Running head: ATTACHMENT ANXIETY AND DEPRESSIVE SYMPTOMS
Attachment Anxiety and Depressive Symptoms in Middle Childhood: The Role of Repetitive Thinking About Negative Affect and About Mother
Abstract
Two current studies aimed to investigate whether repetitive thinking about negative affect (RTna) and repetitive thinking about mother (RTm) can be mechanisms in the association between attachment anxiety and depressive symptoms in middle childhood. In Study 1 (N = 381) and Study 2 (N = 157) 9- to 12-year-olds completed self-report questionnaires measuring attachment, RTna and depressive symptoms. In Study 2, additionally, a questionnaire was developed to measure RTm, and a compound score for self- and mother-reported depressive symptoms was calculated. Results showed positive associations between attachment anxiety, RTna and RTm, and self-reported depressive symptoms and depressive symptoms agreed upon by mother and child. RTna andRTm mediated the relationship between attachment anxiety and these depressive symptoms. RTm mediated this relationship even beyond RTna for the multi-informant compound score. Thus, RTna and RTm seem independent mechanisms explaining the association between attachment anxiety and depressive symptoms in middle childhood.
Key words: attachment anxiety; depressive symptoms; heightening strategy; repetitive thinking about negative affect; repetitive thinking about mother
Attachment Anxiety and Depressive Symptoms in Middle Childhood: The Role of Repetitive Thinking About Negative Affect and About Mother
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Depression is a frequent problem in adolescence and adulthood with a great impact on development (Hankin et al., 1998; Weller & Weller, 2000). For adolescent boys and girls it is the predominant cause of illness and disability (World Health Organization [WHO], 2014). Depression substantially increases the risk of suicide (Wulsin, Vaillant, & Wells, 1999), which is the third cause of death in adolescents (WHO, 2014). Moreover, even subclinical depressive symptoms are associated with impaired functioning (Cuijpers & Smit, 2002; Lewinsohn, Solomon, Seeley, & Zeiss, 2000). Therefore, research has focused on identifying vulnerability factors that contribute to the development of depressive symptoms.
Empirical studies with children and adolescents suggest that insecure attachment is one vulnerability factor in the development of depressive symptoms (Armsden, McCauley, Greenberg, Burke, & Mitchell, 1990; Brumariu & Kerns, 2010).According to Bowlby (1969, 1973), early experiences in interactions with the caregiver are stored in Internal Working Models (IWM). An IWM is a cognitive structure consisting of representations of the self, of the attachment figure and of the environment that generate expectations about an attachment figure’s availability and support in times of distress(Bowlby, 1969/1982, 1973; Cassidy, 2008). Individual differences in quality of interactions with the caregiver are reflected in different contents of the IWM. Recurrent experiences with an attachment figure who is available, sensitive and responsive in times of distress, lead to the expectation that an attachment figure will be available to provide support when needed in the future, and thus, secure attachment (Bowlby, 1969/1982, 1973). Instead, when children repeatedly experience that an attachment figure is unavailable, insensitive or unresponsive, they become uncertain about that attachment figure’s support in times of distress, and, as a result, develop insecure attachment (Bowlby, 1969/1982).
In line with the finding that individual differences in attachment are continuously distributed, rather than categorically, insecure attachment, has been represented along two dimensions in middle childhood: attachment avoidance and attachment anxiety (Brennan, Clark, & Shaver, 1998; Fraley & Spieker, 2003). Attachment avoidance involves self-reliance and discomfort with closeness, dependence, and intimate self-disclosure. Instead, attachment anxiety involves preoccupation with social support, jealousy, a strong desire for interpersonal merger, and fear of and vigilance for rejection and abandonment by an attachment figure (Brennan et al., 1998; Brenning, Soenens, Braet, & Bosmans, 2011; Cassidy & Berlin, 1994).Although two meta-analyses (Groh, Roisman, van Ijzendoorn, Bakermans-Kranenburg, & Fearon, 2012; Madigan, Atkinson, Laurin, & Benoit, 2013) find that internalizing symptoms are more strongly related to attachment avoidance and less to attachment anxiety, these meta-analyses’ results generalize less to middle childhood depressive symptoms for different reasons. The age of the samples when internalizing symptoms were assessed, was age 9 or above for only eight of 42 (Groh et al., 2012) and six of 61 (Madigan et al., 2013) independent samples, whilethe prevalence of depressive symptoms is rather low under age 10 (Hammen & Rudolph, 2003; Weller & Weller, 2000). Moreover, the outcomes included more anxiety-related symptoms that typically covary with other avoidance behavior (Bosmans, Dujardin, Field, Salemink, & Vasey, 2015). According to a narrative review (Brumariu & Kerns, 2010) and a recent meta-analysis (Madigan, Brumariu, Villani, Atkinson, & Lyons-Ruth, n.d.), in late middle childhood (age 10-12), the association between attachment anxiety and depressive symptoms tends to be more consistently found than between attachment avoidance and depressive symptoms. This suggests that there may be specific maladaptive mechanisms underlying the association between attachment anxiety and depressive symptoms in middle childhood. However, surprisingly little is known about which mechanisms explain these associations(Brumariu & Kerns, 2010; Kerns, 2008). Therefore, the current study aimed to better understand the specific vulnerabilitiesthat can explain depressive symptoms in anxiously attached children.
