War trauma impacts in Ukrainian combat and civilian populations: Moral injury and associated mental health symptoms.

This is the first study to compare active-duty soldiers and student civilian samples during the first three months of the Ukrainian-Russian war in relation to moral injury and its association with PTSD, anxiety and depression. A total of 350 participants, including 191 active-duty soldiers of the Ukrainian Armed Force (UAF), who were on the frontline during the full-scale invasion of Russian troops in February 2022, and 159 students from different HEIs in Volyn oblast, were recruited into the study through their attendance at the Ukrainian Psychotrauma Center. Prior to the in-person group-intervention program of psychosocial support for military and civil populations at the Ukrainian Psychotrauma Center, moral injury, PTSD, depression, and anxiety were assessed. Results showed significantly higher moral injury, PTSD, depression, and anxiety scores in civilian students, with a two-way ANOVA indicating a significant impact of female gender in civilians only. A hierarchical regression indicated that moral injury is a predictor of PTSD symptoms in both active-duty and civilian student groups. However, previous family trauma of genocide is associated with PTSD symptoms in active soldiers only. The findings of the current study could contribute insights for clinical practice for combatants and civilians during the current war.

Attachment style, loneliness and depression in older age women.

Older adults tend to have more avoidant attachment styles, which may make them more vulnerable to becoming isolated and lonely and increase the risk for developing mental health problems. This study used intensive interviews and logistic regression to explore how insecure attachment styles were associated with poor social support, isolation, loneliness and depression. Avoidantly, attached adults were at an increased risk for social isolation. Specifically, older adults with an Angry-Dismissive style were more likely to be lonely and experience mental health problems. Attachment style should be taken into consideration when promoting healthy aging.

Characteristics of severe life events, attachment style, and depression - Using a new online approach.

OBJECTIVES: Severe life events are established as provoking agents for depression in combination with vulnerability factors. Identifying features of severe events improves the prediction of disorder but are rarely utilized, mainly because life event research is increasingly dominated by self-report checklists with no capacity for inferring such characteristics. This paper investigates the association of severe life events' features with depression and insecure attachment styles using a new online measure of life events in a clinical and control sample. METHODS: A total of 202 participants (75 clinical and 127 matched control participants), taken from an earlier national Depression Case Control genetic study and followed up after 12 years, completed the Computerised Life Events Assessment Record to assess characteristics of life events, the Vulnerable Attachment Style Questionnaire to measure attachment insecurity, and the General Health Questionnaire to measure depression. RESULTS: The clinical group had higher self-reported depression, severe life events, and insecure attachment style. They also reported more loss, danger, humiliation, and trauma severe events. Intra-respondent analysis showed individuals experiencing these types of events were more likely to report depression. Insecure attachment style and severe life events were both significantly related to recent depression and history of depressive disorder. Anxious attachment style was significantly related to relationship events and bereavements, as well as severe loss or humiliation events, whereas avoidant style was not. CONCLUSIONS: Identifying salient features of severe life events improves associations with depression and insecure attachment style. Utilizing a new online approach can aid research and clinical approaches for depression at low cost. PRACTITIONER POINTS: Salient features of severe life events (e.g., loss, humiliation) give insight into the potential impact on attachment vulnerability and depression. Clinicians and researchers can use online methods to economically gain detailed life event information needed for clinical formulation and valid data on stressors. The self-reported scale for recent depression is only a proxy measure of clinical disorder, but the clinical group selection is a more robust criterion for depression history.

Linking lack of care in childhood to anxiety disorders in emerging adulthood: the role of attachment styles.

