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. 2025 Aug 20:16:1611258.
doi: 10.3389/fpsyt.2025.1611258. eCollection 2025.

The mediating role of family adaptability in the relationship between insecure attachment and family functioning in patients with major depression disorder: a cross-sectional study

Xinlei Cheng  1   2 , Xinfei Li  3 , Jinlong Zhao  1   2 , Lei Wang  1   2 , Xiaoning Shi  1   2
Affiliations

The mediating role of family adaptability in the relationship between insecure attachment and family functioning in patients with major depression disorder: a cross-sectional study

Xinlei Cheng et al. Front Psychiatry. .

Abstract

Introduction: Depression ranks as the second leading cause of the global health burden; therefore, identification of its risk and influencing factors is essential to develop more effective multidimensional interventions. The aim of the present study was to analyze the mediating role of family adaptability (FA) on the relationship between insecure attachment (IA) and family functioning (FF) in patients with major depressive disorder (MDD), which currently remains unclear. It also aims to provide a theoretical reference for optimizing rehabilitation interventions.

Methods: This cross-sectional study enrolled 62 patients with MDD who were admitted to a tertiary hospital in Beijing from March 2024 to December 2024. Participants completed the General Information Questionnaire, Family Assessment Device, Family Adaptability and Cohesion Evaluation Scale, and the Experiences in Close Relationships Relationship Structures Scale. The 17-item Hamilton Depression Rating Scale was also administered. Subsequently, association analysis was performed.

Results: Notable correlations were observed among IA, FA, and FF in adults with MDD. Regression analysis established both IA and FA as reliable predictors of FF. Bootstrap-mediated analysis revealed that FA partially mediated the relationship between IA and FF, accounting for 35.47% of the total association. Further analysis demonstrated differential mediation proportions; FA mediated 39.36% of the association between anxious IA and FF and 42.61% of the association between avoidant IA and FF, with all mediation pathways meeting conventional thresholds for statistical significance.

Conclusions: IA in adult patients with MDD negatively impacts FF, with both anxious and avoidant IA subtypes showing independent negative associations partially linked by FA. Rehabilitation strategies should prioritize multidimensional interventions targeting the enhancement of FA to improve FF and facilitate clinical recovery.

Keywords: family adaptability; family functioning; insecure attachment; major depressive disorders; mediating.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Hypothesized mediation model of family adaptability.
Figure 2
Figure 2
Intermediary role of family adaptability. Nonstandardized coefficients are reported. N = 62. *p < 0.05, **p < 0.01, ***p < 0.001. C indicates total effect; C’ indicates direct effect. IA, Insecure Attachment. Arrows only represent statistical associations,not causal direction.
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