strategies has never been longitudinally tested in adolescence. Additionally, previous research only focused on strategies for regulating negative affect, whereas strategies for regulating positive affect may also serve as a mechanism linking insecure attachment to depressive symptoms. This study aimed to fill these research gaps by testing whether the association between attachment and change in depressive symptoms over time is explained by strategies for regulating negative and positive affect in adolescence. Adolescents (N = 1706; 53% girls; Mage = 12.78 years, SDage = 1.54 at Time 1) were tested three times, with a 1-year interval between measurement times. They reported on their attachment anxiety and avoidance at Time 1, depressive symptoms at Times 1 and 3, and regulation of negative affect (brooding and dampening) and positive affect (focusing and reflection) at Time 2. The results from multiple mediation analyses showed that more anxiously attached adolescents developed more depressive symptoms via increased brooding and dampening. More avoidantly attached adolescents developed more depressive symptoms via decreased focusing. These findings provide longitudinal support for attachment theory's emotion regulation hypothesis, and show that the regulation of both negative and positive affect is important.

Social Support, Attachment Closeness, and Self-Esteem Affect Depression in International Students in China

With an increase in the number of international students in China, there has been a simultaneous increase in their emotional problems, such as depression, as well as the importance of their emotional well-being. This study aimed to investigate the influence of social support on depression and the mediation and moderation mechanisms of this relationship in international students. In total, 349 international students in China responded to a questionnaire survey comprising the Social Support Rating Scale, Self-rating Depression Scale, Adult Attachment Scale, and Self-Esteem Scale. The results showed that: (1) attachment closeness had a significant direct predictive effect on depression; (2) attachment closeness played a mediating role in the relationship between social support and depression; and (3) the direct effect of social support on depression and the mediating effect of attachment and closeness are regulated by self-esteem. Therefore, interventions aimed at improving the social support, attachment closeness, and self-esteem of international students in China can be effective in reducing their depressive symptoms.

Does the Psychopathology of the Parents Predict the Developmental-Emotional Problems of the Toddlers?

Introduction

Parental psychopathology has been defined in respect of psychopathological development in early childhood. This study aimed to investigate the effects of parental psychopathologies on social and emotional problems in the age range of 1-3 years and to determine children at risk.

Methods

The study data were obtained from the 2009 Early Childhood Mental Health Profile taking population distribution into consideration with the properties representing Turkey. The primary caregiver of the child completed the Psychiatric Evaluation Form for 1-3 years, the Brief Infant-Toddler Social Emotional Assessment (BITSEA), the Ages and Stages Questionnaire (ASQ), and the Brief Symptom Inventory (BSI) for themselves. Machine learning models used for prediction. The performance of prediction models was evaluated with the ten-fold cross-validation method. Area Under Curve (AUC) values were calculated with Receiver Operating Characteristic (ROC) curves to evaluate the performance of each model.

Results

The evaluation was made of the data of 2775 children, comprising 1507 (54.3%) males and 1268 (45.7%) females with a mean age of 26.19±9.11 months (range, 10-48 months). A total of 106 children were identified as at risk, as they were above the clinical cut-off point (1.5 standard deviations) of the BITSEA points and below the cut-off points of any one of the developmental areas of the ASQ. Modeling was applied to the data of these 106 children. The Support Vector Machines (SVM) model was selected for prediction with the automatically optimized highest AUC value. Weighting for the SVM algorithm showed mothers' BSI scores, fathers' education and health problems, duration of breastfeeding, unplanned pregnancy are significant for predicting BITSEA-problem scores in the model.

Conclusion

To be able to understand the complex relationship with parental psychopathology and behavioral problems, machine learning methods were used successfully in this study. Further studies with more massive data sets, more extended follow-up periods, and stronger algorithms will be able to identify risk groups earlier and allow early interventions to be implemented.

Mediational mechanisms involved in the relation between attachment insecurity and depression: A meta-analysis

BACKGROUND

Several studies have investigated the intermediate variables or mediators through which attachment insecurity influence the development of depression. However, there has not been a systematic synthesis of this literature to date. The current meta-analytic review aimed at identifying such mediators and quantifying their effect size.

METHODS

We systematically searched Medline, Pubmed, Psycinfo, Embase, Proceedings Web of Science and ProQuest Dissertations & Theses Global up until May 2019. 108 studies met inclusion criteria (i.e., investigated intermediate variables that explain the effect of attachment insecurity [exposure] on depressive symptoms [outcome]). Standardized regression coefficients of the indirect and total paths of mediation models of 80 studies were pooled using the inverse of their variance as a weight. Studies were coded and ranked for quality.