BACKGROUND: Emotional neglect can be characterized as cold or critical parenting and denotes a parent intentionally or unintentionally overlooking the signs that a child needs comfort or attention and ignoring its emotional needs. Parental emotional neglect is widely posited as an antecedent of anxiety disorder, with attachment researchers arguing for anxious-ambivalent attachment style as a mediating factor. METHOD: Childhood experience of neglect and abuse, including antipathy (cold, critical parenting), attachment styles, and anxiety disorders were assessed in a high-risk sample of 160 adolescents and young adults by means of interview measures. RESULTS: Antipathy was associated with 12-month prevalence of anxiety disorders in the sample. Anxious-ambivalent attachment scores statistically mediated the relationship between antipathy and anxiety disorders. CONCLUSIONS: Clinicians treating anxiety disorders in youths need to consider that emotional neglect in childhood in the form of antipathy could lead to anxious-ambivalent internal working models operating around fear of rejection and fear of separation.

Content Moderator Mental Health, Secondary Trauma, and Well-being: A Cross-Sectional Study.

Content moderators (CMs) analyze and remove offensive or harmful user generated content that has been uploaded to the internet. Jobs which involve exposure to other people's suffering are associated with raised rates of secondary traumatic stress and mental health problems. However, research establishing psychological baseline symptoms in CMs is lacking. This study used an online survey to explore rates of psychological distress, secondary trauma, and well-being in a sample of CMs. Regression analysis explored how various features of the work affected mental health. There was a dose-response effect between frequency of exposure to distressing content and psychological distress and secondary trauma, but not well-being. The results suggested supportive colleagues and feedback about the importance of their role ameliorated this relationship. Implications for CM working conditions are discussed.

Anxiety and hospitalization in adolescence: relations to attachment style and parental support.

This exploratory study examined attachment style and state/trait anxiety in adolescents - 30 recently hospitalized psychiatric patients, and 49 school controls. All were aged 13-18, with the majority (67%) female. The attachment style interview (ASI, Bifulco et al. 2002) was administered, together with the Recent Life Events questionnaire (Brugha & Cragg 1990) and the STAI anxiety questionnaire (Spielberger et al. 1983). Results showed the hospitalised group to have significantly more negative interactions with parents and poorer support than the comparison group. They had significantly more insecure attachment style (96% s 37%). Among the hospitalized adolescents, both the Anxious and the Avoidant attachment style group had higher anxiety scores on the STAI-trait scores than on the STAI-state scores assessed during the first days of hospitalisation. This suggests adolescents, even those with Avoidant attachment feel less anxious after admission. Implications for assessing attachment style in adolescent patients to aid with care planning is discussed.

The moderation effect of secure attachment on the relationship between positive events and wellbeing.

Positive events can reduce depression as well as enhance wellbeing. The role of secure attachment style in moderating the relationship between positive events and wellbeing is examined to further understand wellbeing models. Participants (n = 490) included two midlife groups and a student group from the UK. They completed the online Computerized Life Event Assessment Record (CLEAR), a measure of life events, the Vulnerable Attachment Style Questionnaire (VASQ), and the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS). Age was associated with higher rates of wellbeing and secure attachment style. A significant relationship was found between number of positive events and wellbeing, number of people close, and secure attachment score. Hierarchical multiple regression indicated a significant interaction between secure attachment style, number of positive life events, and wellbeing. Simple slopes analysis demonstrated the association between positive life events and wellbeing was significant for secure attachment (B = 1.27, p = .003) but not insecure attachment (B = 0.04, non-significant). This suggests securely attached individuals are better able to take advantage of positive life events than insecurely attached individuals and experience a greater increase in wellbeing.

Life events, depression and supportive relationships affect academic achievement in university students.

BackgroundStudents often simultaneously deal with shifting support networks, stressful life changes and psychological distress which may affect academic achievement. Methods: 285 students completed the General Health Questionnaire (GHQ-12) to assess depression and the Computerized Life Events Assessment Record (CLEAR), to establish life events and supportive relationships. Module grades were used to measure academic achievement. A general linear model was used with student grade as the dependent variable and life events, depression and supportive relationships as independent variables. Confounding variables included age and sex. Results: A three-way interaction between life events, depression and lack of supportive relationships was found. It indicated the performance of depressed students depended on whether they had supportive relationships and that this interaction also depended on whether they had experienced a life event in the past year. Conclusions: Universities need to provide more support to students with life stress as they transition into university life.

