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

Abstract 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. Limitations Size of the prospective sample was restricted. Conclusion 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.