Associations between insecure attachment styles to parents and suicidal ideation in adolescents with depression

Objective: Suicidal ideation and depressive symptoms are often interrelated in clinical settings. Insecure attachment may be a risk factor for suicidal ideation in depressed adolescents. To our knowledge, this study is the first to examine the association between self-reported insecure attachment styles to both parents and suicidal ideation in a clinical sample of adolescents with depression. Methods: Fifty clinically depressed adolescents (13-17 years, 84% girls) completed self-reported measures of suicidal ideation, depressive symptoms, and attachment style to parents. Results: There was a statistically significant bivariate association between higher levels of attachment anxiety in relation to mothers and fathers and higher levels of suicidal ideation. When attachments to both parents were included in the same multivariate model, only attachment anxiety to the mother was significantly associated with the level of suicidal ideation. Self-reported depressive symptoms remained significantly associated with the level of suicidal ideation in all analyses. Younger adolescents with attachment anxiety reported higher levels of suicidal ideation than older adolescents. Conclusion: Conclusions about directionality and causality of associations between insecure attachment and suicidal ideation are limited due to the cross-sectional design. Our findings suggest that attachment anxiety in relation to the mother and father is associated with increased levels of suicidal ideation. Implication of these findings for treatment selection is discussed

Organisering og integrasjon av affekt hos pasienter med borderline personlighetsforstyrrelse : en kvalitativ studie med utgangspunkt i affektbevissthetsmodellen

Bakgrunn: Borderline personlighetsforstyrrelse er en alvorlig psykisk lidelse kjennetegnet av ustabilitet i interpersonlige relasjoner, identitet og affekt. Tilstanden har trolig en multifaktoriell etiologi, hvor både genetiske faktorer og spesifikke miljøbelastninger er vist å ha betydning. Affektbevissthetsmodellen tar utgangspunkt i Silvan Tomkins' affekt- og skript-teori satt inn i en selvpsykologisk forståelsesramme. Modellen antar at ulike affekter er differensierte, evolverte systemer med sentral betydning for motivasjon og interpersonlig kommunikasjon, og at integrasjon av affektaktivering spiller en sentral rolle i opplevelsen av et sammenhengende selv. Studien forsøker å belyse borderline personlighetsforstyrrelse gjennom affektbevissthetsmodellen. Metode: Data ble hentet fra den norske Multisenterstudien av prosess og utfall i psykoterapi. Affektbevissthetsintervjuer med elleve pasienter diagnostisert med borderline personlighetsforstyrrelse ble analysert for å beskrive individuelle mønstre av affektive problemer. Analysemetoden var hermeneutisk, med et eksplisitt teoretisk utgangspunkt. Resultater: Det er betydelig heterogenitet i de affektive problemene pasientene presenterer, men mulig å identifisere noen overordnede mønstre. Affekt knyttet til eksklusjon fra relasjoner eller sosiale grupper står frem som et sentralt element for alle. Problemer med å opprettholde en stabil opplevelse av et sammenhengende selv fremstår som et annet sentralt element. Konklusjon: En differensiell affektintegrasjonsmodell kan bidra i å utvikle mer spesifikke modeller av rollen affekt spiller i borderline personlighetsforstyrrelse. Begrensninger i utvalg og analysemetode gjør samtidig at det ikke kan trekkes klare konklusjoner om borderline personlighetsforstyrrelse som fenomen på bakgrunn av denne studien

Conflict with Parents in Adolescent Depression

Model code and samples from the paper Conflict with Parents in Adolescent Depression: Associations with Parental Interpersonal Problems and Depressive Symptoms, published in Child Psychiatry and Human Development DOI : 10.1007/s10578-020-00955-0

Discrepancies in report of parent-adolescent conflict and adolescent hopelessness: A replication study

Preregistration and analysis code related to the paper at https://doi.org/10.1007/s10826-023-02610-

Moderation of treatment effects by parent-adolescent conflict in a randomised controlled trial of Attachment-Based Family Therapy for adolescent depression

Background: Conflict with parents is frequent in adolescent depression, and has been shown to predict poor treatment outcomes. Attachment Based Family Therapy (ABFT) is a manualised treatment for adolescent depression that may be robust to parent-adolescent conflict. Objective: To evaluate the hypothesis that parent-adolescent conflict moderates the outcome of Attachment-Based Family Therapy compared with treatment as usual. Methods: Data were obtained from a randomised trial comparing 16 weeks of ABFT to treatment as usual, in Norwegian Child and Adolescent Mental Health Services. Sixty adolescents with moderate to severe depression and their parents were recruited. Change in Grid-Hamilton Depression Rating Scale scores from baseline to week 16 was modelled using linear mixed models, and a three-way interaction of time, treatment allocation and a continuous measure of parent-adolescent conflict was fitted to estimate a moderator effect. The moderator model was compared to simpler models using leave-one-out cross-validation. Results: Better outcomes were predicted for Attachment-Based Family Therapy at high levels of mother-adolescent conflict, and for treatment as usual at low levels of mother-adolescent conflict, giving preliminary support to the moderator hypothesis. Findings for father-adolescent conflict were mixed. Cross-validation did not clearly support the moderator model over a simple effect of time, indicating that the replicability of these findings is uncertain. Conclusion: The results suggest that parent-adolescent conflict should be further studied as a moderator of outcome in Attachment-Based Family Therapy. The trial did not meet its recruitment target and had high attrition, limiting the conclusions that may be drawn

