Adolescent depression is a serious disorder with prevalence rates ranging between 2.5 and 8.3% and a high risk of suicidality, recurrence and chronicity (Birmaher et al.
; Dunn and Goodyer
; Fombonne et al.
). In the past decade, the role of family factors in the development of depressive symptoms has received increased attention in research (Sander and Mc Carty
). One such factor is attachment. When caregivers are available to their child and respond in a loving and responsive way, the child develops a secure attachment bond with the caregivers and experiences confidence in self and others. A lack of protective and sensitive responding of the caregivers leads to a sense of insecurity and to an increase in levels of distress. Moreover, the child may develop an insecure attachment to the caregiver over time (Bowlby
). Self-report measures of attachment have been utilized to assess the quality of attachment relations in adolescence in comparison with the observational measures utilized in infancy (Gullone and Robinson
). Armsden et al. (
) have found that depressed adolescents reported significantly less secure parent and peer attachment relations in terms of trust, communication, and alienation than their non-depressed counterparts (see also Green and Goldwyn
Recently, there has been interest in gaining a better understanding of the mechanisms by which attachment relationships are related to depressive symptoms. A good candidate here might be rumination. A ruminative response style can be defined as the tendency to engage in repetitive thinking about the depressive symptoms, as well as the causes and consequences of these symptoms (Nolen-Hoeksema
A recent meta-analysis has shown that rumination is significantly associated with symptoms of depression in youth (Rood et al.
). There have been relatively few attempts to examine developmental antecedents of rumination. There is some evidence suggesting that people who report having psychologically over controlling parents, tend to engage in rumination in response to depressed mood (Spasojevic and Alloy
). For attachment, rumination has been found to mediate the pathway to depression in insecurely-attached adolescents, when confronted with stress involving romantic relationships (Margolese et al.
). Thus, the quality of the relationship between caregivers and children might determine to what extent the child becomes a ruminator.
The aim of the current study was to bring together research on attachment relations, rumination, and symptoms of depression. With respect to attachment, peer relations become more important during adolescence as more time is spent with friends. There is evidence to suggest that adolescents prefer friends over parents for their company, and as sources of comfort and emotional support, but parents continue to serve as bases of security (Hazan and Zeifman
). The current study focused on the quality of attachment relations (i.e., trust, communication, and alienation) rather than attachment status and included both parents and peers. Second, we examined the relative contribution of indices of quality of attachment relations in explaining variance in depressive symptoms. We hypothesized that quality of attachment relations to both parents and peers would account for a unique portion of the variance in depression scores. Finally, the current study examined rumination as a mediator in the relation between indices of quality of attachment relations and symptoms of depression. Alienation as an attachment relationship variable refers to interpersonal isolation and has some resemblance to lack of social support. Abela et al. (
) found some evidence to suggest that rumination did not only mediate the relation between low social support and depressive symptoms, but also that social support mediated the relation between rumination and depression, as rumination may create a vicious cycle wherein rumination may lead to a negative view of the social environment resulting in depression. We therefore tested both mediation models. The findings may contribute to a more differentiated picture of what parent and peer attachment variables are associated with depression through the cognitive mechanism of rumination.
This study sought to examine the links between quality of attachment relations with parents and peers, rumination, and depressive symptoms in a non-clinical sample of adolescents. More specifically, a mediational model was proposed in which rumination was hypothesized to mediate the relation between quality of attachment relations and symptoms of depression. Alienation was also tested as a mediator in the relation between rumination and depressive symptoms. Results can be summarized as follows. First, most indices of quality of attachment relations were associated with rumination and depression. Second, in examining the relative contribution the indices of quality of attachment relations to explaining variance in depression scores, parental trust, alienation from peers, communication with peers were significantly associated. Finally, full mediation was found for rumination in the relation between communication with peers and depressive symptoms, whereas partial mediation for rumination was found in the relations between parental trust and alienation from peers, and symptoms of depression.
