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Attachment insecurity partially mediates the relationship between childhood trauma and depression severity in bipolar disorder

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posted on 2025-05-09, 20:51 authored by Anna L. Wrobel, Samantha E. Russell, Tobin J. Ehrlich, David F. Marshall, Michael Berk, Melvin G. McInnis, Anuradhi Jayasinghe, Mojtaba Lotfaliany, Alyna Turner, Olivia M. Dean, Sue M. Cotton, Claudia Diaz-Byrd, Anastasia K. Yocum, Elizabeth R. Duval
Background: Childhood trauma is associated with greater depression severity among individuals with bipolar disorder. However, the mechanisms that explain the link between childhood trauma and depression severity in bipolar disorder remain poorly understood. The mediational role of attachment insecurity in childhood and adulthood was assessed in the current study. Methods: Participants with bipolar disorder (N = 143) completed measures of childhood trauma (Childhood Trauma Questionnaire), attachment insecurity (Experiences in Close Relationships Scale) and depression severity (Hamilton Depression Rating Scale) as part of the Prechter Longitudinal Study of Bipolar Disorder. A sequential mediation model was tested using path analysis: the direct and indirect effects of childhood trauma on depression severity with attachment insecurity (attachment anxiety and avoidance) in childhood (mother and father) and adulthood (partner) as mediators were estimated. Results: The final path model demonstrated an excellent fit to the data (comparative fit index = 0.996; root mean square error of approximation = 0.021 [90% confidence interval = 0.000–0.073]). Supporting the hypothesised sequential mediation model, maternal attachment anxiety in childhood and romantic attachment avoidance in adulthood partially mediated the relationship between childhood trauma and depression severity; this effect accounted for 12% of the total effect of childhood trauma on depression severity. Conclusion: Attachment insecurity in childhood and adulthood form part of the complex mechanism informing why people with bipolar disorder who have a history of childhood trauma experience greater depression severity. Addressing attachment insecurity represents a valuable psychotherapeutic treatment target for bipolar disorder.

History

Journal title

Acta Psychiatrica Scandinavica

Volume

145

Issue

6

Pagination

591-603

Publisher

Wiley-Blackwell

Language

  • en, English

College/Research Centre

College of Health, Medicine and Wellbeing

School

School of Medicine and Public Health

Rights statement

© 2022 The Authors. Acta Psychiatrica Scandinavica published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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