Adult attachment style. 1: Its relationship to clinical depression

Abstract

Although there are an increasing number of studies showing an association of adult attachment style to depressive disorder, such studies have rarely utilised epidemiological approaches with
large community-based series and have relied heavily
on brief self-report measurement of both attachment
style and symptoms. The result is a wide inconsistency
in the type of insecure style shown to relate to disorder.
The present study examined adult attachment style in a
high-risk community sample of women in relation to
clinical depression. It utilised an interview measure of
adult attachment which allowed for an assessment of
both type of attachment style and the degree of insecurity
of attachment. A companion paper examines its relationship
with other depressive-vulnerability (Bifulco
et al. 2002). Method Two hundred and twenty-two highrisk
and 80 comparison women were selected from
questionnaire screenings of London GP patient lists and
intensively interviewed. A global scale of attachment
style based on supportive relationships (with partner
and very close others) together with attitudes to support-
seeking, derived the four styles paralleling those
from self-report attachment assessments (Secure, Enmeshed,
Fearful, Avoidant). In order to additionally reflect
hostility in the scheme, the Avoidant category was
subdivided into ‘Angry-dismissive’ and ‘Withdrawn’.
The degree to which attitudes and behaviour within
such styles were dysfunctional (‘non-standard’) was
also assessed.Attachment style was examined in relation
to clinical depression in a 12-month period. For a third
of the series this was examined prospectively to new onset
of disorder. Results The presence of any insecure
style was significantly related to 12-month depression.
However,when controls were made for depressive symptomatology
at interview,only the ‘non-standard’ levels of
Enmeshed, Fearful or Angry-dismissive styles related to
disorder.Withdrawn-avoidance was not significantly related
to disorder. Conclusion The relationship of attachment
style to clinical depression is increased by differentiating
the degree of insecurity of style and
differentiating hostile and non-hostile avoidance.