Vulnerability, life events and depression amongst Moslem Malaysian women: comparing those married and those divorced or separated.

INTRODUCTION: The experiences of married and single mothers were compared in an investigation of psychosocial vulnerability, stress and depression in a community-based study of Moslem mothers in Malaysia. For the first time, a model of vulnerability-provoking agent originally developed by Brown et al. in the UK was tested in a Malaysian context. METHODS: A cross-sectional study was carried out in the district of Johor Bahru, Malaysia. Of the 1,200 women approached from membership of community associations, 1,002 (84%) completed the questionnaires. Severe life events Recent Life Events Questionnaire (Brugha and Cragg in Acta Psychiatr Scand 82:77-81, 1990) and psychosocial vulnerability (VDQ) (Moran et al. in Br J Clin Psychol 40:411-427, 2001) were used to measure vulnerability factors. Depression was measured by the General Health Questionnaire (GHQ-30) (Havenaar et al. in Soc Psychiatry Psychiatr Epidemiol 43:209-215, 2008). RESULTS: Single mothers had significantly higher rates of depression than those married (60.5 vs. 39.5%), as well as higher rates of severe life events and Negative Elements in Close Relationships (lack of support and conflict with children). However, married mothers had greater Negative Evaluation of Self. The two vulnerability factors were correlated to each other and to severe life events and social adversity. Logistic regression showed an interaction between severe life events in the material and relationship domains and joint vulnerability for depression outcome. The results are discussed in relation to the low recognition of psychosocial risks for depression in single mothers in Malaysia, as well as lack of appropriate services.

Attachment style and psychological adjustment in couples.

The present study addresses the gap in research concerning poor marital support together with insecure attachment style explaining risk for anxiety or depression in both members of a couple expecting a baby. The Attachment Style Interview (ASI) was administered separately to both members of a couple (N = 126) during the second trimester of pregnancy together with measures of state-anxiety (STAI-S) and depression (EPDS). These measures were repeated at three months postpartum. While insecure attachment style was related to higher anxiety and depression symptoms in both partners at both time periods, there was an increase of postnatal depression symptoms in women. Poor partner support contributed to anxiety symptoms only in men. When insecure attachment combinations in both members of the couple were examined, insecure styles increased anxiety and depression symptoms in both genders antenatally, but postnatal anxiety symptoms only in women. A combined effect of partner's support and attachment style on temporal changes of anxiety symptoms was observed differently for women and men. It is important to assess attachment style and partner support of both members, as well as the mutual interplay between them, to understand gendered differences in psychological adjustment of a couple expecting a baby.

[Childhood Experiences of Care and Abuse (CECA) - validation of the German version of the questionnaire and interview, and results of an investigation of correlations between adverse childhood experiences and suicidal behaviour]. / Validierung der deutschen Version von Fragebogen und korrespondierendem Interview sowie Ergebnisse einer Untersuchung von Zusammenhangen belastender Kindheitserlebnisse mit suizidalen Verhaltensweisen.

OBJECTIVES: Validation of the German translation of a questionnaire and the corresponding interview for the assessment of adverse childhood experiences within the family environment and investigation of an association of these experiences with suicidal behaviour. METHOD: The questionnaire was tested in a consecutively recruited sample of 125 psychiatric inpatients (aged 13 to 25 years) at the University Hospital Heidelberg. Retests and corresponding interviews were also performed. Suicidal behaviour was measured by the Paykel Suicide Scale. RESULTS: The questionnaire and interview showed very good internal consistency and retest reliability; the interrater reliability of the interview was good, and there was a significant correlation between the questionnaire and the interview. Suicidal behaviour was significantly associated to all adverse childhood experiences, but maternal neglect and antipathy proved to be the best predictors of suicidal behaviour. CONCLUSIONS: The CECA instruments are reliable and valid instruments for the assessment of adverse childhood experiences. They assess a broad spectrum of adverse childhood experiences including negative bonding experiences. The association of these experiences to higher levels of suicidal behaviour shows the importance of assessing such experiences in research and therapy.

