title: The association between attachment and mental health symptoms among school-going adolescents in northern Uganda: the moderating role of war-related trauma.
abstract: BACKGROUND
  The association between attachment and mental health symptoms in adolescents in a post-conflict low resource setting has not been documented.
  
  
  METHODS
  We investigated the relationship between parent and peer attachment and posttraumatic stress, depression and anxiety symptoms in a sample of 551 adolescents aged 13-21 years old. Attachment quality was assessed using the Inventory of Parent and Peer Attachment (IPPA). Post-traumatic stress, depression and anxiety symptoms were assessed using the Impact of Events Scale Revised (IESR) and Hopkins Symptom Checklist for Adolescents (HSCL-37A) respectively. Gender differences in attachment relationships were determined using independent t-tests. Multivariate logistic regression was used to assess whether attachment relationships were independently associated with posttraumatic stress, depression and anxiety symptoms. Hierarchical linear regression analyses were conducted to explore the moderating role of war-related trauma.
  
  
  RESULTS
  Our analyses revealed gender differences in attachment to parents, with males reporting stronger attachment than females. Parental attachment was protective against depression and anxiety symptoms but not posttraumatic stress symptoms after adjusting for potential confounders. Alienation by parents was independently associated with an increase in these mental health symptoms while peer attachment was not associated with any of these symptoms. However, in situations of severe trauma, our analyses showed that peer attachment was significantly protective against post-traumatic stress symptoms.
  
  
  CONCLUSIONS
  Secure parental attachment is associated with better psychosocial adjustment in adolescents affected by war. Further, adolescents with secure peer attachment relationships in situations of severe war trauma may be less likely to develop posttraumatic stress symptoms. Interventions to enhance peer support in this post conflict setting would benefit this vulnerable population.
authors.affiliation: Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda; Department of Psychiatry, Gulu University, Gulu, Uganda; Department of Social Welfare Studies and Centre for Children in Vulnerable Situations, Ghent University, Ghent, Belgium.
authors.forename: James
authors.initials: J
authors.lastname: Okello
authors.affiliation: Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: Etheldreda
authors.initials: E
authors.lastname: Nakimuli-Mpungu
authors.affiliation: Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: Seggane
authors.initials: S
authors.lastname: Musisi
authors.affiliation: Department of Orthopedagogics, Ghent University, Ghent, Belgium.
authors.forename: Eric
authors.initials: E
authors.lastname: Broekaert
authors.affiliation: Department of Social Welfare Studies and Centre for Children in Vulnerable Situations, Ghent University, Ghent, Belgium.
authors.forename: Ilse
authors.initials: I
authors.lastname: Derluyn
mesh_terms: D000293:Adolescent; D003710:Demography; D005260:Female; D006801:Humans; D008297:Male; D008603:Mental Health; D015999:Multivariate Analysis; D009769:Object Attachment; D010290:Parents; D010379:Peer Group; D012044:Regression Analysis; D012574:Schools; D012727:Sex Characteristics; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology*; D014454:Uganda; D014857:Warfare; D055815:Young Adult