Toward a causal link between attachment styles and mental health during the COVID‐19 pandemic

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Abstract

Background

Recent research has shown that insecure attachment, especially attachment anxiety, is associated with poor mental health outcomes, especially during the COVID‐19 pandemic. Other research suggests that insecure attachment may be linked to nonadherence to social distancing behaviours during the pandemic.

Aims

The present study aims to examine the causal links between attachment styles (secure, anxious, avoidant), mental health outcomes (depression, anxiety, loneliness) and adherence to social distancing behaviours during the first several months of the UK lockdown (between April and August 2020).

Materials & Methods

We used a nationally representative UK sample (cross‐sectional n = 1325; longitudinal n = 950). The data were analysed using state‐of‐the‐art causal discovery and targeted learning algorithms to identify causal processes.

Results

The results showed that insecure attachment styles were causally linked to poorer mental health outcomes, mediated by loneliness. Only attachment avoidance was causally linked to nonadherence to social distancing guidelines.

Discussion

Future interventions to improve mental health outcomes should focus on mitigating feelings of loneliness. Limitations include no access to pre‐pandemic data and the use of categorical attachment measure.

Conclusion

Insecure attachment is a risk factor for poorer mental health outcomes.

Related collections

Most cited references 48

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A brief measure for assessing generalized anxiety disorder: the GAD-7.

Robert L Spitzer, Kurt Kroenke, Janet B W Williams … (2006)

Generalized anxiety disorder (GAD) is one of the most common mental disorders; however, there is no brief clinical measure for assessing GAD. The objective of this study was to develop a brief self-report scale to identify probable cases of GAD and evaluate its reliability and validity. A criterion-standard study was performed in 15 primary care clinics in the United States from November 2004 through June 2005. Of a total of 2740 adult patients completing a study questionnaire, 965 patients had a telephone interview with a mental health professional within 1 week. For criterion and construct validity, GAD self-report scale diagnoses were compared with independent diagnoses made by mental health professionals; functional status measures; disability days; and health care use. A 7-item anxiety scale (GAD-7) had good reliability, as well as criterion, construct, factorial, and procedural validity. A cut point was identified that optimized sensitivity (89%) and specificity (82%). Increasing scores on the scale were strongly associated with multiple domains of functional impairment (all 6 Medical Outcomes Study Short-Form General Health Survey scales and disability days). Although GAD and depression symptoms frequently co-occurred, factor analysis confirmed them as distinct dimensions. Moreover, GAD and depression symptoms had differing but independent effects on functional impairment and disability. There was good agreement between self-report and interviewer-administered versions of the scale. The GAD-7 is a valid and efficient tool for screening for GAD and assessing its severity in clinical practice and research.

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COVID-19 pandemic and mental health consequences: systematic review of the current evidence

Nina Vindegaard, Michael Eriksen Benros (2020)

Highlights • COVID-19 patients displayed high levels of PTSS and increased levels of depression. • Patients with preexisting psychiatric disorders reported worsening of psychiatric symptoms. • Higher levels of psychiatric symptoms were found among health care workers. • A decrease in psychological well-being was observed in the general public. • However, well conducted large-scale studies are highly needed.

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Mental health before and during the COVID-19 pandemic: a longitudinal probability sample survey of the UK population

Matthias Pierce, Holly F Hope, Tamsin Ford … (2021)