RESULTS

Dysfunctional attitudes (β = 0.10, 95% CI = 0.01 to 0.20), self-criticism (β = 0.17, 95% CI = 0.04 to 0.28), low self-compassion (β = 0.16, 95% CI = 0.02 to 0.29), and cognitive hyperactivating regulation strategies (β = 0.13, 95% CI = 0.05 to 0.20), such as repetitive thinking (β = 0.17, 95% CI = 0.07 to 0.28), and particularly, brooding rumination β = 0.20, 95% CI = 0.07 to 0.32), mediated the association between insecure attachment and depressive symptoms. Indirect effects were only significant among adult populations.

LIMITATIONS

The methodological quality of studies was mostly moderate to low and analyses revealed considerable heterogeneity.

CONCLUSION

Our findings support the direct targeting of cognitive-emotional psychological mechanisms in prevention programs and treatment of depression. More longitudinal studies are needed to clarify the interplay of such mediators along with other interpersonal factors between insecure attachment and depression.

Parents' Personality-Disorder Symptoms Predict Children's Symptoms of Anxiety and Depressive Disorders - a Prospective Cohort Study

Personality disorder (PD) symptomatology is characterized by interpersonal problems and emotional dysregulation, which may affect offspring of parents with PD symptoms. Notably though, studies are needed to discern (i) whether parental PDs forecast symptoms of psychiatric disorders in offspring during their childhood years and (ii) whether such prospective relations obtain after accounting for common causes (e.g., genetics, common methods). To address these issues, we followed up a community sample of Norwegian children biennially from ages 4 to 8 (n = 594), using a semi-structured psychiatric interview (PAPA/CAPA) to capture DSM-IV defined symptoms of emotional disorders. Parental symptoms of personality disorders were captured by the DSM-IV and ICD-10 Personality Questionnaire (DIP-Q), whereas depression and anxiety in caregivers were measured using the Beck Depression Inventory -II and Beck Anxiety Inventory, respectively. Upon applying a hybrid fixed and random effects method that takes into account all unmeasured time-invariant confounders, we found that: (i) Parental symptoms of DSM-IV defined Cluster A and C were related to symptoms of anxiety disorders in offspring two years later, even after accounting for children's initial levels of anxiety and parental anxiety, whereas (ii) Parental DSM-IV Cluster B predicted symptoms of depressive disorders in children, adjusted for children's initial levels of depression and parental depression. Clinical implications of the results are discussed.

Mediating role of depressive symptoms linking insecure attachment and disordered eating in adolescents: A multiwave longitudinal study

Research has supported a link between insecure attachment and disordered eating in adolescents; however, how this influence is exerted remains unclear. This study explored whether depressive symptoms constitute a pathway through which insecure attachment to parents predicts subsequent development of disordered eating in the transition from childhood to adolescence. The study also examines whether there are differential effects regarding the attachment figure, child's gender, or reciprocity between variables. A community-based sample of Spanish youth (n = 904; 49.4% girls) was followed biennially from age 10 to 16 years. Attachment, depressive symptoms, and disordered eating were measured using the Inventory of Parental and Peer Attachment, Children's Depression Inventory, and Children's Eating Attitudes Test, respectively. Prospective data were analyzed using a dynamic panel model, which accounts for unmeasured time-invariant factors. Whereas insecure attachment to the father did not predict later depression or disordered eating, higher insecure attachment to the mother at ages 10 and 12 years predicted more disordered eating at ages 14 and 16 years via increased depressive symptoms at ages 12 and 14 years. No child's gender-specific or reverse mediational effects were found. This study suggests that an increase in depressive symptoms might be one mechanism by which insecure attachment exerts its influence on the development of eating disorders symptomatology in adolescence. Intervention efforts aimed at strengthening particularly the mother-child attachment relationship may reduce the vulnerability to develop depressive symptoms and disordered eating.

Attachment to Parents and Peers and Adolescent Mental Health: The Mediating Role of Alexithymia

The current research aims to study the mediating role of alexithymia on the relationship between attachment to parents and peers and mental health problems in a sample of 242 non-referred adolescents. Participants completed the Inventory of Parent and Peer Attachment, the Toronto Alexithymia Scale, and the Symptom Check List-90-R. Mediation analysis shows that alexithymia fully mediates the relations between attachment to peers and mental health problems in both adolescent males and females. Findings suggest the importance to identify promptly vulnerabilities and risks in order to create prevention and intervention programs aimed to foster positive attachment experiences and to support emotional regulation.

Predictors of treatment outcome in OCD: An interpersonal perspective

Although effective treatments for obsessive compulsive disorder (OCD) are increasingly available, a considerable percentage of patients fails to respond or relapses. Predictors associated with improved outcome of OCD were identified. However, information on interpersonal determinants is lacking. This study investigated the contribution of attachment style and expressed emotion to the outcome of exposure and response prevention (ERP), while accounting for previously documented intrapersonal (i.e., symptom severity and personality pathology) predictors. Using logistic regression analyses and multi-level modeling, we examined predictors of treatment completion and outcome among 118 adult OCD patients who entered ERP. We assessed outcome at post treatment, and at four and 13 months from treatment completion. OCD baseline severity and fearful attachment style emerged as the main moderators of treatment outcome. Severe and fearfully attached patients were more likely to dropout prematurely. The improvement of fearful clients was attenuated throughout treatment and follow-up compared to non-fearful clients. However, their symptom worsening at the long-term was also mitigated. Severe OCD patients had a more rapid symptom reduction during treatment and at follow-up, compared to less severe clients. The findings suggest that both baseline OCD severity and fearful attachment style play a role in the long-term outcome of ERP.

