The role of attachment and resiliency in the
intergenerational transmission of depression:
results from the Cambridge Longitudinal Study
Lynne Murray
Winnicott Research Unit, University of Reading
with
Adriane Arteche, Peter Cooper, Sarah Halligan, Pasco Fearon and Matt Woolgar
Funding: MRC, UK; Tedworth Trust; Winnicott Trust
Intergenerational transmission of
depression
• Consistent reports of offspring of parents with depression
being at substantially increased risk for depression themselves:
- e.g.,
Leib et al., 2002
Lewinsohn et al., 2005
Weissman et al., 2006
Timko et al., 2008
• However, little prospective longitudinal data concerning
development of disorder through childhood.
How might insecure attachment be
involved in intergenerational transmission
of psychopathology?
Bowlby’s theory of attachment
• Concerns propensity to make close emotional bonds
• Need for protection a prominent feature early in
development
• Security promotes independence
Attachment quality
• Secure: can rely on parent for support when
distressed
• Insecure avoidant: minimize expression of
distress, avoid close contact
• Insecure ambivalent: maximize expression of
distress at separation, mixed with anger
• Disorganised: no clear strategy, confused,
irrelevant, freezing
Parenting and attachment
•
•
•
•
Secure: available, responsive, sensitive
Insecure avoidant: rejection
Insecure ambivalent: inconsistent
Disorganised: frightening behaviour/
maltreatment
Bowlby’s view of mental health
implications
• Avoidant
–
–
–
–
Deny needs
Attempt to live without others’ love and support
Sense of self as not worthy of love
Low expectations of others
• Ambivalent
– Pervasive anxiety, especially re. separation/abandonment
– Limited exploration of world
– Coping capacities not developed
Characteristics of attachment
• Repeated patterns of interaction become
internalised as IWM’s
• Self-perpetuating
• Relatively flexible early on, but become more
fixed over time
• Early experience special, as provides ‘setting
point’
Evidence to date: Minnesota longitudinal
study of mental health outcomes
• Avoidant/disorganized – predicts more global pathology
(Sroufe, 2005)
• Ambivalent – predicts anxiety diagnoses (Warren, 1997)
• Avoidant – predicts externalizing, early onset antisocial
(Aquilar, 2000; Sroufe, 2005)
• Disorganised – predicts dissociation (Carlson, 1998)
other disorders (Liotti, 2004; 2008)
• NB not strong effects, adversity adds
Role of attachment insecurity in
transmission of depression
• Depressed mothers’ interactions:
Generally insensitive –
- Withdrawn, unresponsive
- Intrusive, hostile
Effects of depression on infant
attachment
Systematic associations shown between PND
and insecure attachment
Meta analysesMartins and Gaffan, 2000
Atkinson et al., 2000
Plus
Campbell et al., 2004 (NICHD sample)
Bowlby’s view of mental health implications of
attachment for ego resiliency
• Avoidant
–
–
–
–
Deny needs
Attempt to live without others’ love and support
Sense of self as not worthy of love
Low expectations of others
• Ambivalent
– Pervasive anxiety, especially re. separation/abandonment
– Limited exploration of world
– Coping capacities not developed
Ego resiliency
Thus, the insecure child may:lack capacity to cope with threat
have rigid, or limited coping strategies
be overwhelmed with sense of loss/anxiety
have low self-worth
(Erikson, 1985)
Predicted pathway
PND insecurity low ego resiliency depression
Cambridge longitudinal study
•
•
•
•
•
•
Sample
Low risk mothers cohabiting/married
Infants healthy
Community sample screened at 6 weeks
58 depressed, 42 controls recruited
Assessed so far to 16 years
video clips of interactions
Key child assessments beyond
postnatal period
•
•
•
•
18 months- attachment
5 years- ego resiliency
8 years- ego resiliency
16 years- psychiatric outcome
Other potentially important influences
• Continuing quality of mother-child
relationship
• Chronicity of maternal depression
• Marital conflict
Occurrence of depression assessed
8-16 years
• At each time point, a standardised interview (the KSADS) was used, and administered by a researcher
unaware of maternal diagnosis, to mother and child
independently
• At 8 years current state was assessed
• At 13 and 16 years current and previous mental state
to previous assessment was assessed
• Diagnoses assigned by senior clinical team, according
to best estimate, combining maternal and child report.
Percent Disorder
Cambridge Longitudinal study: Depression in the
children 8-13 years
50
45
40
35
30
25
20
15
10
5
0
Control (n=41)
PND (n=53)
**
*
Any
Diagnosis
Depression
Anxiety
Behavioural
Depression begins to emerge at 11-yrs: higher rates of
depressive disorder present in the PND group by 13-yrs
Percent disorder
Cambridge Longitudinal study: Depression in the
children 13 to 16-years
50
45
40
35
30
25
20
15
10
5
0
**
Control (n=40)
PND (n=53)
***
Any
Diagnosis
Depression
Anxiety
Behavioural
Rates of disorder continue to increase, particularly because of
the emergence of depression in the PND group
Cambridge Longitudinal PND study: 16 years
life-time depression - full sample
Control
PND
50
40
%
30
20
10
0
% Depressed
2
X (1)=9.31; p<.01
PND and 16 yr life-time depression, including
child sex
PND & DEPRESSION OUTCOME BOYS
PND & DEPRESSION OUTCOME GIRLS
Control
PND
50
Control
PND
50
40
30
%
20
10
0
40
%
30
20
10
% Depressed
X2(1)=6.17; p=.01
0
% Depressed
2
X (1)=3.56; p=.05
Developmental trajectory to depression
The roles of infant attachment and ego
resiliency, and the subsequent mother-child
relationship
Insecure infant attachment: Effects of PND
100
80
%
60
Control
PND
40
20
0
% Insecure
2
X (1)=14.01; p<.001
Infant attachment: Relation to 16 years
lifetime depression
80
60
Not Depressed
Depressed
% 40
20
0
% Insecure
2
X (1)=3.73; p<.05
Ego resiliency at 5 and 8 years: Effects of
PND and attachment, and relation to 16 yr
life-time depression
•
•
•
•
The Snap card game (Murray et al., 2001)
Child at home with friend
Competitive card game
Rigged by experimenter to provide losing and
winning deals (both children win at end!)
