Emotional childhood trauma, attachment dimensions, and depression severity in women with major depressive disorder

Childhood trauma is a well-established risk factor for depression in adulthood. However, its clinical correlates may differ according to trauma subtype and patient population. In women with major depressive disorder, attachment-related interpersonal patterns may be relevant to understanding variation in depressive symptom severity. This study examined childhood trauma subtypes, attachment anxiety, attachment avoidance, and depression severity in adult women with major depressive disorder. This cross-sectional study included 120 adult women with major depressive disorder who had not yet initiated pharmacological or psychotherapeutic treatment for the current depressive episode. Participants completed the Childhood Trauma Questionnaire-33, the Experiences in Close Relationships Scale–Short Form, and the Patient Health Questionnaire-9. Spearman correlation analyses were used to examine bivariate relationships among study variables. Exploratory cross-sectional indirect association models with 5,000 bootstrap resamples were estimated to examine whether attachment dimensions statistically accounted for the associations between childhood trauma subtypes and depression severity. The mean age of participants was 35.85 years (SD = 12.53), and the mean PHQ-9 score was 16.48 (SD = 5.03). Overall childhood trauma was correlated with PHQ-9 scores (ρ = 0.246, p < 0.01). Among trauma subtypes, emotional abuse (ρ = 0.203, p < 0.05), physical abuse (ρ = 0.246, p < 0.01), and emotional neglect (ρ = 0.236, p < 0.01) were correlated with PHQ-9 scores. In exploratory indirect association models, attachment anxiety showed indirect estimates with confidence intervals excluding zero for emotional abuse (B = 0.042, 95% CI [0.003, 0.111]) and emotional neglect (B = 0.037, 95% CI [0.004, 0.101]). Attachment avoidance showed indirect estimates with confidence intervals excluding zero for emotional abuse (B = 0.037, 95% CI [0.001, 0.112]), physical abuse (B = 0.061, 95% CI [0.001, 0.177]), sexual abuse (B = 0.092, 95% CI [0.009, 0.228]), and emotional neglect (B = 0.030, 95% CI [0.001, 0.091]). These findings suggest that attachment-related interpersonal processes may be relevant to the association between childhood trauma and depression severity in women with major depressive disorder. However, given the cross-sectional design and the exploratory nature of the indirect association analyses, the results should be interpreted cautiously and require replication in larger longitudinal studies.