Effectiveness of attachment-based family therapy compared to treatment as usual for depressed adolescents in community mental health clinics

Background Major Depressive Disorder (MDD) is a disabling mood disorder, profoundly affecting a large number of adolescent’s quality of life. To date, no obvious treatment of choice for MDD in adolescents is available and progress in the treatment of depressed adolescents will have important public health implications. Attachment-Based Family Therapy (ABFT), as the only empirically supported family therapy model designed to treat adolescent depression, aims to repair interpersonal ruptures and rebuild an emotionally protective parent–child relationship. Objective To study the effectiveness of ABFT compared with treatment as usual (TAU) delivered within child- and adolescent mental health services (CAMHS) to adolescents with MDD. Method Sixty adolescents (86.7% girls), aged 13–18 years (M = 14.9, SD = 1.35), with MDD referred to two CAMHS were randomized to 16 weeks of ABFT or TAU. ABFT consisted of weekly therapy sessions (family/individual or both) according to the treatment manual. TAU was not monitored. Primary outcomes were assessed by blinded evaluators at baseline and post-treatment with the Hamilton Depression Scale (HAMD). Self-reported (Beck Depression Inventory-II, BDI-II) depressive symptoms were assessed at baseline, and after 4, 6, 8, 10,12, 14, and 16 weeks. Analyses were performed according to intent-to-treat principles. Results At post-treatment, clinician-rated remission rates on the HAMD (5% in ABFT and 3.33% in TAU, p = 1, OR = 1.54, Fisher’s exact test) and self-reported symptoms of depression on the BDI-II did not differ significantly between groups (X2[2, N = 60] = 0.06, p = 0.97). In both treatment groups participants reported significantly reduced depressive symptoms, but the majority (63.3%) of adolescents were still in the clinical range after 16 weeks of treatment. Conclusion ABFT was not superior to TAU. Remission and response rates were low in both groups, suggesting none of the treatments were effective in treating MDD in adolescents. Findings must be viewed in the context of the study’s small sample size, missing data, and implementation challenges. Continued efforts to improve treatment for MDD in outpatient clinics are warranted. Future research should examine moderators of and mechanisms for individual differences to treatment response, as well as the feasibility and cost-effectiveness of implementing treatment models which may require extensive training and expertise to yield clinically meaningful improvements in non-research settings. Trial registration Clinicaltrials.gov identifier: NCT01830088 https://clinicaltrials.gov/ct2/show/NCT01830088?term=Villab%C3%B8&draw=2&rank=1 Date of registration: April 12, 201

Associations between insecure attachment styles to parents and suicidal ideation in adolescents with depression

Suicidal ideation and depressive symptoms are often interrelated in clinical settings. Insecure attachment may be a risk factor for suicidal ideation in depressed adolescents. To our knowledge, this study is the first to examine the association between self-reported insecure attachment styles to both parents and suicidal ideation in a clinical sample of adolescents with depression

Efficacy of attachment-based family therapy compared to treatment as usual for suicidal ideation in adolescents with MDD

Attachment-Based Family Therapy (ABFT) is the only empirically supported family therapy model designed to treat adolescent depression, including those at risk for suicide, and their families. ABFT aims to repair interpersonal ruptures and rebuild an emotionally protective parent-child relationship. To study the effectiveness of ABFT compared with Treatment as Usual (TAU) in reducing suicidal ideation in clinically depressed adolescents. Sixty adolescents (86.7% girls), aged 13 to 18 years ( M = 14.9), with major depressive disorder referred to two CAMHS were randomized to receive 16 weeks of ABFT or TAU. ABFT consisted of weekly therapy sessions according to the treatment manual. Suicidal ideation was measured with the Suicidal Ideation Questionnaire-Junior at 4, 6, 8, 10, 12, 14, and 16 weeks. Linear mixed models were fitted to test our hypothesis, time was the only factor to have a significant effect on suicidal ideation t(31.05) = −3.32, p < .01. Participants in both treatment groups reported significantly reduced suicidal ideation, but the majority were still in the clinical range after 16 weeks of treatment. ABFT was not associated with more favorable outcomes than TAU. Findings must be interpreted with caution given the study limitations