OBJECTIVE

To explore the associations between early adverse stress, attachment insecurity in adulthood (anxious and avoidant), pathological personality styles (self-criticism and dependency), difficulties in emotion regulation, and depression severity.

METHODS

Cross-sectional study of 178 outpatients diagnosed with major depression in Santiago, Chile. Participants filled the Childhood Trauma Questionnaire Short Form, the Experience in Close Relationships Scale, the Depressive Experience Questionnaire, the Difficulties in Emotion Regulation Scale, and the Patient Health Questionnaire-9 item. Full-information maximum likelihood path analyses with bias-corrected bootstrapped confidence intervals were conducted.

RESULTS

Anxious attachment in adulthood and self-criticism mediated the association between early adverse stress and depression severity through their effects on difficulties in emotion regulation. Early adverse stress was not associated with avoidant attachment in adulthood and dependency; these variables were indirectly associated with depression severity. Difficulties in emotion regulation were exclusively directly related to depression severity, mediating the effects of the preceding variables.

CONCLUSIONS

Our findings propose an integrative model for psychological mechanisms mediating between early adverse stress and depression. Difficulties in emotion regulation should be considered when treating adults with depression exposed to early adverse stress. The contribution of specific types of early adverse stressors and difficulties in emotion regulation should be further explored.