Developmental pathways established during childhood are considered to be instrumental for the wellbeing of the individual across the lifespan. The main focus of this essay will be evaluating evidence illustrating that insecure attachment style, child adversity and trauma are pathways for developing depression later in adulthood.
Depression is a mood disorder characterised by: depressed mood, lack of interest in daily activities, disrupted diet, inability to concentrate, fatigue, extreme feelings of guilt and worthlessness (American Psychiatric Association, 2013).
Suffering from depressive symptoms during childhood predicts a continuity of struggling with the same disorder in adulthood (Copeland et al.,2009). Childhood adversity and trauma are divided into four categories containing a total number of 12 types of adversities:
- interpersonal loss (parental divorce),
- parental maladjustment (family violence),
- maltreatment (abuse, neglect),
- and other childhood adversities (illness) (Kessler et al., 2010).
Moreover, the attachment theory illustrates the development of an emotional connection between the infant and its primary caregiver as a means to regulate behaviour and emotion, especially during times of distress and the exploration period (Bowlby 1969).
Child maltreatment is one of most prominent determinant for the development of psychiatric disorders in adolescence and adulthood (McLaughlin, 2015). According to the sensitization theory individuals who suffered from adversity and trauma during childhood are more prone to developing Depression later in life as a result of daily stressors (Bandoli, et al.,2017). Research examining the stress sensitization theory has focused primarily on modifications to the hypothalamic- pituitary-adrenal (HPA) axis as a result of trauma. However, differences in type of adversity suffered, duration and time of the incident have led to inconsistent results in concretely identifying how a certain adversity determines a particular malformation of the HPA axis (Nemeroff, 2004).
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The HPA axis is part of the neuroendocrine stress response system which aims to ensure adaptation of the organism to its current circumstances, therefore, preserving health and stability (McEwen, 2004). Hyperactivity of the HPA axis has been found as one of the most significant brain changes in Major Depression (Heim, et al., 2008). Alterations to the HPA axis are associated with childhood adversity such as insecure attachment and abuse (Hammen et al., 2000). Heim et al., (2008) reviewed several studies concluding childhood adversities can cause a sensitization of the stress response system, which would lower the individuals’ tolerance to stress thus explaining the link between trauma and Depression. Early childhood trauma is associated with a number of neuroanatomical and neuroendocrine changes (corticotropin- releasing factor (CRF) systems), which are similar to those described in animal studies. There are certain determinants that additionally increase the risk of depression such as being female and genetic factors.
Hammen, et al., (2000) conducted a longitudinal study aimed to assess depressive episodes, caused by stressful file events in young women who were transitioning into adulthood. Women who have suffered from childhood adversities are more likely to suffer from depressive episodes when exposed to a lower threshold of stress than women without a traumatic background. The obtained results are consistent with the views expressed by the developmental psychopathology model, illustrating that childhood adversity and trauma is a pathway to depression (Cicchetti & Schneider-Rosen, 1986). Amirkhan and Marckwordt, (2017) comes in support of the previous study, as they uncovered that individuals who have suffered from childhood adversity are more likely to suffer from a greater level stress, caused by current life events as well as, avoid the stressful issues.
Bandoli et al., (2017) uncovered that childhood maltreatment increases the risk of developing Depression in a sample consisting of new US army soldiers. The said effect may occur because, in addition to childhood trauma, military personnel also experience great levels of stress, resulting in an interaction that is detrimental to their psychological wellbeing and mental health. The results of the study align with the stress sensitization theory as they depict the influences of childhood adversity on stress sensitivity. Soldiers who have suffered from maltreatment are at greater risk of suffering from Major Depression, when compared to soldiers who benefited from a healthy upbringing.
Furthermore, attachment is divided into 3 categories:
- and insecure (anxious or avoidant.)
Insecure attachment patterns are the product of inconsistent caregiving, lack of attention towards the child, neglect and rejection (Dagan et al.,2018). The interaction between the infant and the caregiver shapes into a representational model of self and others (McLaughlin et al., 2013). From an attachment theory point of view, psychopathology (Depression) illustrates maladaptive modifications from the heathy developmental pathway, in order to adapt to the current environment in the short term, at the expense of normal adaptation in the long term (Carson and Sroufe, 1995). Bowlby (1973) considered attachment a dynamic theory of development, suggesting that attachment styles are not stable (dependent on past events), therefore they may change over time as a result of new experiences and relationships as well as, have the power to influence and give a negative meaning to the said experiences (Sroufe et al., 2005).
