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

Abstract

Background: 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.

Methods: 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.

Results: 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.

Limitations: Size of the prospective sample was restricted.

Conclusion: 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.