Does Childhood Psychological Abuse Contribute to Intimate Partner Violence Victimization? An Investigation Using the Childhood Experience of Care and Abuse Interview.

Although psychological abuse is recognized as a particularly insidious form of child abuse, research on the impact of this type of abuse related to intimate partner violence (IPV) is scant. This study examined the contribution of childhood psychological abuse to IPV in female victims and non-victims. Furthermore, it investigated the role of cumulative abuse in predicting IPV. The study included 38 women victims of IPV and 40 non-IPV women. All participants were investigated using the Childhood Experience of Care and Abuse Interview (CECA); the Revised Conflict Tactics Scale (CTS2) and the IPV History Interview were used to assess IPV in the last year and lifetime, respectively. Results indicated that psychological abuse was a stronger predictor of IPV than other maltreatment types. Furthermore, dose-response effects of cumulative abuse on IPV are well evidenced. Future research should continue examining impacts of psychological abuse on IPV so as to further inform clinical practice and intervention planning.

Malaysian Moslem mothers' experience of depression and service use.

Standard psychiatric criteria for depression developed in the United States and United Kingdom are increasingly used worldwide to establish the prevalence of clinical disorders and to help develop services. However, these approaches are rarely sensitive to local and cultural expressions of symptoms or beliefs about treatment. Mismatch between diagnostic criteria and local understanding may result in underreporting of depression and underutilization of services. Little such research has been conducted in Malaysia, despite the acknowledged high rate of depression and low access to services. This study examines depression in Moslem Malay women living in Johor Bahru, Southern Peninsular Malaysia, to explore depression symptoms using the Structured Clinical Interview for DSM-IV. The 61 women interviewed were selected on the basis of high General Health Questionnaire scores from a large questionnaire survey of 1,002 mothers. The illustrative analysis looks at descriptions of depressed mood, self-depreciation and suicidal ideation, as well as attitudes toward service use. The women gave full and open descriptions of their emotional symptoms, easily recognizable by standard symptom categories, although somatic symptoms were commonly included, and the spiritual context to understanding depression was also prevalent. However, few women had knowledge about treatment or sought medical services, although some sought help from local spiritual healers. Attending to such views of depression can help develop services in Malaysia.

Problem partners and parenting: exploring linkages with maternal insecure attachment style and adolescent offspring internalizing disorder.

An intergenerational study examined mothers' insecure attachment style using the Attachment Style Interview (ASI; Bifulco et al., 2002a) in relation to her history of partner relationships, her parenting competence, and depression or anxiety disorder in her offspring. The sample comprised 146 high-risk, mother-adolescent offspring pairs in London, who were recruited on the basis of the mothers' psychosocial vulnerability for depression. Retrospective, biographical, and clinical interviews were undertaken independently with mother and offspring. A path model was developed, which showed that mothers' insecure attachment style had no direct link to either recalled child neglect/abuse or currently assessed disorder in their adolescent and young adult offspring. The connections appeared to be indirect, through the quality of relationships in the family system: mothers' insecure attachment and their partners' problem behavior accounted for variance in mothers' incompetent parenting as rated by interviewers. These variables predicted her neglect/abuse of the child, which was the only variable directly associated with internalizing disorder in her offspring. Mother's lifetime depression did not add to the model. It is argued that an ecological approach (emphasizing social adversity and different role domains) and a lifespan approach (emphasizing a history of adverse relationships a different life stages) is important in understanding the mechanisms by which parental insecure attachment style influences transmission of risk to the next generation.

Assessing child abuse: "We need to talk!"