Attachment Style of Volunteer Counselors in Telephone Emergency Services Predicts Counseling Process

Telephone emergency services (TES) provide emotional support and aim to prevent suicide. The current study examines a potential change of volunteer counselors' attachment characteristics during TES training and investigates the predictive influence of counselor attachment for their competence and working alliance with callers. We recruited 261 volunteers enrolled in training for paraprofessional counseling in the German Telephone Emergency Service (TelefonSeelsorge). Participants were assessed three times during their training (mean training duration 13.3 months) and responded to questionnaires on adult attachment (Experience in Close Relationships-Revised) and their counseling competence (adapted Development of Psychotherapists Common Core Questionnaire). In addition, they indicated the quality of the working alliance (adapted Working Alliance Inventory - Short, Revised) with their client callers upon training completion. Results showed that attachment anxiety, but not attachment avoidance, significantly decreased during training. Lower attachment avoidance predicted better working alliances with callers as well as better general skillfulness. Implications for the training of volunteer telephone counselors are discussed.

Prospective Bidirectional Associations between Attachment and Depressive Symptoms from Middle Childhood to Adolescence

Insecure attachment to parents consistently correlates with adolescent depression. However, the order of cause and effect, the impact of confounding, and gender disparities in this relationship remain unresolved. The present study therefore examined the prospective associations between attachment relationships to mothers and fathers and depressive symptoms in a community sample of Spanish children (n = 904; 49.4% females) assessed biennially from age 10-16 years, net of all unmeasured time-invariant confounding. Insecure relationships predicted depressive symptoms, and more so among girls, but depressive symptoms also forecasted worsened attachment relationships. At ages 12-14, mother-child attachment proved to be more important for the development of depressive symptoms than father-child attachment. These findings reveal a pattern of reciprocal influence between attachment relationships and depressive symptoms that appears to vary as a function of the parental and child's gender and developmental period. Thus, efforts aimed at strengthening the parent-child attachment relationship-across the transition from middle childhood to adolescence-may prevent or reduce depressive symptoms, especially by targeting mothers and female adolescents.

The effect of content and tone of maternal evaluative feedback on self-cognitions and affect in young children

Feedback that young children receive from others can affect their emotions and emerging self-views. The current experiment tested the effect of negative content (criticism) and negative tone (hostile) of the feedback on children's affect, self-evaluations, and attributions. We also explored whether maternal history of depression and children's temperament moderated these relations. Participants were 152 mothers and children (48% girls) aged 4 and 5 years (M = 61.6 months, SD = 6.83). The task involved three scenarios enacted by dolls; a child doll made something (e.g., picture, house, numbers) that had a mistake (e.g., no windows on the house) and proudly showed it to the mother doll, who then gave feedback (standardized, audio recorded) to the child. Children were randomized to one of four maternal feedback conditions: negative or neutral content in either a negative or neutral tone. Negative content (criticism) produced significantly more negative affect and lower self-evaluations than neutral content. When the tone of the feedback was hostile, children of mothers who had been depressed during the children's lifetimes were significantly more likely to make internal attributions for mistakes than children of nondepressed mothers. In addition, among children with low temperamental negative affectivity, in the presence of negative tone, negative content significantly predicted more internal attributions for the errors. Findings are discussed in terms of understanding the role of evaluative feedback in children's emerging social cognitions and affect.

Developmental trajectories of attachment and depressive symptoms in children and adolescents

Previous research has found that insecure attachment is associated with depression. In the present study, we use an accelerated longitudinal cohort design to examine how the association between attachment and depression develops during childhood and adolescence. Specifically, 690 children from 3 distinct cohorts (grades 3, 6, and 9) completed self-report measures of attachment and depressive symptoms 3 times over 3 years. Growth curve analyses indicated that attachment anxiety and attachment avoidance were uniquely related to depressive symptoms. Higher levels of attachment anxiety and avoidance predicted higher levels of depressive symptoms over time. Additionally, changes in attachment security were associated with changes in depressive symptoms. The analyses suggest that insecure attachment and depressive symptoms co-vary and that these dynamics are evident in childhood and adolescence.

