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Emotion, 13 , Standardized results for the direct paths of the multiple mediation models for number of depressive episodes a and Depression Severity b Including PDS Scores. Standardized bootstrap results for total, total indirect, specific indirect, and direct effects of the multiple mediation models including PTSD symptom severity. Similarly, in the second extended multiple mediation model using depression severity as the DV there was also a significant total indirect effect through the four mediators found Table 4. The direct effect of CTQ on depression severity was not significant anymore in this model.
Past research has consistently shown that CM increases the risk of developing depression, but is also associated with higher depressive symptom severity and a more severe course of the disorder Nelson et al.
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This study replicates and extends these findings in a sample of acute and recovered depressed individuals. As predicted, the CM was associated with the severity of depression and the number of lifetime depressive episodes. From a theoretical point of view, it appears interesting to investigate the processes mediating the link between CM and depression.
In addition, this is also highly relevant from a clinical perspective as it may provide information on promising targets for innovative interventions offered specifically for CM survivors suffering from depression. This study investigated the role of emotion regulation difficulties, attachment, and attributional style as three possible psychological mediators.
CM was significantly and substantially associated with all proposed mediators. Depressed individuals who had been exposed to high levels of CM showed more severe impairments in understanding and accepting their emotions, engaging in goal-directed behavior, controlling impulsive behavior when experiencing negative emotions, and using appropriate emotion regulation skills. This finding is consistent with earlier findings showing a close association between CM and emotion regulation difficulties Cook et al.
In addition, participants who had experienced more severe CM reported a larger tendency to elude closeness and intimacy in relationships avoidance and to attribute negative life events to internal, stable, and global causes depressogenic attributional style. Both results support previous research and theories suggesting an association between CM and insecure attachment as well as dysfunctional attributional style e. Our key hypothesis was that emotion regulation difficulties, avoidant attachment, and a depressogenic attributional style mediate the association of CM and the severity and course of depression.
This hypothesis was tested in two multiple mediation models with the DVs depressive symptom severity and number of depressive episodes, respectively. Results supported the hypothesis in that the complete set of mediators had significant indirect effects in explaining the relationship between severity of CM and depression severity as well as the number of episodes.
The directions of the a and b paths were consistent with the interpretation that more severe CM leads to more difficulties in emotion regulation, more avoidance in close relationships, and more depressogenic attributions, which in turn leads to more severe depression. It should be noted that results were more clear-cut for depression severity than for the number of episodes experienced.
When looking at depression severity, the three psychological processes fully mediated the relationship between CM and severity of depression. In addition, emotion regulation difficulties and depressogenic attributional style were identified as significant specific mediators for depression severity, whereas no significant specific indirect effect was found for any of the mediators for the number of episodes.
This suggests that additional mediators not included in these models may play a role. Unexpectedly, a large proportion of participants in our sample showed at least some degree of PTSD symptoms. It appeared conceivable that higher depression severity and a more severe course of depression in participants with CM may at least partly be related to PTSD symptoms experienced by this group. In order to test this idea, the two mediation analyses were repeated, entering PTSD symptom severity as an additional mediator.
Significant indirect effects were found in both analyses, and the direct path from CM to depression was rendered non-significant. The significant indirect effects were found to be primarily driven through PTSD symptom severity. Emotion regulation difficulties could be identified as the only potent mediator over and above PTSD. The high prevalence of PTSD symptoms in our sample was unexpected, as participants were merely recruited based on their depression status, and neither PTSD nor CM were mentioned during recruitment.
A selection bias in the recruitment phase therefore appears unlikely. As many earlier studies in this area did not systematically assess PTSD, it remains unclear whether the high prevalence of PTSD symptoms in our sample is unusual. Our findings raise a number of interesting hypotheses that should directly be tested in future research. First, the high intercorrelation between the mediators raises the question whether these are different or rather similar constructs.
However, this renders the interpretation of indirect effects for specific mediators less informative than the total indirect effect. In addition, theory predicts the different mediators to represent independent psychological constructs that are nevertheless related in specific ways. In order to better understand the effect of CM on emotional, cognitive, interpersonal, and biological vulnerabilities, more specific theoretical models regarding the interplay of these different processes need to be developed and tested using longitudinal designs.
Second, a number of explanations for the finding of PTSD as a strong mediator between CM and depression are conceivable. From a traditional disorder-focused view, this finding is not entirely surprising as there is a substantial symptom overlap between MDD and PTSD, which may inflate their relationship in our data. In addition, PTSD may be a primary response to CM that amplifies the severity and maintenance of secondary depressive symptoms later in life.
From a transdiagnostic perspective, on the other hand, the data may suggest that there are two different pathways linking CM to depression later in life.
Via the first pathway, CM impairs the development of self-regulation on an emotional, interpersonal, cognitive, and psychobiological level, which in turn increases vulnerability for depression. The crucial distinction between the two pathways is the hypothesized role of CM for the processes maintaining current symptomatology. Based on the current data, this transdiagnostic view on the link between CM and depression remains highly speculative. However, if supported in future research it may have important clinical implications.
