Exposure to interpersonal trauma, attachment insecurity, and depression severity

Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA. Electronic address: .
Journal of Affective Disorders (Impact Factor: 3.38). 03/2013; 149(1-3). DOI: 10.1016/j.jad.2013.01.045
Source: PubMed


BACKGROUND: Exposure to traumatic events is a nonspecific risk factor for psychiatric symptoms including depression. The trauma-depression link finds support in numerous studies; however, explanatory mechanisms linking past trauma to current depressive symptoms are poorly understood. This study examines the role that attachment insecurity plays in mediating the relationship between prior exposure to trauma and current expression of depression severity. METHODS: Past trauma and attachment anxiety and avoidance were assessed at baseline in a large cohort (N=705) of adults admitted to a specialized adult psychiatric hospital with typical lengths of stay ranging from 6 to 8 weeks. Depression severity was assessed at day 14 of treatment using the Beck Depression Inventory-II. RESULTS: Interpersonal trauma (e.g., assaults, abuse) was correlated with depression severity, whereas exposure to impersonal trauma (e.g., natural disasters, accidents) was not. Adult attachment partially mediated the relationship between past interpersonal trauma and depression severity at day 14 among psychiatric inpatients. LIMITATIONS: Measure of trauma exposure did not systematically differentiate the age of exposure or relationship to the perpetrator. Individuals scoring high on the self-report attachment measure may be prone to over-report interpersonal traumas. CONCLUSIONS: Treatment of depression in traumatized patients should include an assessment of attachment insecurity and may be fruitful target for intervention.

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Available from: James Christopher Fowler
    • "They were predominantly white and never married. The study sample was admitted with severe mental illness (Fowler et al., 2013), having an extensive psychiatric treatment history (multiple previous therapists, psychopharmacologists, acute and extended [> 5 days] psychiatric hospitalizations). Psychiatric comorbidity was common (see Table 1 for details). "
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    ABSTRACT: The authors examined the reliability and concurrent validity of a modified version of the Stressful Life Events Screening Questionnaire (SLESQ) in a sample of 1,517 psychiatric inpatients characterized by serious mental illness. The scale showed a high level of internal consistency as well as a readily interpretable factor structure that differentiated sexual trauma from physical assaults and emotional distress. As well as revealing gender differences, the scale showed statistically significant but generally modest relationships between different aspects of trauma and diverse measures of psychopathology, including depression, anxiety, somatic symptoms, suicide attempts and self-harm, diminished well-being, functional disability, impaired emotion regulation, and limited experiential acceptance. The study extends prior normative research with the SLESQ based on samples of undergraduates to a large psychiatric sample and presents the first factor analysis of the instrument, lending further support to its clinical utility. (Bulletin of the Menninger Clinic, 79[3], 187-202).
    No preview · Article · Sep 2015 · Bulletin of the Menninger Clinic
    • "Demographic variables and history of psychiatric hospitalization and psychiatric service usage were assessed using a standardized patient information survey (Fowler et al., 2013). Patient Health Questionnaire-Depression (PHQ-9) is a 9-item screen for depression severity with excellent internal consistency, construct validity, and test-retest reliability (Kroenke and Spitzer, 2002) and has demonstrated robust sensitivity to change (L€ owe et al., 2006). "
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    ABSTRACT: Treatment non-response among high-risk, psychiatric patients exposes those suffering to suicidal risk as well as persistent social and occupational difficulties. Strategies for identification of treatment non-response are limited. Diagnostic efficiency of a self-report, cross-cutting symptom measure was assessed as a marker of treatment non-response. 835 inpatients at a specialist psychiatric hospital completed the Patient Health Questionnaire - Depression (PHQ-9) at admission and every two weeks during hospitalization. For patients admitted with severe depression (PHQ-9 ≥ 20), results indicated good accuracy of 2-week PHQ-9 change score in identifying treatment non-response (AUC = 0.80, SE = 0.04, p < .0001; sensitivity = 85%; specificity = 73%; OR = 14.91). The search for predictors of non-response to psychiatric treatment has a long and generally unfulfilled history. The PHQ-9 change score holds promise as a cost-effective test with comparable diagnostic characteristics to other medical tests. Copyright © 2015 Elsevier Ltd. All rights reserved.
    No preview · Article · Sep 2015 · Journal of Psychiatric Research
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    • "In summing up , the attachment framework has the potential to give further understanding of the relationship between interpersonal trauma and psychopathology in the middle childhood ( Fowler et al . , 2013 ) . The purpose of this study is to investigate attachment representations and post - traumatic symptoms in two groups of children : children with an internalizing problem , Somatic Symptom Disorder ( SSD ) ; and children with an externalizing problem , Disruptive Behavior Disorder ( DBD ) . SSD is characterized by multiple and variable"
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    ABSTRACT: In line with literature, the quality of adult-infant interactions and mental representations of the caregivers play an essential role in influencing the children's well-being. Many studies focused the attention on the role of attachment for a better evaluation of child psychopathological outcomes. The flexibility of the child's attachment model gives the opportunity to parents to be helped in modifying their own caregiving quality, encouraging the reflection on the children's state of mind with respect to attachment. The aims of this study were to evaluate: (1) the attachment models in young patients diagnosed with Disruptive Behavior Disorders (DBDs) and Somatic Symptoms Disorders (SSDs); (2) the levels of post-traumatic symptomatology; (3) the association between the attachment models and post-traumatic symptomatology. Forty Italian patients, aged from 8 to 15, recruited at Gaslini Paediatric Hospital of Genoa, previously diagnosed with SSD (N = 20) and DBD (N = 20) were assessed using the Child Attachment Interview (CAI), the Separation Anxiety Test (SAT), the Trauma Symptom Checklist for Children (TSCC-A). Socio-demographic data were collected. In both the clinical samples, the findings on the distribution of attachment models showed a significant presence of insecure attachment with respect to both parents in more than a half of the patients and high levels of disorganized attachment. No significant differences between DBD and SSD samples were found on post-traumatic symptomatology (Post-Traumatic Stress and Dissociation). Significant differences were found on Depression, Anxiety, and Fantasy subscales. This study can provide a detection of dysfunctional aspects in clinical populations. The findings suggest that the quality of the attachment to parents may be a fundamental element to better assess SSD and DBD in children and adolescents. Clinical implications of this study aimed at improving parental caregiving are highlighted.
    Full-text · Article · Aug 2015 · Frontiers in Psychology
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