Bifulco A, Moran P M, Ball C, Lillie A
Lifespan Research Group, Dept of Social and Political Science, University of London, UK.
Soc Psychiatry Psychiatr Epidemiol. 2002 Feb;37(2):60-7. doi: 10.1007/s127-002-8216-x.
A range of studies show adult attachment style is associated with depressive-vulnerability factors such as low self-esteem, poor support and childhood adversity. However, there is wide inconsistency shown in the type of insecure style most highly associated. Few studies have examined attachment style in relation to clinical depression together with a range of such factors in epidemiological series. The present study uses an interview measure of adult attachment which differentiates type of attachment style and degree of insecurity of attachment, to see: (a) if it adds to other vulnerability in predicting depression and (b) if there is specificity of style to type of vulnerability.
Two hundred and twenty-two high-risk and 80 comparison women were selected from questionnaire screenings of London GP patient lists and intensively interviewed. The Attachment Style Interview (ASI) differentiated five styles (Enmeshed, Fearful, Angry-dismissive, Withdrawn and Standard) as well as the degree to which attitudes and behaviour within such styles were dysfunctional ('non-standard'). Attachment style was examined in relation to low self-esteem, support and childhood experience of neglect or abuse, and all of these examined in relation to clinical depression in a 12-month period.
The presence of any 'non-standard' style was significantly related to poor support, low self-esteem and childhood adversity. Some specificity of type of style and type of vulnerability was observed. Logistic regression showed that non-standard Enmeshed, Fearful and Angry-dismissive styles, poor support and childhood neglect/abuse provided the best model for clinical depression.
Non-standard attachment in the form of markedly Enmeshed, Fearful or Angry-dismissive styles was shown to be associated with other depressive-vulnerability factors involving close relationships, self-esteem and childhood adversity and added to these in modelling depression.
一系列研究表明，成人依恋风格与抑郁易感性因素相关，如低自尊、支持不足和童年逆境。然而，在与之关联度最高的不安全依恋风格类型上，存在广泛的不一致。很少有研究在流行病学系列研究中，将依恋风格与临床抑郁症以及一系列此类因素联系起来进行考察。本研究采用一种成人依恋访谈测量方法，该方法能区分依恋风格类型和依恋不安全程度，目的是：（a）考察其在预测抑郁症时是否能补充其他易感性因素；（b）考察依恋风格类型与易感性类型之间是否具有特异性。
从伦敦全科医生患者名单的问卷调查筛选中选取222名高危女性和80名对照女性，并进行深入访谈。依恋风格访谈（ASI）区分了五种风格（相互缠结型、恐惧型、愤怒-dismissive型、回避型和标准型），以及这些风格中的态度和行为功能失调（“非标准”）的程度。考察了依恋风格与低自尊、支持以及童年期忽视或虐待经历的关系，并在12个月期间内将所有这些因素与临床抑郁症联系起来进行考察。
任何“非标准”风格的存在都与支持不足、低自尊和童年逆境显著相关。观察到了风格类型与易感性类型之间的一些特异性。逻辑回归显示，非标准的相互缠结型、恐惧型和愤怒-dismissive型风格、支持不足以及童年期忽视/虐待，为临床抑郁症提供了最佳模型。
明显的相互缠结型、恐惧型或愤怒-dismissive型等非标准依恋风格，被证明与涉及亲密关系、自尊和童年逆境的其他抑郁易感性因素相关，并在抑郁症模型中增加了这些因素。
