Nele Struck1, Axel Krug2, Matthias Feldmann3, Dilara Yuksel4, Frederike Stein5, Simon Schmitt5, Tina Meller5, Katharina Brosch5, Udo Dannlowski6, Susanne Meinert6, Nils Opel6, Hannah Lemke6, Lena Waltemate6, Igor Nenadić5, Tilo Kircher5, Eva-Lotta Brakemeier7. 1. Department of Clinical Psychology and Psychotherapy, University of Marburg, Marburg, Germany. Electronic address: nele.struck@staff.uni-marburg.de. 2. Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany; Center for Mind, Brain and Behavior, University of Marburg, Marburg, Germany; Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany. 3. Department of Clinical Psychology and Psychotherapy, University of Marburg, Marburg, Germany. 4. Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany; Center for Health Sciences, SRI International, Menlo Park, CA, USA. 5. Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany; Center for Mind, Brain and Behavior, University of Marburg, Marburg, Germany. 6. Department of Psychiatry, University of Münster, Münster, Germany. 7. Department of Clinical Psychology and Psychotherapy, University of Marburg, Marburg, Germany; Center for Mind, Brain and Behavior, University of Marburg, Marburg, Germany; Department of Clinical Psychology and Psychotherapy, University of Greifswald, Greifswald, Germany.
Abstract
OBJECTIVE: To examine attachment insecurity and low social support as potential mediators of the association between childhood maltreatment (CM) types and depression severity in patients with a lifetime history of major depressive disorders (MDD). METHOD: Participants with an acute or remitted MDD (N = 580) completed questionnaires about CM (Childhood Trauma Questionnaire), attachment (Relationship Scales Questionnaire), social support (Social Support Questionnaire), and depression severity (Beck Depression Inventory). Mediation and path models with CM types as independent variables, attachment avoidance and anxiety as mediators and depression severity as dependent variable were calculated. In addition, a sequential mediation model with attachment insecurity and social support as mediators of the association between CM and depression was tested. RESULTS: Attachment avoidance and anxiety partially mediated the effect of CM on depression. In the path model including the different CM types, there were significant indirect effects of emotional abuse on depression via attachment anxiety and of emotional neglect on depression via attachment avoidance. Results also supported the hypothesized sequential mediation via attachment insecurity and social support. LIMITATIONS: A cross-sectional design with a retrospective self-report measure of CM was used and the developmental timing of exposure to CM was not considered. CONCLUSION: Our findings suggest that the effect of emotional abuse and emotional neglect on depression is partially mediated by attachment avoidance and anxiety. Further, the results support the hypothesis of a sequential mediation via attachment insecurity and social support. Accordingly, attachment insecurity is discussed as a target of psychotherapy for patients with MDD and CM.
OBJECTIVE: To examine attachment insecurity and low social support as potential mediators of the association between childhood maltreatment (CM) types and depression severity in patients with a lifetime history of major depressive disorders (MDD). METHOD:Participants with an acute or remitted MDD (N = 580) completed questionnaires about CM (Childhood Trauma Questionnaire), attachment (Relationship Scales Questionnaire), social support (Social Support Questionnaire), and depression severity (Beck Depression Inventory). Mediation and path models with CM types as independent variables, attachment avoidance and anxiety as mediators and depression severity as dependent variable were calculated. In addition, a sequential mediation model with attachment insecurity and social support as mediators of the association between CM and depression was tested. RESULTS: Attachment avoidance and anxiety partially mediated the effect of CM on depression. In the path model including the different CM types, there were significant indirect effects of emotional abuse on depression via attachment anxiety and of emotional neglect on depression via attachment avoidance. Results also supported the hypothesized sequential mediation via attachment insecurity and social support. LIMITATIONS: A cross-sectional design with a retrospective self-report measure of CM was used and the developmental timing of exposure to CM was not considered. CONCLUSION: Our findings suggest that the effect of emotional abuse and emotional neglect on depression is partially mediated by attachment avoidance and anxiety. Further, the results support the hypothesis of a sequential mediation via attachment insecurity and social support. Accordingly, attachment insecurity is discussed as a target of psychotherapy for patients with MDD and CM.
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