Middle childhood (age 8-12) has been proposed as a crucial developmental period to investigate the mechanisms in this association for various reasons. First, precursors of depressive symptoms, such as maladaptive cognitive strategies, start developing in middle childhood (Hampel & Petermann, 2005; Mezulis, Hyde, & Abramson, 2006). Second, prevalence and incidence rates for depressive symptoms increase from childhood to adolescence, with a peak between ages 15 and 18 (Hammen & Rudolph, 2003; Hankin et al., 1998; Weller & Weller, 2000). For these reasons, the association between insecure attachment and depressive symptoms can be observed more easily from late middle childhood onwards (Brumariu & Kerns, 2010), making it possible to study mechanisms in this relationship while they are developing. These mechanisms could shed light on the high recurrence of depressive symptoms as childhood depressive symptoms increase the risk for the onset of a long-term trajectory of depressive symptoms continuing far into adulthood (Weller & Weller, 2000).Moreover, therapies for depression are generally less effective than therapies for other disorders (Weisz, McCarty, & Valeri, 2006), so a better understanding of depressogenic mechanisms and antecedents in middle childhood could mean a step forward for clinical practice.
Traditionally, the association between attachment anxiety and depressive symptoms has been explained as resulting from maladaptive emotion regulation (ER) strategies. ER models of attachment (Cassidy, 1994; Shaver & Mikulincer, 2002) describe that anxiously attached individuals adopt a heightening strategy to attain and maintain sufficient proximity and support from their inconsistently available attachment figure. This heightening strategy is supposed to consist of two components, namely heightening negative affect and heightening the importance of the attachment relationship (Cassidy, 1994; Shaver & Mikulincer, 2002). Theoretically, it seems reasonable to assume that children’s strategy to heighten their focus on a potentially rejecting attachment figure could also be a mechanism explaining attachment anxiety’s association with depressive symptoms. However, until now, research merely focused on the role of heightening negative affect in this association.
Heightening negative affect can be defined as chronically exaggerating negative affect, even in response to relatively benign stimuli (Cassidy, 1994; Mikulincer & Florian, 1998; Shaver & Mikulincer, 2002). Evidence suggests that heightening negative affect mediates the link between attachment anxiety and depressive symptoms in middle childhood. In a crosssectional study with a middle childhood and early adolescence sample, Brenning, Soenens, Braet, and Bosmans (2012) operationalized this component as dysregulation. There was a unique and positive association between attachment anxiety and dysregulation, and dysregulation mediated the relationship between attachment anxiety and depressive symptoms (Brenning et al., 2012). However, a closer inspection of the items assessing dysregulation (see Roth, Assor, Niemiec, Deci, & Ryan, 2009) revealed that dysregulation might not have been an adequate operationalization of strategically heightening negative affect. Instead, these items assessed children as “experiencing emotions but not having the capacity to regulate those emotions” (Brenning et al., 2012, p. 448). More specifically, the dysregulation items seem to measure the extent to which children have the impression that their ER strategy is not successful. Consequently, based on Brenning et al. (2012) one cannot confidently conclude that the association between attachment anxiety and depressive symptoms specifically reflects heightening of negative affect.