Attachment as a pathway to Depression can best assessed for both avoidant and anxious attachments. Duggal et al., (2001) conducted a longitudinal study which uncovered that both anxious and avoidant attachments are moderately related to depression. Perhaps, the reason for this is that infants presenting anxious attachment are becoming hyper-vigilant in order to ensure that they will attract the attention of the caregiver, whose responsiveness towards the needs of the child is usually inconsistent. Sroufe et al (2005) proposed two explanatory routes of depression from an attachment perspective: avoidant attachment, leads to feelings of rejection and hopelessness caused by the emotional unavailability of the caregiver, as well as a disconnection of interpersonal relationships. While anxious attachment causes feelings of hopelessness and anxiety, due to inconsistent caregiving, which generates a hypervigilant child, as the caregiver is deemed unreliable.
Dagan et al., (2018) conducted a meta-analysis analysing a number of studies examining attachment as a pathway to depression. The study uncovered that insecurely attached individuals regardless of the sub-type are more likely to suffer from depression as opposed to those who are securely attached. One of the major limitation of the study is represented by the fact that both clinical and non-clinical samples were assessed, therefore, the obtained results do not illustrate a pure depiction of attachment as a pathway to clinically diagnosed Major Depression, but rather to long term prevalence of depressive symptoms. In addition, it is difficulty to infer causality due to the fact that, although insecure attachment representation may predict depression, it is also possible that some individuals develop insecure attachment styles because they suffer from depressive symptoms.
Despite the fact that attachment pattern during infancy was adaptive to the respective situation, it is particularly likely to become precarious across the lifespan, as it will be applied to other relationships. Studies have identified that insecurely attached individuals are more attentive to negative affective information in comparison to securely attached people (Maier et al.,2005). Moreover, it may determine insecurely attached individuals to misinterpret the behaviour of others, deeming it as hostile, unreliable or rejecting (Dykas & Cassidy, 2011). Consequently, insecure attachment is likely to cause difficulties in forming, preserving as well as, emotionally investing in interpersonal relationships (Pietromaco & Beck,2015). As such, insecurely attached individuals are suffering from interpersonal stress, which has been shown to be a significant predictor of Depression.
Tsachi et al., (2018) found that avoidant attachment had higher levels epigenetic markers such as OXTR and NR3C1. These results illustrate that in the case of avoidant attachment, the OXTR factor causes an inability to regulate stress through positive social relationships, therefore illustrating a maladaptation to the gene environment interactions. Respectively, the NR3C1 factor indicates towards dysfunctions of the HPA axis, which results in a reduced regulation of stress and emotions. There were no significant results between these two epigenetic markers and anxious attachment. Causality between these results cannot be inferred as the study was cross-sectional.
Lastly, Kessler et al., (2010) concluded that childhood adversity and trauma has a strong influence on the development of any kind of mental health issues across the life-span, regardless of the country of origin. Attachment represents the first interpersonal relationship humans build therefore, being particularly important for a healthy growth from a psychological point of view. In addition, insecure attachment can be considered a type of childhood maltreatment. Consequently, there is some overlap between the two developmental pathways as both are highly related to stress, thus, leading to alterations of the HPA axis (Hammen, et al.,2000;; Tsachi et al., 2018). The evidence regarding their influence on development of depression in adulthood is not sufficient when it comes to the processes by which they lead to depression and there is a clear need for further investigations.
Perhaps, more longitudinal studies are needed for assessing these processes in order to systematically investigate attachment and maltreatment as pathways for depression through observation, as well as, having the possibility to establish causation. The majority of studies have focused on self-report retrospective measures which are somewhat unreliable and biased. Despite this a number of studies have found that both insecure attachment and childhood adversity lead to suffering from depressive symptoms from childhood but mostly in adulthood. Major depression affects 2.8% of children under 13 years’ old, but these statistics increase to 5.6% for adolescents, reaching 16.2% in adulthood (McLaughlin et al., 2013) therefore it can be considered a significant mental health problem. Given the results of a great number of studies, there is sufficient evidence to conclude that childhood attachment and adversities are pathways to developing depression in adulthood, even though the precise mechanisms by which they happen are yet to be determined.
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