Measurement of heart rate variability and cognitive abilities based on attachment styles in children with chronic medical conditions

Recognizing the biopsychosocial dimensions of chronic medical conditions in children and preparing them to adapt to medical processes is one of the most significant issues in the field of health psychology. The aim of this study was to measure heart rate variability and cognitive abilities based on attachment style in children with chronic medical conditions. To this end, 45 children aged 12-15 years who had received a diagnosis of a chronic medical disease and were matched with the inclusion/exclusion criteria, were entered the study using available sampling method. These children were assigned to three groups of secure, avoidance and anxiety attachment style based on the Collins and Reid Attachment Scale. These groups had been demographically homogeneous. Then heart rate variability and cognitive abilities were measured. One-way ANOVA results showed a significant difference between the three groups in the heart rate variability and cognitive abilities. Post hoc test showed that children with secure attachment style had higher efficiency in heart rate variability and cognitive abilities. These results indicate that attachment style is one of the factors influencing the health status of children with chronic medical illness. These findings highlight the importance of paying attention to psychological factors, especially attachment and its role in the health status of children with chronic medical conditions.

Mediators linking insecure attachment to eating symptoms: A systematic review and meta-analysis

In the last two decades, the number of studies focused on the mediators connecting insecure attachment with Eating Disorders (EDs), at both clinical and sub-clinical level, has considerably increased. However, there has not been a systematic synthesis of this literature to date. To fill this gap, the current meta-analytic review aimed at identifying and quantifying the extent to which mediators contribute to the explanation of this relationship. The present study was registered with PROSPERO (CRD42017076807). A comprehensive search process in seven different electronic databases retrieved 24 studies that examined how insecure attachment leads to ED symptoms through mediation analysis. Standardized regression coefficients of the indirect and total paths of 21 mediation models were pooled. Studies were coded and ranked for quality. We found evidence to show that maladaptive emotion regulation and depressive symptoms had the highest effect size for mediation (mediation ratio [P_M] = 0.71). Further, body dissatisfaction, neuroticism, perfectionism, mindfulness and social comparison had significant, but moderate to low mediating effects (P_M = 0.21–0.58). The methodological quality of these studies was mostly low to moderate and potential areas for development were highlighted. Our findings support the direct targeting of these psychological constructs in prevention programs and treatment of EDs. Future investigations addressing the time sequence between the variables will provide valuable clues to untangle the prospective contribution of each variable on the development and maintenance of eating pathology.

A prognostic index for long-term outcome after successful acute phase cognitive therapy and interpersonal psychotherapy for major depressive disorder

BACKGROUND

Major depressive disorder (MDD) has a highly recurrent nature. After successful treatment, it is important to identify individuals who are at risk of an unfavorable long-term course. Despite extensive research, there is no consensus yet on the clinically relevant predictors of long-term outcome in MDD, and no prediction models are implemented in clinical practice. The aim of this study was to create a prognostic index (PI) to estimate long-term depression severity after successful and high quality acute treatment for MDD.

METHODS

Data come from responders to cognitive therapy (CT) and interpersonal psychotherapy (IPT) in a randomized clinical trial (n = 85; CT = 45, IPT = 40). Primary outcome was depression severity, assessed with the Beck Depression Inventory II, measured throughout a 17-month follow-up phase. We examined 29 variables as potential predictors, using a model-based recursive partitioning method and bootstrap resampling in conjunction with backwards elimination. The selected predictors were combined into a PI. Individual PI scores were estimated using a cross-validation approach.

RESULTS

A total of three post-treatment predictors were identified: depression severity, hopelessness, and self-esteem. Cross-validated PI scores evidenced a strong correlation (r = 0.60) with follow-up depression severity.

CONCLUSION

Long-term predictions of MDD are multifactorial, involving a combination of variables that each has a small prognostic effect. If replicated and validated, the PI can be implemented to predict follow-up depression severity for each individual after acute treatment response, and to personalize long-term treatment strategies.

Extent of Depression in Juvenile and Adolescent Patients with Idiopathic Scoliosis During Treatment with Braces

OBJECTIVE

We compared the depression levels of juvenile and adolescent patients with idiopathic scoliosis who had undergone bracing and identified the factors that influenced the extent of depression in these patients.

METHODS

Our study included 112 patients with adolescent idiopathic scoliosis (AIS) and 96 patients with juvenile idiopathic scoliosis (JIS). The demographic characteristics and Zung Self-Rating Depression Scale, Strengths and Difficulties Questionnaire, and Center for Epidemiological Studies Depression Scale for Children scores were evaluated to select the relative factors of depression in patients and parents. Cognitive evaluations, using the Wechsler Intelligence Scale for Children-Revised scale, and an independent evaluation using the Functional Independence Measure for Children scale, were conducted.

RESULTS

The mean Center for Epidemiological Studies Depression Scale for Children score in the AIS group (38.3 ± 3.0) was greater than that in the JIS group (23.8 ± 4.6), a statistically significant difference (P < 0.05). Age at initial bracing, bracing duration, parental depression, Cobb angle at initial bracing, cognitive function, independence, peer problems, prosocial behaviors, emotional symptoms, and total difficulties were significant factors in our regression model for JIS. The AIS patients showed similar results, except for the age at initial bracing, cognitive function, and independence.

