Cheng Xinlei, Li Xinfei, Zhao Jinlong, Wang Lei, Shi Xiaoning
Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.
Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
Front Psychiatry. 2025 Aug 20;16:1611258. doi: 10.3389/fpsyt.2025.1611258. eCollection 2025.
Depression ranks as the second leading cause of the global health burden; therefore, identification of its risk and influencing factors is essential to develop more effective multidimensional interventions. The aim of the present study was to analyze the mediating role of family adaptability (FA) on the relationship between insecure attachment (IA) and family functioning (FF) in patients with major depressive disorder (MDD), which currently remains unclear. It also aims to provide a theoretical reference for optimizing rehabilitation interventions.
This cross-sectional study enrolled 62 patients with MDD who were admitted to a tertiary hospital in Beijing from March 2024 to December 2024. Participants completed the General Information Questionnaire, Family Assessment Device, Family Adaptability and Cohesion Evaluation Scale, and the Experiences in Close Relationships Relationship Structures Scale. The 17-item Hamilton Depression Rating Scale was also administered. Subsequently, association analysis was performed.
Notable correlations were observed among IA, FA, and FF in adults with MDD. Regression analysis established both IA and FA as reliable predictors of FF. Bootstrap-mediated analysis revealed that FA partially mediated the relationship between IA and FF, accounting for 35.47% of the total association. Further analysis demonstrated differential mediation proportions; FA mediated 39.36% of the association between anxious IA and FF and 42.61% of the association between avoidant IA and FF, with all mediation pathways meeting conventional thresholds for statistical significance.
IA in adult patients with MDD negatively impacts FF, with both anxious and avoidant IA subtypes showing independent negative associations partially linked by FA. Rehabilitation strategies should prioritize multidimensional interventions targeting the enhancement of FA to improve FF and facilitate clinical recovery.
抑郁症是全球健康负担的第二大主要原因；因此，识别其风险和影响因素对于制定更有效的多维度干预措施至关重要。本研究的目的是分析家庭适应性（FA）在重度抑郁症（MDD）患者不安全依恋（IA）与家庭功能（FF）之间关系中的中介作用，目前这一作用尚不清楚。本研究还旨在为优化康复干预措施提供理论参考。
本横断面研究纳入了2024年3月至2024年12月在北京一家三级医院住院的62例MDD患者。参与者完成了一般信息问卷、家庭评估工具、家庭适应性和凝聚力评估量表以及亲密关系体验关系结构量表。还进行了17项汉密尔顿抑郁评定量表评估。随后进行了关联分析。
在患有MDD的成年人中，IA、FA和FF之间存在显著相关性。回归分析确定IA和FA都是FF的可靠预测因素。自举中介分析表明，FA部分中介了IA与FF之间的关系，占总关联的35.47%。进一步分析显示了不同的中介比例；FA中介了焦虑IA与FF之间关联的39.36%以及回避型IA与FF之间关联的42.61%，所有中介路径均达到统计学意义的传统阈值。
成年MDD患者的IA对FF有负面影响，焦虑型和回避型IA亚型均显示出独立的负相关，部分由FA联系起来。康复策略应优先考虑针对增强FA的多维度干预措施，以改善FF并促进临床康复。
