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


CONCLUSIONS
Size of the prospective sample was restricted.


CONCLUSIONS
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.
Conradi
Henk Jan
HJ
Department of Psychiatry, University Medical Center Groningen, University of Groningen, The Netherlands. h.j.conradi@med.umcg.nl
de Jonge
Peter
P
D000328:Adult; D000367:Age Factors; D003863:Depression / Q000523:psychology*; D005239:Fear / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D009769:Object Attachment; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors