Article summary of What mediates the link between childhood maltreatment and depression? The role of emotion dysregulation, attachment, and attributional style by Schierholz et al. - Chapter

Preface

Child abuse is associated with an increased risk of developing various psychological problems, including major depressive disorder. There is evidence for a strong association between child abuse and major depressive disorder. It is important to note that child abuse not only increases the risk of developing a major depressive disorder, but that it also affects the severity and course of the disorder. It is important to gain a better understanding of the processes that mediate the link between child abuse and depression. To date, few studies have looked at psychological processes that mediate associations between child abuse and depression. This study examines three potential mediators:

• Problems with emotion regulation

• Attachment

• Attributional style

Criteria

The variables are chosen based on the following criteria:

• Proof of a relationship with child abuse

• Proof of a relationship with depression

• Existing theoretical explanation for the variable as a mediator

• Suitable for online assessment

Problems with emotion regulation

There are increasing indications that support the role of emotion regulation as a mediator between child abuse and the onset of depression. There is also indirect evidence for that child abuse leads to problems with emotion regulation, such as problems with understanding and naming affective states, low emotional acceptance and the use of inappropriate emotion regulation strategies.

Attachment

There are indications of a relationship between child abuse and unsafe attachment in adulthood. There are two unsafe attachment styles: avoidance and fear. Avoiding consists of a tendency to avoid closeness and intimacy in relationships, while fear refers to feelings of insecurity and a lack of close relationships.

Attributional style

Experiences of hopelessness can lead to depressogenic inferential styles that are characterized by the tendency to attribute negative life events to internal, stable and global causes. This attribution style is a cognitive risk factor that interacts with acute stressors, which reliably predict depressive reactions after a stressful event.

Hypothesis

In this study, the mediators described above were studied simultaneously in a group of people with a depressive disorder. Three hypothesis have been drawn up:

1. The severity of child abuse is accompanied by the severity of depression and more depressive episodes

2. Severity of child abuse, the severity and course of depression are associated with the mediators described

3. There is an indirect effect of the mediators on the relationship between child abuse and depression on the one hand and the number of depressive episodes on the other hand

Method

Participants were acquired through online forums and self-help organizations for people with depression. 340 participants took part in the study, who spoke fluent German, were between 18 and 65 years old and had a (suspected) diagnosis of major depressive disorder. The PHQ-9 was used to screen the diagnoses of major depressive disorder and to assess the severity of the symptoms. Child abuse has been established by means of a shortened version of CTQ. Emotion regulation was measured using the Difficulties in Emotion Regulation Scale (DERS). The attachment was determined by ECR, the depressive attribution style was measured by Depressive Attributions Questionnaire (DAQ) and lastly traumatic experiences were measured using The Posttraumatic Diagnostic Scale.

Results

As predicted in the first hypothesis, the severity of child abuse (measured with the CTQ) is significantly correlated with the severity of depression and the number of depressive episodes. In addition, the CTQ scores were significantly associated with all proposed mediators, as predicted in hypothesis two. In addition, scores on the DERS, ECR subscale avoidance and DAQ were significantly correlated with the severity of depression and the number of depressive episodes. However, scores on the ECR anxiety subscale were not significantly associated with the number of depressive episodes. As a result, hypothesis three is not fully confirmed, so mediator attachment 'anxiety' is not associated with a connection between child abuse and depression on the one hand and the number of depressive episodes on the other.

Discussion

This study has shown that the severity of child abuse is associated with the severity of depression and the number of depressive episodes. This involved research into the role of problems with emotion regulation, attachment and attribution style as possible mediators. Child abuse had a significant association with all proposed mediators.

Limitations research

• Found result possibly caused by other, not investigated, factors

• Study is primarily based on self-reports, which means that reliability and validity are unclear

• Not known if the sample collected online is representative

Conclusions

Despite a number of limitations, this study provides new evidence for the role of emotion regulation problems, avoidant attachment, depressive attribution style and PTSD as a mediator between the relationship of child abuse and depression.