• Rate child’s distress and anxiety in the face of the
mild threat of loss
video clips of card game
Ego resiliency at 5 and at 8 years:
Effects of PND
20
15
M
E
A
N
Control
PND
10
5
0
5yr ER
8yr ER
F(1,88)=4.22, p<.05
F(1, 80)=3.17, p<.10
Ego resiliency at 5 and at 8 years:
Effects of attachment
M
E
A
N
20
15
10
5
0
Secure
Insecure
5yr ER
F(1,88)=2.47, ns
8yr ER
F(1, 80)=3.67, p<.10
Ego resiliency at 5 and at 8 years:
Relation to 16 yr life-time depression
M
E
A
N
Not Depressed
Depressed
20
15
10
5
0
5yr ER
Wald=3.36, OR=1.07, p<.10
8yr ER
Wald=7.67, OR=1.07, p<.01
Maternal sensitivity and emotional
support at 5 and 8 years
• Maternal sensitivity at 5 years- assessed during
‘snack’ in research unit (warmth, appropriate
responsiveness) (Murray et al., 1999)
• Maternal emotional support at 8 yearsassessed during child homework session
(available, positively responsive) (Murray et al.,
2006)
Maternal insensitivity at 5 years:
Effects of PND
4
+
no PND
PND
M
E
A
N
3
2
1
Insensitivity
PND effects: F(1, 84)=2.91, p<.10
sex effects: ns
PND*sex: ns
Maternal insensitivity at 5 years:
Effects of attachment
4
+
Secure
Insecure
M
E
A
N
3
2
1
Insensitivity
attachment effects: F(1, 84)=2.90, p<.10
sex effects: ns
attachment*sex: ns
Maternal insensitivity at 5 years:
Relation to adolescent depression
4
*
No Depression
Depression
M
E
A
N
3
2
1
Insensitivity
No effects of 8 yr emotional support
Pathway so far: PND, attachment, 5 and 8 yr
resiliency, and maternal insensitivity at 5 yrs
ER
5yrs
ER
8yrs
p=.05
p=.06
p<.001
PND
p=.06
p=.06
16y
lifetime
depression
p=.05
Infant
Attach
p=.004
p=.05
p=.09
5yrs
insensitivity
p=.006
The role of chronic difficulties
• Maternal depression
– Assessed at each time point, with month-by-month
recording of offsets and onsets of disorder to give
chronicity
• Marital conflict
– Assessed at each time point by interview/questionnaire
Chronicity of maternal depression
Women in the PND group experienced further
depression outside the postnatal period
Marital conflict: Relation to PND
80
70
**
**
60
**
50
No PND
PND
% 40
30
20
10
0
18m MC
5y MC
8y MC
13y MC
What about continuing maternal depression &
marital conflict? Effects of these difficulties
following each stage of child development
chronicity mat.
depression
p<.01
attachment
18m
marital conflict at
18m, 5, 8 & 13y
p=.04
Depression <16yrs
chronicity mat.
depression (5y-onset)
p<.05
MODEL 1
attach
18m
marital conflict 5+8 +13
p=.06
Depression <16yrs
low ego
resilience 5y
chronicity mat. depression
(8y-onset)
ns
MODEL 2
attach
18m
low ego
resilience 5y
low ego
resilience 8y
marital conflict at 8+
13y
ns
Depression <16yrs
What about mother-child interactions?
maternal
insensitivity at 5yrs
p<.10
maternal emotional support
at 8yrs
ns
attachment
18m
Depression <16yrs
maternal
insensitivity at 5yrs
ns
MODEL 1
attachment
18m
low ego
resilience 5y
maternal emotional
support at 8yrs
ns
Depression <16yrs
Summary
Main study finding: Child depression up to 16
yrs is predicted by PND, insecure attachment,
and poor resiliency, especially at 8 yrs.
Supplementary findings: a) the role of
subsequent maternal interactions
• Once infant attachment is taken into account, the
contribution of maternal insensitivity at 5 yrs is only
marginal. That of 8yr maternal support is not
significant.
• Once infant attachment and 5yr resiliency are taken
into account, the mother’s insensitivity at 5 yrs does
not contribute further to risk of depression (and 8yr
support remains non-significant)
Supplementary findings: b) the role of
further maternal depression and conflict
• Once infant attachment is taken into account, there is still an
additional effect of continuing maternal depression and marital
conflict
• Once attachment and 5yr resiliency are taken into account, the
effect of continuing maternal depression is still significant, but
the role of subsequent marital conflict is reduced
• Once attachment and both 5 and 8yr resiliency are taken into
account, neither further maternal depression, nor marital
conflict add to the risk of child depression
Overall conclusion
• PND and its effects on child development
through the first 8 years predict the occurrence
of child depression up to 16 years.
• Negative experience subsequent to the first 8
years does not add further to the child’s risk of
depressive disorder