CONCLUSIONS

Patients with AIS and JIS who had undergone bracing showed differences in the extent of depression, and female adolescents were more vulnerable to depressive psychological status. Higher levels of cognitive function and independence and older age at bracing, longer bracing duration, larger Cobb angle, negative parental attitudes, and undesirable Strengths and Difficulties Questionnaire scores contributed to greater depression.

Recalled Parenting Practices and Psychological Distress in Turkish Emerging Adults: The Role of Self-Criticism

Research investigating the development of psychological problems among children has typically focused on the role of parenting practices. The purpose of this study was to investigate the direct effects of recalled parenting practices (emotional warmth, rejection, and overprotection) on psychological distress and indirect effects through self-criticism. Participants were 410 undergraduate students (290 females and 120 males) with a mean age of 20.10 ( SD = 1.65). Participants completed the measure of My Memories of Upbringing—Egna Minnen Betraffande Uppfostra; Forms of Self Criticizing/Attacking and Self Reassuring Scale; and Depression, Anxiety, and Stress Scale as self-report measures. Results provided evidence for highly similar patterns of associations among parenting practices, self-criticism, and psychological distress for both maternal and paternal models. Findings showed that parental emotional warmth and rejection were directly related to self-criticism and were indirectly related to psychological distress through self-criticism. Only maternal rejection was directly related to psychological distress. However, maternal and paternal overprotection was not related to psychological distress either directly or indirectly. Moreover, maternal and paternal parenting practices explained 61% and 58% of the variance in psychological distress, respectively. The findings of the present study highlighted the importance of self-criticism and past memories of parenting as intervention targets to support well-being of young people.

Antecedents of Looming Cognitive Style: Associations With Reported Perceived Parenting and Attachment

Looming Cognitive Style, which was proposed as cognitive vulnerability model specific for anxiety disorders, suggests that anxiety-prone individuals have a tendency to perceive threats and dangers as getting closer, becoming larger, and more agonizing every passing minute. Yet, very few studies focused on the family-related variables that are associated with development of Looming Cognitive Style. This study aims to investigate the relationship of Looming Cognitive Style with measures perceived parenting and attachment. A cross-sectional study was conducted with 389 university students aged between 18 and 35 as participants. The participants were assessed through Looming Cognitive Style, perceived parenting, attachment anxiety, and avoidance. Hierarchical regression analyses indicated Looming Cognitive Style to be significantly predicted by maternal overprotection and anxiety dimension of attachment. The results are important in understanding how parenting-related variables are related to development of cognitive vulnerabilities specific to anxiety disorders.

Positive Social Interactions in a Lifespan Perspective with a Focus on Opioidergic and Oxytocinergic Systems: Implications for Neuroprotection

In recent years, a growing interest has emerged in the beneficial effects of positive social interactions on health. The present work aims to review animal and human studies linking social interactions and health throughout the lifespan, with a focus on current knowledge of the possible mediating role of opioids and oxytocin. During the prenatal period, a positive social environment contributes to regulating maternal stress response and protecting the fetus from exposure to maternal active glucocorticoids. Throughout development, positive social contact with the caregiver acts as a “hidden regulator” and promotes infant neuroaffective development. Postnatal social neuroprotection interventions involving caregiver–infant physical contact seem to be crucial for rescuing preterm infants at risk for neurodevelopmental disorders. Attachment figures and friendships in adulthood continue to have a protective role for health and brain functioning, counteracting brain aging. In humans, implementation of meditative practices that promote compassionate motivation and prosocial behavior appears beneficial for health in adolescents and adults. Human and animal studies suggest the oxytocinergic and opioidergic systems are important mediators of the effects of social interactions. However, most of the studies focus on a specific phase of life (i.e., adulthood). Future studies should focus on the role of opioids and oxytocin in positive social interactions adopting a lifespan perspective.

Investigation of associations between attachment, parenting and schizotypy during the postnatal period

BACKGROUND

Parenting can be a stressful experience particularly for people with mental health problems or people who experienced abuse or attachment difficulties in their own childhoods. This study examined the relationships between earlier trauma, attachment, parenting and schizotypy in a non-clinical sample, with the specific hypothesis that parenting stress and competence would mediate any association between trauma, attachment and schizotypy.

METHODS

One hundred and thirty-four first time parents with a child under 12 months old completed the following questionnaires online: the Experiences of Close Relationships Scale - Short Form (ECR-S), the Schizotypal Personality Questionnaire - Brief, Revised (SPQ-BR) the Parenting Stress Scale, the Parenting Sense of Competence Scale (PSOC) and the Adverse Childhood Experiences (ACE) Questionnaire.

RESULTS

Parenting stress mediated the association between attachment and schizotypy, though parenting competence did not have a significant effect as a mediator in a parallel model. Childhood trauma was associated with attachment and schizotypy but did not correlate with the parenting variables.

