Childhood adversity and the development of depression, personality and trauma related disorders

Research has captured the direct relationship between Adverse Childhood Experiences (ACEs) and the development of mental health disorders in later life. Potential mediators of this relationship are less well understood however there is emerging evidence that attachment, mentalisation and interpersonal difficulties may influence this relationship across a diverse range of depression, personality and trauma related disorders. PURPOSE: An empirical study using existing data was then undertaken to investigate if mentalisation and interpersonal difficulties mediated the relationship between childhood emotional abuse, childhood emotional neglect and depression. A better understanding of potential mediators between childhood adversity and mental health diagnoses was sought with the intention of contributing to the evidence base of treatment and preventative measures. METHODS: To identify relevant research articles the following online databases were searched in March 2021: psychINFO, MEDLINE, EMBASE, Cochrane, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and web of science. Data extraction and narrative synthesis was performed. The sample analysed in this research is taken from an unpublished cross-sectional study (Clarke, Shinton, Cai and Drummond 2019). Participants completed four self-report measures: Child and Adolescent Trauma Scale (CATS) (Sanders et al 1995), Reflective Functioning Questionnaire (RFQ) (Fonagy et al 2016), Inventory of Interpersonal Problems 32 (IIP-32) (Barkham et al 1996) and the Depression Anxiety Stress Scales – 21(DASS-21) (Antony et al 1998). Serial mediation analysis was then performed to investigate the relationship between childhood emotional neglect, childhood emotional abuse, interpersonal difficulties, mentalisation and depression. RESULTS: Of the nineteen papers identified for narrative synthesis five investigated depression, nine personality disorders and five trauma related disorders. Across all studies results were reported which suggest insecure attachment may play a role in the development of depression, personality and trauma related disorders following childhood adversity. In the empirical study, serial mediation analysis demonstrated that interpersonal problems and deficits in reflective functioning, specifically hypomentalising, better explain the relationship between childhood adversity and depression. This hypothesised model builds on the established direct link between childhood adversity and depression to provide an improved understanding of the trajectory. DISCUSSION: Results from the systematic review indicate that insecure attachment may be involved in the development of mental health difficulties following childhood adversity. Suggestions include adopting an attachment-based perspective to prevention, treatment and governmental policy. In the empirical study results from the serial mediation analysis implicate reflective functioning, or mentalising, and interpersonal problems with depression following childhood emotional abuse and neglect. Consequences for treatment, prevention and policy are considered