For CM survivors suffering from depression who additionally show high levels of CM-related memories, thoughts, feelings, or behaviors, trauma-focused treatments aimed at processing the traumatic experience may be promising, even if they do not suffer from full-blown PTSD. Our study shows a number of strengths, including the relatively large sample size. In addition, this is one of the first studies investigating multiple psychological mediators between CM and clinical characteristics of depression.
On the other hand, some limitations are noteworthy. Firstly, because of the cross-sectional design, it could not be tested whether the mediators indeed preceded the outcome. Although, we think that a cross-sectional design is defendable as a first step, future research using longitudinal designs is necessary. In addition, future studies will need to assess potentially confounding variables in more detail.
For example, avoidant attachment in adulthood may not only be the consequence of CM but other processes such as late-life trauma, PTSD, or even attributional style may have had an additional impact. Secondly, the study relied exclusively on self-report measures. Reassuringly, most variables could be assessed with well-validated instruments. However, the reliability and validity of our single-item measure assessing the number of depressive episodes remains unclear.
Although our study shares this limitation with most earlier studies in the field Nelson et al. Thirdly, it remains to be shown whether results from our web-based survey can be replicated using other types of assessment. However, it cannot be ruled out that our method of recruitment and data collection may have led to a composition of the sample that is different to samples recruited, for example, via clinical services. In addition, the relatively large dropout during data collection, albeit typical for web-based surveys, may additionally have contributed to biased sampling.
Despite these limitations, this study provides novel evidence for the role of emotion regulation difficulties, avoidant attachment, depressogenic attributional style, and PTSD symptom severity as mediators for the link between CM and depression. Future research should combine the psychobiological and the psychological perspectives to examine these vulnerabilities across different levels of analysis.
AS carried out data collection. AS and JB analyzed the data. AS and TE drafted the manuscript. All authors read and approved the final manuscript. National Center for Biotechnology Information , U. Journal List Eur J Psychotraumatol v. Eur J Psychotraumatol. Published online Oct Author information Article notes Copyright and License information Disclaimer.
You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use. This article has been cited by other articles in PMC. Results The experience of CM was related to more severe depression and more depressive episodes. Conclusions Our findings provide preliminary evidence for psychological mediators between CM and depression that may be promising targets for interventions tailored for the treatment of depression in this subgroup.
Highlights of the article Childhood maltreatment CM is related to more severe depression. Keywords: Depression, childhood trauma, mediation, emotion dysregulation, attribution, attachment.
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CM and risk for depression Evidence for a particularly strong association between CM and MDD comes not only from retrospective studies e. Mediators of the link between CM and depression In order to improve treatment for CM survivors suffering from depression, it appears important to better understand the processes mediating the link between maltreatment and depression.
Emotion regulation difficulties One psychological process that may be related to the neurobiological alterations described above is emotion regulation. Attributional style According to Abramson, Metalsky, and Alloy , experiences of hopelessness can lead to depressogenic inferential styles that are characterized by a tendency to attribute negative life events to internal, stable, and global causes.
This study In this study, proposed mediators of the relationship between CM and depression were assessed simultaneously in a large group of individuals with a depressive disorder. Methods Participants The study was conducted as a web-based survey. Procedure The study was approved by the local Research Ethics Committee and conducted in accordance with the declaration of Helsinki. Results About Correlational analyses Correlations between the relevant variables of the hypothesized mediation model are shown in Table 1.
Table 1 Means, standard deviations, and WLSMV estimated correlations between childhood maltreatment, depression, and proposed mediators. CTQ PHQ-9 Number of episodes ordinal 1. DERS ECR avoidance ECR anxiety DAQ Open in a separate window. Table 2 Standardized bootstrap results for total, total indirect, specific indirect, and direct effects of the multiple mediation models excluding PTSD symptom severity.
Table 3 Means, standard deviations, and WLSMV estimated correlations between severity of childhood maltreatment, characteristics of depression, proposed mediators, and PTSD symptom severity. PDS Table 4 Standardized bootstrap results for total, total indirect, specific indirect, and direct effects of the multiple mediation models including PTSD symptom severity.
Discussion Past research has consistently shown that CM increases the risk of developing depression, but is also associated with higher depressive symptom severity and a more severe course of the disorder Nelson et al. Relationship between CM and potential mediators CM was significantly and substantially associated with all proposed mediators.
Mediation analyses Our key hypothesis was that emotion regulation difficulties, avoidant attachment, and a depressogenic attributional style mediate the association of CM and the severity and course of depression. Possible implications Our findings raise a number of interesting hypotheses that should directly be tested in future research. Strengths and limitations Our study shows a number of strengths, including the relatively large sample size.
Conclusions Despite these limitations, this study provides novel evidence for the role of emotion regulation difficulties, avoidant attachment, depressogenic attributional style, and PTSD symptom severity as mediators for the link between CM and depression. Funding statement The study was conducted without any external funding. Conflict of interest and funding The authors state that there is no conflict of interest.
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Ontogenese der Emotionen und der Emotionsregulation
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