LIMITATIONS

The study utilised a cross-sectional design and self-report measures which limits the ability to make causal inferences from the results. However, findings warrant replication in clinical samples with psychosis.

CONCLUSIONS

The study adds to the understanding of what may exacerbate schizotypal symptoms in the first 12 months postpartum as parental attachment insecurity and parental stress together predicted elevated self-reported experiences of schizotypal symptoms.

Friendship Attachment Style Moderates the Effect of Adolescent Exposure to Violence on Emerging Adult Depression and Anxiety Trajectories

Exposure to violence during adolescence is associated with increased risk behaviors and mental health problems in adulthood. Friendship attachment during adolescence may, however, mitigate the negative effects of exposure to violence on trajectories of depression and anxiety in young adulthood. In this study, we used growth curve modeling to examine associations between exposure to violence and mental health outcomes, followed by multi-group analyses with friendship attachment as the moderator. The sample was drawn from a longitudinal study (12 waves; 1994-2012) of 676 (54% female) urban high school students. We found strong positive associations between exposure to violence during adolescence and later self-reported depressive and anxiety symptoms. Notably, securely attached adolescents reported faster decreases in mental health symptoms as a function of violence relative to their insecurely attached peers as they transitioned into adulthood.

Psychometric properties of the attachment style questionnaire in Swedish pregnant women: short and full versions

OBJECTIVES

(i) To evaluate the reliability and factor structure of the Attachment Style Questionnaire - Short Form (ASQ-SF) for use in pregnant women and (ii) to compare the reliability and factor structure of the short- and full version-ASQ among pregnant women.

BACKGROUND

Adult attachment insecurity is currently included as a major risk factor in studies of perinatal health. None of the self-report measures with a Swedish translation have been psychometrically evaluated in a pregnant cohort.

METHODS

A population-based cohort of 1631 pregnant women answered the ASQ in late pregnancy. Internal consistency (item-subscale correlations, Cronbach's α, and α if item deleted) was evaluated for the seven available subscales. Confirmatory factor analysis (CFA) was run to examine the factor structure of the short form compared with the full-version. Test-retest correlations were assessed in a subgroup (n = 48).

RESULTS

All mean item-subscale correlations for the ASQ-SF were > 0.30. Cronbach's α's for ASQ-SF dimensions were as follows: Avoidance (0.87); Anxiety (0.89); Discomfort with Closeness (0.85); Relationships as Secondary (0.54); Confidence (0.83); Need for Approval (0.76); and Preoccupation with Relationships (0.77). No item removal substantively increased subscale α's. The CFA demonstrated better model fit for the ASQ-SF than for the full-version ASQ, while other reliability measures were similar. Test-retest correlations ranged from 0.65 to 0.84.

CONCLUSION

The ASQ-SF showed similar psychometric properties in pregnant women as in the general population and had good reliability, but the optimal factor structure needs to be studied further. Results support the usage of the ASQ-SF in pregnant cohorts.

Attachment, dysfunctional attitudes, self-esteem, and association to depressive symptoms in patients with mood disorders

BACKGROUND

Cognitive factors might be the link between early attachment experiences and later depression. Similar cognitive vulnerability factors are discussed as relevant for both unipolar and bipolar disorders. The goals of the study were to test if there are any differences concerning attachment style and cognitive factors between remitted unipolar and bipolar patients compared to controls, and to test if the association between attachment style and depressive symptoms is mediated by cognitive factors.

METHODS

A path model was tested in 182 participants (61 with remitted unipolar and 61 with remitted bipolar disorder, and 60 healthy subjects) in which adult attachment insecurity was hypothesized to affect subsyndromal depressive symptoms through the partial mediation of dysfunctional attitudes and self-esteem.

RESULTS

No differences between patients with remitted unipolar and bipolar disorders concerning attachment style, dysfunctional attitudes, self-esteem, and subsyndromal depressive symptoms were found, but both groups reported a more dysfunctional pattern than healthy controls. The path models confirmed that the relationship between attachment style and depressive symptoms was mediated by the cognitive variables 'dysfunctional attitudes' and 'self-esteem'.

LIMITATIONS

With the cross-sectional nature of the study, results cannot explain causal development over time.

CONCLUSIONS

The results emphasize the relevance of a more elaborate understanding of cognitive and interpersonal factors in mood disorders. It is important to address cognitive biases and interpersonal experiences in treatment of mood disorders.

The Association between the Parent-Child Relationship and Symptoms of Anxiety and Depression: The Roles of Attachment and Perceived Spouse Attachment Behaviors

Research shows that the parent-child relationship affects attachment security, which correlates with anxiety and depression in adulthood. Additional research shows that romantic attachment behaviors may supersede individual attachment security and buffer against negative processes. Using data from 680 married couples in the general population, we examined whether attachment mediates the link between the parent-child relationship and depressive and anxiety symptoms in adulthood. In addition, we tested whether perceived spouse attachment behaviors moderate the effects of attachment insecurity. There was an indirect effect of poor parent-child relationships on symptoms via insecure attachment. Perception of spouse's attachment behaviors was related to depression for both spouses, and they moderated the effect of attachment insecurity on depressive symptoms for husbands. Clinical implications are discussed.

