Recurrent depression and the role of adult attachment: A prospective and a retrospective study

• Published in: Journal of affective disorders Vol. 116; no. 1; pp. 93 - 99
• Main Authors: Conradi, Henk Jan, de Jonge, Peter
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier B.V 01.07.2009; Elsevier
• Subjects: Adult; Adult and adolescent clinical studies; Adult attachment; Age Factors; Antidepressant drugs; Attachment; Attachment style; Biological and medical sciences; Depression; Depression - psychology; Fear - psychology; Female; Follow-Up Studies; Humans; Interpersonal Relations; Male; Medical sciences; Middle Aged; Mood disorders; Object Attachment; Primary care patients; Primary health care; Prospective Studies; Psychiatric Status Rating Scales; Psychiatric/Mental Health; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Recurrence; Recurrent; Recurrent depression; Retrospective Studies; Severity of Illness Index; Time Factors; Vulnerability; Vulnerability; Adult attachment; Recurrent depression; Primary care patients; Human; Mood disorder; Affect affectivity; Relapse; Primary health care; Depression; Retrospective; Affective attachment; Adult; Public health
• ISSN: 0165-0327; 1573-2517; 1573-2517
• DOI: 10.1016/j.jad.2008.10.027

Recurrent depression is associated with interpersonal dysfunctioning which is related to underlying insecure attachment. In this study we examined associations between adult attachment and the long-term course of depression in depressed primary care patients. Depressed primary care patients were 3-monthly assessed during a prospective 3-year follow-up regarding: (1) severity of depression (BDI); and proportions of: (2) depression-free time; (3) depressive symptom-free time; and (4) time on antidepressants (all CIDI interview). Attachment style was assessed by the Experiences in Close Relationships questionnaire at two points in time: (1) one year before the end of follow-up (1-year prospectively followed subsample; n = 68); and (2) at the end of the 3-year follow-up (3-year retrospective subsample; n = 145). Mixed model analyses and non-parametric tests were used to determine whether different attachment styles were associated with different courses of depression. Fearfully attached patients in the prospective sample reported a statistically significant worse depression course compared with securely attached patients (adjusted mean BDI 12.7 v. 6.8 respectively; F = 3.22; p = 0.029), which was confirmed in the retrospective sample (adjusted mean BDI 15.7 v. 8.8; F = 7.86; p < 0.001). They reported significantly more prior depressive episodes and residual symptoms, longer use of antidepressants, and worse social functioning as well. Size of the prospective sample was restricted. Fearfully attached subjects constitute a particularly vulnerable category of depressed patients. Information on their attachment style may provide GPs with indications regarding intensity, goals and approach of treatment.