Instead, the definition of heightening negative affect seems conceptually closely linked to different types of repetitive thinking (e.g. depressive rumination, brooding, or emotionfocused rumination). Segerstrom, Stanton, Alden, and Shortridge (2003) defined repetitive thought as the “process of thinking attentively, repetitively or frequently about one’s self and one’s world” (p. 909). Repetitive thinking characterized by negatively valenced and abstract thought content is a vulnerability factor for different disorders, with each disorder being characterized by a specific thought content (Ehring & Watkins, 2008; Watkins, 2008). In depression, this repetitive thinking is passive, comparative, self-critical and focused on the depressed feelings and on the reasons of their occurrence (Nolen-Hoeksema, 1991; Treynor, Gonzalez, & Nolen-hoeksema, 2003; Watkins, 2008). In children, adolescents, as well as adults, this repetitive thinking about negative affect (RTna) contributes to the onset, duration and severity of depressive symptoms (Abela & Hankin, 2011; Nolen-Hoeksema, 1991; Rood, Roelofs, Bögels, Nolen-Hoeksema, & Schouten, 2009) and is related to concurrent depressive symptoms and increases in depressive symptoms over time (Burwell & Shirk, 2007; Lopez, Driscoll, & Kistner, 2009; Treynor et al., 2003; Verstraeten, Vasey, Raes, & Bijttebier, 2010). This seems similar to the description of Shaver and Mikulincer (2002) that, when anxiously attached individuals heighten negative affect, “ they focus on their own distress, ruminate on negative thoughts, and adopt emotion-focused coping strategies which exacerbate rather than diminish distress” (p. 141). Therefore, it seems a plausible hypothesis that RTna is one specific, well defined and clearly operationalizable mechanism through which attachment anxiety is linked with depressive symptoms.
This hypothesis has never been directly tested, but several studies have focused on the role of parenting in the development of RTna. For example, Manfredi et al. (2011) found that adults who retrospectively reported more parental overprotection in the first 16 years of life, reported more RTna. Also, overcontrolling parenting and family expressions of sadness and guilt in the preschool years were associated with more RTna in early adolescence (Hilt, Armstrong, & Essex, 2012). Moreover, in girls, the link between low levels of positive maternal behavior at age 12 and increases in depressive symptoms at age 17 was mediated by increases in RTna at age 15 (Gaté et al., 2013). Although similar parenting practices have often been linked with attachment anxiety (Brenning et al., 2012; Karavasilis, Doyle, & Markiewicz, 2003), only one study has investigated the links between attachment-related expectations, RTna, and depressive symptoms. Ruijten, Roelofs, and Rood (2011) found in an adolescent sample that the negative association between self-reported trust in parental support and depressive symptoms was mediated by higher levels of RTna. However, because a general measure for insecure attachment was used, namely the amount of trust in the parent’s support when needed, it remains to be seen whether RTna is the dominant ER strategy for attachment anxiety and not attachment avoidance. In summary, based on theory and on the mentioned studies, it seems reasonable to assume that RTna may account for at least part of the association between attachment anxiety and depressive symptoms in middle childhood.
Therefore, the current study aimed to provide a better understanding of the heightening strategy and its role in the association between attachment anxiety and depressive symptoms in middle childhood. We focused on the mother-child relationship as she remains the primary attachment figure for most children in middle childhood (Cassidy, 2008; Kerns, Tomich, & Kim, 2006) and as there is no difference in the impact of attachment to mother or father on the development of depressive symptoms. The following hypotheses were tested: We tested the hypotheses that (1) higher levels of attachment anxiety are uniquely associated with higher levels of RTna, (2) higher levels of RTna are associated with higher levels of depressive symptoms, and (3) higher levels of RTna mediate the positive relationship between attachment anxiety and depressive symptoms. To test whether this mediation by RTna is specific for the relationship between attachment anxiety and depressive symptoms, the latter mediation analysis will be repeated with attachment avoidance as predictorindependent variable. In all analyses, the other attachment dimension will be added as a control variable.
Study 1
Method
Participants. In this study, 390 children (53% girls) of the 5th and 6th grade of nine Belgian primary schools participated. The age of the participants ranged between 9 to 13 years (M = 11.25, SD = 0.65).
Procedure. Letters with information about the aim and procedure of the study were distributed in the classrooms. In these letters, children were invited to participate and parents were asked for permission through passive informed consent. This way, the study achieved a 99% response rate. Children collectively filled out the questionnaires in a fixed order during school hours under supervision of a psychology master’s student.
Measures.
