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Sex Effects on Anxiety and Depression: a Retrospective Approach

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Sex Effects on Anxiety and Depression: a Retrospective Approach Master Thesis Parental Bonding, adult attachment and its cross- sex effects on anxiety and depression: a retrospective approach L.M. Roetman S1908030 Clinical Psychology Supervised by M.L.J. Kullberg Department of Clinical Psychology Universiteit Leiden 12 – 09 – 2019 Table of Contents Abstract ...................................................................................................................................... 3 Introduction ................................................................................................................................ 4 Parental Bonding and Anxiety ................................................................................................... 4 Parental Bonding and Depression .............................................................................................. 5 The Cross-Sex Component......................................................................................................... 6 Adult Attachment ....................................................................................................................... 7 The Current Study ...................................................................................................................... 8 Methods ...................................................................................................................................... 8 Participants & study design .................................................................................................... 8 Procedure ................................................................................................................................ 9 Measures ................................................................................................................................. 9 Statistical analysis................................................................................................................. 11 Results ...................................................................................................................................... 12 Demographics and Clinical Characteristics .......................................................................... 12 Parental bonding and anxiety: mediation by adult attachment ............................................. 13 Parental bonding and depression: mediation by adult attachment ....................................... 14 Maternal and Paternal Bonding and Anxiety Symptoms: Moderation by Subject Sex........ 16 Maternal and Paternal Bonding and Depression Symptoms: Moderation by Subject Sex .. 16 Discussion ................................................................................................................................ 17 Parental bonding, adult attachment style and levels of anxiety and depression ................... 18 Cross-sex effects in parental bonding and levels of anxiety and depression ........................ 19 Strengths and Limitations ..................................................................................................... 21 Clinical implications ............................................................................................................. 22 Directions for future research ............................................................................................... 24 References ................................................................................................................................ 26 2 Abstract Background: Research has repeatedly linked suboptimal parental bonding to adult anxiety and adult depression. However, no studies have evaluated the mediating effect of adult attachment behaviours. Furthermore, to this date, very few studies have included both parental sex and subject sex and assessed potential differences between these unique relationships. Method: This study attempts to cover this research gap by 1) building mediation models for anxiety and depression, incorporating adult attachment as a mediator, and 2) building moderation models for anxiety and depression, with subject sex as moderator. Subjects were 2069 participants of the NESDA cohort study at the 9-year follow-up point. Results: The association between parental bonding and depression and anxiety symptoms was partially mediated by insecure adult attachment: people with suboptimal bonding were more likely to be insecurely attached as an adult, and consequently experienced more anxiety and depression. A significant interaction was only found for maternal bonding and subject sex, for anxiety only: females reported more anxiety symptoms compared to males after having suboptimal maternal bonding experiences. Conclusion: Adult attachment style and associated attachment behaviours partly explain why suboptimal bonding leads to higher scores on anxiety and depression. For women in particular, suboptimal maternal bonding experiences affect their anxiety levels in adulthood – unfavourable bonding experiences with the mother are thus more harmful for women, than they are for men. Our findings underline the importance of prevention and intervention strategies and once again highlight the detrimental effect of a negative parent-offspring relationship across the lifespan. Key words: parental bonding, parental bonding instrument, adult attachment, anxiety, depression, cross-sex, gender 3 Introduction Two types of mental disorders with the highest lifetime prevalence are mood and anxiety disorders (3.3% – 21.4% and 4.8% – 31.0% respectively; Kessler et al., 2007). Research has shown that both types inflict a large burden on communities worldwide (Murray & Lopez, 1996), and furthermore demonstrated that adequate treatment for these disorders is frequently lacking (Bijl et al., 2003). One of the aspects that is known to play a fundamental role in the potential development of mood and anxiety disorders is the family setting and, in particular, the parents (Tam & Yeoh, 2008). The quality and type of the parent-child interaction is called parental bonding and is a well-investigated topic within the field of mental health care, especially due to the previously mentioned societal burden and high prevalence (Tam & Yeoh, 2008). Elements that are important for this bond to be considered strong are presence of parental warmth, affection and involvement, and additionally the encouragement of autonomy and self-sufficiency (Rikhye et al., 2008). Intertwined with parental bonding is attachment and attachment theory. This theory assumes that the way in which an infant organises its behaviour towards the mother influences the way in which it organises behaviour towards all other elements in its environment (Ainsworth, 1979). These early attachment experiences form a template, a so-called ‘internal working model’, that guides the infant’s future behaviour (Bowly, 1969). This internal working model influences the way a child approaches social interactions, impacts its emotional functioning and affects its level of cognitive capacities (Bowly, 1969). Over the course of the past decades, research has indicated that within child attachment theory four attachment styles can be distinguished: the secure attachment style, the ambivalent attachment style, the avoidant attachment style and the disorganised attachment style (Ainsworth, 1979; Main & Solomon, 1990). These attachment styles are known to be relatively stable from infancy to adulthood. (Waters, Hamilton & Weinfield, 2000). Parental Bonding and Anxiety Some types of attachment or specific parent-child interaction patterns have been pointed out as possible risk factors in mental dysfunction (Alonso et al., 2018). One of the impairments that is frequently linked to these impaired interaction patterns is adult anxiety (Alonso et al., 2018; Jinyao et al., 2012). Suboptimal parental bonding has been found to associate with 4 anxiety symptoms (Carter et al., 2001; Yap et al., 2014), generalised fear and fear of dying (Meites, Ingram, & Siegle, 2012). Yap and colleagues (2014) also found that substandard bonding experiences during childhood have an effect on anxiety symptoms in adolescents. Similar results were found by Khalid et al. (2018), though the effect was only present in the case of maternal bonding. Other studies confirm this aforementioned link between suboptimal maternal bonding experiences and anxiety symptoms in children and adolescents (Breinholst, Esbjørn & Reinholdt-Dunne, 2015; Van der Bruggen et al., 2010), nevertheless the conclusion is ambiguous, as similar effects for paternal bonding are found in other studies (Möller et al., 2013; Möller et al., 2016). Bögels and Phares (2008) also found that high levels of optimal paternal bonding had a general positive effect on internalising disorders and specifically anxiety. In an elderly sample, overall poor parental quality was associated with ever having received an anxiety diagnosis, but only for males (Burns et al., 2018). Sometimes, an age difference was found: in younger children, suboptimal maternal bonding was associated with anxiety, whereas for adolescents, suboptimal paternal bonding held this association (Verhoeven, Bögels & van der Bruggen, 2012). Finally, emotional- and physical maltreatment and neglect are strongly associated with anxiety symptoms later in life (Gallo et al., 2008). To summarise: some discrepancy regarding the effect of suboptimal parental bonding and its effect on anxiety symptoms exists, though it seems that especially the father seems to play an important role in reducing anxiety symptomatology. Parental Bonding
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