Summary Background The potential impact of the COVID-19 pandemic on population mental health is of increasing global concern. We examine changes in adult mental health in the UK population before and during the lockdown. Methods In this secondary analysis of a national, longitudinal cohort study, households that took part in Waves 8 or 9 of the UK Household Longitudinal Study (UKHLS) panel, including all members aged 16 or older in April, 2020, were invited to complete the COVID-19 web survey on April 23–30, 2020. Participants who were unable to make an informed decision as a result of incapacity, or who had unknown postal addresses or addresses abroad were excluded. Mental health was assessed using the 12-item General Health Questionnaire (GHQ-12). Repeated cross-sectional analyses were done to examine temporal trends. Fixed-effects regression models were fitted to identify within-person change compared with preceding trends. Findings Waves 6–9 of the UKHLS had 53 351 participants. Eligible participants for the COVID-19 web survey were from households that took part in Waves 8 or 9, and 17 452 (41·2%) of 42 330 eligible people participated in the web survey. Population prevalence of clinically significant levels of mental distress rose from 18·9% (95% CI 17·8–20·0) in 2018–19 to 27·3% (26·3–28·2) in April, 2020, one month into UK lockdown. Mean GHQ-12 score also increased over this time, from 11·5 (95% CI 11·3–11·6) in 2018–19, to 12·6 (12·5–12·8) in April, 2020. This was 0·48 (95% CI 0·07–0·90) points higher than expected when accounting for previous upward trends between 2014 and 2018. Comparing GHQ-12 scores within individuals, adjusting for time trends and significant predictors of change, increases were greatest in 18–24-year-olds (2·69 points, 95% CI 1·89–3·48), 25–34-year-olds (1·57, 0·96–2·18), women (0·92, 0·50–1·35), and people living with young children (1·45, 0·79–2·12). People employed before the pandemic also averaged a notable increase in GHQ-12 score (0·63, 95% CI 0·20–1·06). Interpretation By late April, 2020, mental health in the UK had deteriorated compared with pre-COVID-19 trends. Policies emphasising the needs of women, young people, and those with preschool aged children are likely to play an important part in preventing future mental illness. Funding None.

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Author and article information

Contributors

Laura M. Vowels:

ORCID: https://orcid.org/0000-0001-5594-2095

laura.vowels@unil.ch

Journal

Journal ID (nlm-ta): Br J Clin Psychol

Journal ID (iso-abbrev): Br J Clin Psychol

Journal ID (doi): 10.1111/(ISSN)2044-8260

Journal ID (publisher-id): BJC

Title: The British Journal of Clinical Psychology

Publisher: John Wiley and Sons Inc. (Hoboken )

ISSN (Print): 0144-6657

ISSN (Electronic): 2044-8260

Publication date (Electronic): 09 June 2023

Publication date (Print): September 2023

Volume: 62

Issue: 3 ( doiID: 10.1111/bjc.v62.3 )

Pages: 605-620

Affiliations

[ ¹ ] Department of Social and Political Sciences, FAmily and DevelOpment Research Centre (FADO), Institute of Psychology University of Lausanne Lausanne Switzerland

[ ² ] Department of Social and Political Sciences, Cognitive and Affective Regulation Laboratory (CARLA), Institute of Psychology University of Lausanne Lausanne Switzerland

[ ³ ] School of Psychology University of Southampton Southampton UK

[ ⁴ ] Department of Psychology, Sociology and Politics, Centre for Behavioural Science and Applied Psychology Sheffield Hallam University Sheffield UK

[ ⁵ ] School of Education University of Sheffield Sheffield UK

Author notes

[*] [* ] Correspondence

Laura M. Vowels, Department of Psychology, University of Lausanne, Lausanne, Switzerland.

Email: laura.vowels@ 123456unil.ch

Author information

Laura M. Vowels https://orcid.org/0000-0001-5594-2095

Article

Publisher ID: BJC12428 Other ID: BJC-2023-0011.R1

DOI: 10.1111/bjc.12428

PMC ID: 10946758

PubMed ID: 37300241

SO-VID: 824a75c6-a085-44a1-ad39-d928aea245ba

License:

This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

History

Date revision received : 18 May 2023

Date received : 07 February 2023

Date accepted : 18 May 2023

Page count

Figures: 2, Tables: 3, Pages: 16, Words: 7535

Funding

Funded by: Economic and Social Research Council , doi 10.13039/501100000269;

Custom metadata

source-schema-version-number 2.0

cover-date September 2023

details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.3.9 mode:remove_FC converted:18.03.2024

Keywords: attachment style,covid‐19,loneliness,mental health,social distancing behaviours

Data availability:

Keywords: attachment style, covid‐19, loneliness, mental health, social distancing behaviours