Attachment anxiety and attachment avoidance. The child version of the Experiences in Close Relationships Scale-Revised (ECR-RC; Brenning et al., 2011) about mother was completed by the participants to assess attachment anxiety and attachment avoidance. This self-report questionnaire consists of 18 items for the Attachment Anxiety scale (e.g. “I’m worried that my mother might want to leave me.”) and of 18 items for the Attachment Avoidance scale (e.g. “I prefer not to get too close to my mother.”). The items are scored on a 7-point Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree). A mean score for attachment anxiety and for attachment avoidance was computed across each scale’s 18 items. The ECR-RC has been proven to explicitly distinguish between attachment anxiety and attachment avoidance and both scales have strong internal consistency, construct validity and predictive validity (Brenning et al., 2011). In the current sample, internal consistencies of attachment anxiety (α = .87) and attachment avoidance (α = .90) were very good according to the criteria of DeVellis (2003).
Repetitive thinking about negative affect (RTna). RTna was assessed using the Brooding subscale of the Children’s Response Styles Questionnaire-Extended (CRSQ-ext; Verstraeten et al., 2010; adaptation of the CRSQ; Abela, Vanderbilt, & Rochon, 2004). This self-report questionnaire consists of 5 items (e.g. “When I am sad, I think about a recent situation wishing it had gone better.” “When I am sad, I think: ‘‘Why do I always react this way?”), which are scored on a 4-point Likert scale ranging from 1 (almost never) to 4 (almost always). A mean score for RTna was calculated across the 5 items. In the current sample, internal consistency of RTna (α = .77) was respectable according to the criteria of DeVellis (2003).
Depressive symptoms. To assess depressive symptoms, the Children’s Depression Inventory (CDI; Kovacs, 2003; Dutch translation by Timbremont & Braet, 2002) was administered. The 27 items of this self-report questionnaire involve cognitive, affective and behavioral symptoms of depression over the past two weeks. The participants are asked for each item to choose the description that fits best from three descriptions (e.g. “I feel like crying every day/many days/sometimes.”). The items are scored on a 3-point rating scale ranging from 0 to 2, with higher scores reflecting more severe depressive symptoms. A mean score was calculated across all 27 items. The CDI is reliable and valid (Kovacs, 2003; Saylor, Finch, Spirito, & Bennett, 1984) and discriminates children with major depressive disorders from non-depressed children (Kovacs, 2003). For the Dutch version of the CDI, a cut-off score of 0.59 maximized its specificity and sensitivity (Theuwis, Braet, Roelofs, Stark & Vandevivere,2013).In the current sample, internal consistency of depressive symptoms (α = .87) was very good.
Results
Preliminary Analyses. Due to missing values, data for seven children were listwise deleted from the data analyses, resulting in data for 381 children.There were no significant gender or age effects. Therefore, there will not be controlled for these variables in subsequent analyses. In the sample of Study 1, 18.6% of thechildren scored equal to or above the cut-off score on self-reported depressive symptoms. In Table 1, descriptive statistics for all the variables are presented.
Associations between attachment anxiety, attachment avoidance, RTna, and depressive symptoms. In Table 1, zero-order correlations between all the variables are presented. Both attachment anxiety and attachment avoidance correlated positively with RTna. Because attachment anxiety and attachment avoidance were positively correlated, hierarchical multiple regression analyses were conducted in SPSS to investigate whether RTna was uniquely linked with attachment anxiety and not with attachment avoidance. Attachment anxiety remained significantly related to RTna after controlling for attachment avoidance ( = .31, t(378) = 5.21, p < .001), whereas there was no unique association of attachment avoidance with RTna when controlling for attachment anxiety ( = .01, t(378) = 0.24, p = .810) (R² = .10, F(2,378) = 20.91, p < .001). Attachment anxiety was positively related to depressive symptoms, also after controlling for attachment avoidance ( = .35, t(378) = 6.73, p < .001). Attachment avoidance was positively related to depressive symptoms, also after controlling for attachment anxiety ( = .26, t(378) = 4.94, p < .001) (R² = .29, F(2,378) = 78.06, p < 001). RTna had a significantly positive correlation with depressive symptoms.
Mediation analyses.These analyses were conducted with the macro ‘PROCESS’ (Hayes, 2013)in SPSS, which calculates unstandardized regression coefficients, standard errors, and effect sizes for indirect effects of an independent variable (IV) on a dependent variable (DV) through one or multiple simultaneous mediators (M). A bootstrap with N = 10,000 resamples was used. A point estimate of an indirect effect was considered significant in the case zero was not contained in the 95%- or 99%- bias corrected confidence interval (BC CI). When this point estimate is significant, mediation occurs. In the analyses with attachment anxiety as independent variable, attachment avoidance was added as a covariate, and vice versa.