BACKGROUND: This discussion paper adds to the recent critical debate concerning retrospective measurement of childhood abuse and adverse experiences. A series of recent articles found only modest overlap of prospective informant-based records with retrospective self-report questionnaires, with biases evident in the latter. However, this literature has omitted the use of investigator-based interviews as an alternative retrospective tool for triangulation of measurement. Validated interview approaches can ascertain accurate data using expert scoring that can be used to test both dose-effect and specificity analyses for further research and treatment purposes. OBJECTIVE: Arguments for the retention and further promotion of intensive interview measures for retrospective assessment of childhood neglect and abuse in relation to lifetime clinical outcomes are presented, with illustrative analyses. METHOD AND RESULTS: A network analytic approach is outlined, with six types of childhood abuse or neglect experiences scored via a well-validated interview (the Childhood Experiences of Care and Abuse). This indicates distinct pathways between types of neglect and abuse, but also from more common emotional abuse (antipathy, critical parenting) through to more pernicious psychological abuse (coercive, sadistic control) involving physical abuse or sexual abuse pathways. This is supplemented by a case vignette to illustrate the different pathways indicated. CONCLUSIONS: The interview approach gives victims a voice with their narrative (chance to talk) needed for better understanding of the specific dynamics of child abuse and neglect and for an entry into psychotherapeutic work. We need to ensure that such methods are retained in the research and practitioner portfolio of measurement tools.

Web-Based Measure of Life Events Using Computerized Life Events and Assessment Record (CLEAR): Preliminary Cross-Sectional Study of Reliability, Validity, and Association With Depression.

BACKGROUND: Given the criticisms of life event checklists and the costs associated with interviews, life event research requires a sophisticated but easy-to-use measure for research and clinical practice. Therefore, the Computerized Life Events and Assessment Record (CLEAR), based on the Life Events and Difficulties Schedule (LEDS), was developed. OBJECTIVE: The objective of our study was to test CLEAR's reliability, validity, and association with depression. METHODS: CLEAR, the General Health Questionnaire, and the List of Threatening Experiences Questionnaire (LTE-Q) were completed by 328 participants (126 students; 202 matched midlife sample: 127 unaffected controls, 75 recurrent depression cases). Test-retest reliability over 3-4 weeks was examined and validity determined by comparing CLEAR with LEDS and LTE-Q. Both CLEAR and LTE-Q were examined in relation to depression. RESULTS: CLEAR demonstrated good test-retest reliability for the overall number of life events (0.89) and severe life events (.60). Long-term problems showed similar findings. In terms of validity, CLEAR severe life events had moderate sensitivity (59.1%) and specificity (65.4%) when compared with LEDS. CLEAR demonstrated moderate sensitivity (43.1%) and specificity (78.6%) when compared with LTE-Q. CLEAR severe life events and long-term problems were significantly associated with depression (odds ratio, OR 3.50, 95% CI 2.10 to 5.85, P<.001; OR 3.38, 95% CI 2.02 to 5.67, P<.001, respectively), whereas LTE-Q events were not (OR 1.06, 95% CI 0.43 to 2.60, P=.90). CONCLUSIONS: CLEAR has acceptable reliability and validity and predicts depression. It, therefore, has great potential for effective use in research and clinical practice identifying stress-related factors for the onset and maintenance of depression and related disorders.

How do adolescents regulate distress according to attachment style? A combined eye-tracking and neurophysiological approach.

According to attachment theory, attachment representations influence emotion regulation (ER) across the lifespan. However, research into attachment-related ER in adolescence is still scarce. The aim of this study was to assess attachment-related ER using a multimodal approach, relying on behavioral and neurophysiological parameters. Attachment styles in eighty-one adolescents were assessed with the Attachment Style Interview (ASI). A distress-then-comfort paradigm based on visual stimuli (the Besancon Affective Picture Set-Adolescents) was employed to "activate" then "deactivate" the attachment system. Gaze and neurophysiological parameters of ER strategies were assessed using eye-tracking synchronized with a physiological device. During the first phase "distress exposure", attachment style was associated with the early stage of distress processing indexed by first fixation duration. Withdrawn adolescents fixated distress pictures less than other groups. Fearful adolescents showed a longer first fixation duration than withdrawn adolescents. During the following phase, "comfort-seeking", all groups initially fixed joy-complicity and comfort pictures earlier than neutral pictures, except for withdrawn adolescents, who fixated comfort pictures later than neutral pictures. Additionally, withdrawn adolescents explored comfort pictures less than enmeshed adolescents. Enmeshed adolescents explored neutral pictures less than comfort and joy-complicity pictures. Concerning neurophysiological parameters, first fixation duration correlated positively with Skin Conductance Response (SCR) rise time in fearful adolescents, while glance count correlated negatively with SCR latency in withdrawn adolescents. This study provides an innovative and objective evaluation of behavioral and neurophysiological parameters for attachment-related ER in adolescents, with a temporal resolution. These parameters constitute potential biomarkers that could contribute to our understanding of ER differences in insecure adolescents. This study was registered with the clinical trials database ClinicalTrials.gov on August 01, 2016, under the number NCT02851810.