Childhood Maltreatment and Perinatal Mood and Anxiety Disorders: A Systematic Review

Perinatal mood and anxiety disorders (PMADs) compromise maternal and child well-being and may be influenced by traumatic experiences across the life course. A potent and common form of trauma is childhood maltreatment, but its specific impact on PMADs is not well understood. A systematic review was undertaken to synthesize empirical literature on the relationship between maternal histories of childhood maltreatment and PMADs. Of the 876 citations retrieved, 35 reports from a total of 26,239 participants met inclusion criteria, documenting substantial rates of childhood maltreatment and PMADs. Robust trends of association were observed between childhood maltreatment and perinatal depression, as well as post-traumatic stress disorder, but findings for anxiety were less consistent. Examining multivariate results suggested that childhood maltreatment predicts PMADs above and beyond sociodemographic, psychiatric, perinatal, and psychosocial factors, but may also be partially mediated by variables such as later victimization and moderated by protective early relationships. Future research should test mediating and moderating pathways using prospective cohorts, expanding to cross-cultural settings and other disorder outcomes. Treatment and prevention of childhood maltreatment and its sequelae may help mitigate risk for perinatal psychopathology and its impact on maternal and child outcomes.

Social anxiety as a potential mediator of the association between attachment and depression

OBJECTIVE

The study represents a conceptual replication of the study by Eng et al. (2001) in a sample of adult patients diagnosed with social anxiety disorder as primary diagnosis.

METHODS

Two different attachment questionnaires (Bielefeld Questionnaire of Client Expectations (BQCE) and Experiences in Close Relationships (ECR-RD)) were applied to examine whether the effect of attachment on depression (measured by the BDI) is mediated by social anxiety (measured by the LSAS) in a cross-sectional study.

RESULTS

The data confirms such a mediation. The effect of attachment measured with the BQCE on depression was completely mediated, whereas the effect of both scales of the ECR-RD (attachment related avoidance and anxiety) on depression was only partially mediated by social anxiety disorder.

CONCLUSION

The study supports the association of attachment, social anxiety, and depressive symptoms and the need to consider different perspectives on attachment.

Transitions in Friendship Attachment During Adolescence are Associated With Developmental Trajectories of Depression Through Adulthood

PURPOSE

Forming secure friendship attachments during adolescence are important for mental health; few, however, have specifically examined the ways in which the transitions in attachment during adolescence may influence future mental health outcomes among African Americans.

METHODS

The present study examines how transitions in attachment in adolescence predicted changes in depression symptoms from late adolescents through adulthood in an African-American sample. We used growth curve modeling to examine the association between transitions in friendship attachment and changes in depression symptoms in adulthood.

RESULTS

At age 16 years, 346 (64.0%) adolescents reported secure attachment with 195 (36.0%) reporting either avoidant or resistant attachment. At age 17 years, 340 (62.9%) reported secure attachment and 201 (37.2%) reported avoidant or resistant attachment. The largest percentage of participants (46.2%) reported stable-secure attachment across the two time points. Results of the growth model indicated that adolescents who reported a stable-secure attachment style had lower levels of depression symptoms during adulthood than those individuals who transitioned from secure-to-insecure, from insecure-to-secure, or were in the stable-insecure group. Interestingly enough, individuals in both the attachment transition groups had a faster declining rate of depression symptoms over time compared to the two stability groups.

CONCLUSIONS

Data support existing research showing an association between transitions in attachment during adolescence and depression through adulthood. Furthermore, these study findings suggest there may be protective features associated with transitioning between attachment styles during adolescence on later depression, compared to African Americans who remain stable in their attachment style.

Associations Between Parental Attachment and Course of Depression Between Adolescence and Young Adulthood

A study of the associations of maternal, paternal and peer attachment with the course of depression from adolescence to young adulthood. In the Youth and Mental Health study 242 adolescents completed the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime version for depressive disorders at age 15 and 20. Attachment was measured with the inventory for parent and peer attachment, separately for mother, father, and peers, at age 15. Multinomial logistic regression, indicated insecure attachment relationships with both parents, but not with peers, and were associated with the course of depression. Less secure attachment to mothers was associated with becoming depressed. Less secure attachment to both parents was associated with becoming well and remaining depressed. These results suggest attachment relationships with parents as potential influences on the course of depression and may provide important framework for clinical work with adolescents and young adults.

