Anxious attachment and severity of depressive symptomatology in women

A prospective study of depression following combat deployment in support of the wars in Iraq and Afghanistan

OBJECTIVE

We investigated relations between deployment and new-onset depression among US service members recently deployed to the wars in Iraq and Afghanistan.

METHODS

We included 40 219 Millennium Cohort Study participants who completed baseline and follow-up questionnaires and met inclusion criteria. Participants were identified with depression if they met the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire criteria for depression at follow-up, but not at baseline.

RESULTS

Deployed men and women with combat exposures had the highest onset of depression, followed by those not deployed and those deployed without combat exposures. Combat-deployed men and women were at increased risk for new-onset depression compared with nondeployed men and women (men: adjusted odds ratio [AOR]=1.32; 95% confidence interval [CI]=1.13, 1.54; women: AOR=2.13; 95% CI=1.70, 2.65). Conversely, deployment without combat exposures led to decreased risk for new-onset depression compared with those who did not deploy (men: AOR=0.66; 95% CI=0.53, 0.83; women: AOR=0.65; 95% CI=0.47, 0.89).

CONCLUSIONS

Deployment with combat exposures is a risk factor for new-onset depression among US service members. Post-deployment screening may be beneficial for US service members exposed to combat.

Early adverse emotional response to childbirth in Turkey: the impact of maternal attachment styles and family support

Early adverse emotional response which is often detected in the form of depressive symptoms is a predictor of postpartum depression following the birth. The aim of our study is to highlight contextual and individual factors that have an impact on mothers' depressive symptoms during the early postpartum period. One hundred mothers participated in the study. Maternal depressive symptoms were screened by Edinburgh Postpartum Depression Scale (EPDS), and maternal anxiety level was assessed by State-Trait Anxiety Inventory (STAI) at early postpartum period (7-10 days). The Multidimensional Scale of Perceived Social Support (MSPSS) was used for the assessment of maternal social support. The Adult Attachment Scale (AAS) was used to determine the attachment style of the mother. The mean EPDS score of mothers who live in extended families is found to be significantly lower than others who live in nuclear families (extended families 7.13+/-7.39, nuclear families 11.77+/-5.96, p=0.006). Significant positive correlations were found between EPDS total scores and ambivalent attachment style group (r=.0436, p=.000), and avoidant attachment style group (r=.328, p=.001). The level of perceived family support also showed a negative correlation with EPDS total score (r=-.363, p=.000). The regression of EPDS total score with ambivalent attachment style and state anxiety level are positively predicted and the level of perceived family support and existence of wider social network negatively predict the EPDS total score in the first postpartum week. Maternal attachment patterns, living with the extended family and existence of family support have an important impact on early postpartum emotional adaptation. Early intervention strategies should count towards these individual and contextual factors when designing screening and preventive interventions for postpartum depression.

Psychological factors associated with persistent postnatal depression: past and current relationships, defence styles and the mediating role of insecure attachment style

BACKGROUND

This study prospectively investigated the factors underlying the maintenance and persistence of postnatal depression beyond the first year after birth.

METHOD

One hundred primiparous women who were admitted to a parentcraft hospital for a week were assessed after discharge at 4 and 12 months postpartum. Various measures of mood, interpersonal relationships and defence styles were administered at 4 months and the relation between these measures and clinically elevated symptoms of depression at 12 months was examined.

RESULTS

At 12 months, 30% of all mothers and 60% of those diagnosed depressed at 4 months continued to report clinically significant levels of depressive symptomatology. The strongest predictor of depression at 12 months was severity of symptoms at 4 months, and women from a non-English speaking background were significantly more likely to remain depressed. Reports of low maternal care in childhood, marital dissatisfaction at 4 months, an attachment style characterised by anxiety over relationships and immature defence styles were significant predictors of clinically elevated depression scale scores at 12 months. Furthermore, an insecure attachment style was shown to mediate the effect of low maternal care in childhood, while other cognitive and interpersonal factors appeared to contribute additively in maintaining depressive symptoms.

LIMITATIONS

Self-report measures were used to measure insecure attachment styles and depression at 12 months.

CONCLUSIONS

Findings demonstrate that both childhood and concurrent relationship difficulties contribute to the maintenance of postpartum depression. Interventions for persistent depression need to address relationship difficulties as well as depressive symptomatology.

The development and preliminary validation of a new measure of adult attachment: the adult attachment projective

In this paper, we describe the development of and our preliminary work to empirically validate the Adult Attachment Projective (AAP), a new adult attachment classification system that is based on the analysis of individuals' responses to a set of seven attachment-related drawings. The AAP classification system uses evaluations of three dimensions (Discourse, Content and Defensive Processing) to designate four major adult classification groups: Secure, Dismissing, Preoccupied, and Unresolved. Preliminary validation of the AAP is based on 75 participants drawn from three separate samples. The results indicate strong interjudge reliability and convergent agreement between the AAP and Adult Attachment Interview (AAI) classifications. The AAP, thus, appears to be a promising developmental measure for assessing the representation of attachment in adults. Contributions of the AAP to attachment theory and research are discussed. The similarities and differences between AAP stories and other child and adult representational measures are also discussed.