The role of attachment relationship in adolescents' problem behavior development: a cross-sectional study of Kenyan adolescents in Nairobi city.

BACKGROUND: There is a significant link between insecure attachment and the development of psychopathology in adolescence. We investigated the relationship between adolescent attachment styles and the development of emotional and behavioral problems among adolescents in Kenya. We also examined the modifying influence of socio-economic-status (SES). METHOD: One hundred and thirty-seven adolescents who were attending two schools participated in the study. One school (low SES school) catered for children from predominantly low-income households, while the second school (middle SES school) catered for children from predominantly middle-income households. The data were collected using three instruments: researcher designed questionnaire to obtain socio-demographic information, the Strength and Difficulties Questionnaire (SDQ) that is designed to assess symptoms of disorder, and the Vulnerable Attachment Scale Questionnaire (VASQ) that is designed to measure attachment style. RESULTS: Adolescents from the low SES school had higher vulnerable attachment scores than those from the middle SES school (t(135) = - 2.5, P = 0.02). Male students had higher vulnerable attachment scores than females (P = 0.03). Adolescents who had experienced adversity in childhood had higher vulnerable attachment scores than those who had not (P < 0.00). Results from Pearson's correlation showed moderate to strong positive correlations between attachment insecurity and emotional and behavioral problems with participants who had higher emotional symptoms (r = 0.47, P < 0.01), conduct problem score (r = 0.33, P < 0.01), hyperactivity (r = 0.26, P < 0.01) and total difficulty scores (r = 0.47, P < 0.01), experiencing significantly higher levels of attachment insecurity than those with lower scores. CONCLUSIONS AND RECOMMENDATIONS: This study supports the notion that attachment insecurity increases the adolescents' susceptibility to develop psychological problems.

Associations between depression and specific childhood experiences of abuse and neglect: A meta-analysis.

BACKGROUND: Research documents a strong relationship between childhood maltreatment and depression. However, only few studies have examined the specific effects of various types of childhood abuse/neglect on depression. This meta-analysis estimated the associations between depression and different types of childhood maltreatment (antipathy, neglect, physical abuse, sexual abuse, and psychological abuse) assessed with the same measure, the Childhood Experience of Care and Abuse (CECA) interview. METHOD: A systematic search in scientific databases included use of CECA interview and strict clinical assessment for major depression as criteria. Our meta-analysis utilized Cohen's d and relied on a random-effects model. RESULTS: The literature search yielded 12 primary studies (reduced from 44), with a total of 4372 participants and 34 coefficients. Separate meta-analyses for each type of maltreatment revealed that psychological abuse and neglect were most strongly associated with the outcome of depression. Sexual abuse, although significant, was less strongly related. Furthermore, the effects of specific types of childhood maltreatment differed across adult and adolescent samples. LIMITATIONS: Our strict criteria for selecting the primary studies resulted in a small numbers of available studies. It restricted the analyses for various potential moderators. CONCLUSION: This meta-analysis addressed the differential effects of type of childhood maltreatment on major depression, partially explaining between-study variance. The findings clearly highlight the potential impact of the more "silent" types of childhood maltreatment (other than physical and sexual abuse) on the development of depression.