Muted neural response to distress among securely attached people

Neural processes that support individual differences in attachment security and affect regulation are currently unclear. Using electroencephalography, we examined whether securely attached individuals, compared with insecure individuals, would show a muted neural response to experimentally manipulated distress. Participants completed a reaction time task that elicits error commission and the error-related negativity (ERN)-a neural signal sensitive to error-related distress-both before and after a distressing insecurity threat. Despite similar pre-threat levels, secure participants showed a stable ERN, whereas insecure participants showed a post-threat increase in ERN amplitude. These results suggest a neural mechanism that allows securely attached people to regulate distress.

Mediating Role of Cognitive Emotion Regulation Strategies on the Relationship Between Attachment Styles and Alexithymia

The main objective of the present study was to investigate the mediating role of cognitive emotion regulation strategies on the relationship between attachment styles and alexithymia. Five hundred and thirty six undergraduate students (282 girls, 254 boys) from public universities in Tehran participated in this study. Participants were asked to complete the Adult Attachment Inventory (AAI), the Farsi version of the Toronto Alexithymia Scale (FTAS-20), and Cognitive Emotion Regulation Questionnaire (CERQ). The results illustrated a significant negative correlation between secure attachment style and alexithymia. Moreover, the results revealed a significant positive correlation between avoidant and ambivalent attachment styles with alexithymia. Regression analysis showed that both adaptive and maladaptive cognitive emotion regulation strategies, have a mediating role on the relationship between attachment styles and alexithymia. Secure and insecure attachment styles predicted changes in alexithymia through adaptive and maladaptive cognitive emotion regulation strategies in opposite directions. Based on these findings, it can be concluded that the mediating role of cognitive emotion regulation strategies on the relationship between attachment styles and alexithymia is partial.

The association between adult attachment style, mental disorders, and suicidality: findings from a population-based study

Attachment theory categorically assesses how a person perceives and experiences interpersonal relationships. Attachment style is linked to numerous physical and psychological phenomena; however, there is a paucity of research examining its relationship to suicide ideation and attempt in adults. Our study addresses this and investigates the relationship of adult attachment style and mental disorders in a nationally representative sample. Using data from the National Comorbidity Survey Replication (N = 5692, aged >18 years), multiple logistic regression analyses were conducted to examine these relationships. After adjusting for confounding variables, insecure attachment styles were associated with greater reporting of suicidal ideation, attempt, and all mental disorder categories analyzed (adjusted odds ratio range, 1.13-1.81). Secure attachment styles were associated with a decreased likelihood of reporting suicidal ideation, attempt, and any anxiety disorder (adjusted odds ratio range, 0.67-0.91). Clinicians should be aware of attachment issues in their patients to ensure better health outcomes and more effective physician-patient relationships.

Don't be Too Strict with Yourself! Rigid Negative Self-Representation in Healthy Subjects Mimics the Neurocognitive Profile of Depression for Autobiographical Memory

Autobiographical memory (AM) comprises representation of both specific (episodic) and generic (semantic) personal information. Depression is characterized by a shift from episodic to semantic AM retrieval. According to theoretical models, this process ("overgeneralization"), would be linked to reduced executive resources. Moreover, "overgeneral" memories, accompanied by a negativity bias in depression, lead to a pervasive negative self-representation. As executive functions and AM specificity are also closely intricate among "non-clinical" populations, "overgeneral" memories could result in depressive emotional responses. Consequently, our hypothesis was that the neurocognitive profile of healthy subjects showing a rigid negative self-image would mimic that of patients. Executive functions and self-image were measured and brain activity was recorded, by means of fMRI, during episodic AMs retrieval in young healthy subjects. The results show an inverse correlation, that is, a more rigid and negative self-image produces lower performances in both executive and specific memories. Moreover, higher negative self-image is associated with decreased activity in the left ventro-lateral prefrontal and in the anterior cingulate cortex, repeatedly shown to exhibit altered functioning in depression. Activity in these regions, on the contrary, positively correlates with executive and memory performances, in line with their role in executive functions and AM retrieval. These findings suggest that rigid negative self-image could represent a marker or a vulnerability trait of depression by being linked to reduced executive function efficiency and episodic AM decline. These results are encouraging for psychotherapeutic approaches aimed at cognitive flexibility in depression and other psychiatric disorders.

Trajectories of loneliness during childhood and adolescence: predictors and health outcomes

The present study employed latent growth mixture modeling to discern distinct trajectories of loneliness using data collected at 2-year intervals from age 7-17 years (N = 586) and examine whether measures taken at age 5 years were good predictors of group membership. Four loneliness trajectory classes were identified: (1) low stable (37% of the sample), (2) moderate decliners (23%), (3) moderate increasers (18%), and (4) relatively high stable (22%). Predictors at age 5 years for the high stable trajectory were low trust beliefs, low trusting, low peer acceptance, parent reported negative reactivity, an internalizing attribution style, low self-worth, and passivity during observed play. The model also included outcome variables. We found that both the high stable and moderate increasing trajectories were associated with depressive symptoms, a higher frequency of visits to the doctor, and lower perceived general health at age 17. We discuss implications of findings for future empirical work.