Rumination was found to fully mediate the relation between communication with peers and depression and to partially mediate the relation between parental trust and alienation from peers on the one hand and symptoms of depression on the other hand. Surprisingly, with respect to communication with peers, a positive association was found for this variable with symptoms of depression, whereas the zero-order correlation with depression was near to zero. A negative association between this communication with peers and depressive symptoms might be captured within the shared variance of communication with peers and the remaining two attachment scales (i.e., parental trust and alienation from peers) as this negative association should explain, together with the positive association found in the mediation analysis (which is the relative contribution of communication with peers to explaining variance in depression symptoms), the near to zero correlation between communication with peers and symptoms of depression. Thus, communication to peers seems to have two faces here: adolescents may communicate either more or less when feeling depressed. In explaining the positive relation between communication with peers and symptoms of depression, it may be that communication among adolescents may take the form of rumination on stressful events and negative consequences of one’s mood, which may be positively related to depressive symptoms. In the friendship literature, Rose (
) has introduced the concept of co-rumination, which refers to excessively discussing problems with friends and is proposed to contribute both to positive friendship adjustment, but also to problematic emotional adjustment (e.g., depressive symptomatology). Research findings pertaining to the relation between co-rumination and depressive symptoms remain, however, inconclusive (Rose
; Rose et al.
; Starr and Davila
Rumination partially mediated the relation between alienation from peers and depression, but alienation did not mediate the relation between rumination and symptoms of depression. These findings partly concur with Abela et al. (
) who found mediation in both directions for social support (instead of alienation). Although high social support is associated with lower feelings of alienation (e.g., Fleming et al.
), it may be the case that once adolescents start to ruminate they communicate to peers about it (e.g., co-rumination) rather than perceiving the social environment as negative and consequently make less attempts to seek out for social support. An intriguing question here is in what way co-rumination takes place in adolescents. In this context, rumination has also been found to mediate the relation between depression and excessive reassuring seeking behaviours (Weinstock and Whisman
). These behaviours may serve the purpose of managing feelings of low self-worth and depression, but may eventually lead to interpersonal rejection, resulting in alienation. Thus, although speculative, it may be that excessive reassurance seeking fuels the process of alienation by facilitating interpersonal rejection.
Partial mediation was found between parental trust and symptoms of depression. This finding underscores the importance of the parents even in middle and late adolescence and adds to previous research suggesting that parents still serve as secure base for their children (e.g., Fraley and Davis,
; Nickerson and Nagle
). The finding of partial mediation suggests that no or little trust in parents is associated with depressive symptoms directly as well as indirectly through rumination. It is generally believed that trust in parents serves as a foundation for fulfilling the basic needs of children such as sense of safety, connectedness to others, self-esteem, and autonomy. If these needs cannot be fulfilled, youngsters may apply a number of coping strategies in order to deal with this. As such, rumination might be considered one cognitive coping strategy associated with depressed mood (see Nolen-Hoeksema
Although the current study used non-clinical adolescents, the findings may tentatively have some clinical implications. A meta-analysis by Weisz et al. (
) has shown that the mean effect size generated by treatments for juvenile depression was .34 indicating small to medium effect (Cohen
), and leaving room for improvement such as the inclusion of parents in treatment. However, on the basis of a review of family factors involved in the treatment of depression in youth, Sander and McCarthy (
) have concluded that the effectiveness of treatments that involve children and adolescents exclusively is almost similar to that of treatments that include parents as well. The authors did conclude that it is important to disentangle specific components of treatment that produce successful results in terms of symptom reduction or relapse prevention. The results from our study provide a more detailed picture of what factors might be good candidates. An important tenet of depression treatment might be the inclusion of parental bonds (i.e., interaction between youngster and the parents). For example, Diamond et al. (
) describes the Attachment-Based Family Treatment (ABFT) which is a brief, manualized treatment model tailored to the specific needs of depressed adolescents and their families. Attachment theory serves as the main theoretical framework to guide the process of repairing relational ruptures and rebuilding trustworthy relationships. There is an ongoing randomized clinical trial that assesses the effects of an ABFT-based treatment of which the first preliminary findings seem promising.
Interpersonal psychotherapy (IPT) for depressed adolescents includes the family context as well, but also takes peer relationships into account. IPT was originally developed by Klerman and colleagues (
) and adapted for adolescents by Mufson and colleagues (
). The adaptation for adolescents include developmental issues such as separation from parents, exploration of authority in relationships to parents, development of dyadic interpersonal relationships, initial experience with the death of relative or friend, peer pressure, and the single parent family. Results from a clinical trial have shown that IPT for depressed adolescents leads to a decrease in depressive symptoms and greater improvement in overall social functioning, functioning with friends, and specific problem-solving skills compared to controls (Mufson et al.
). Another interpersonal view on depression proposes that adolescent depression may be associated with an adolescent’s failure to negotiate autonomy from parents while maintaining closeness and intimacy (Allen and Land
; Powers and Welsh
In addition to targeting family factors in treatment, it may also be important to target rumination in treatment. Recently, rumination focused cognitive-behavioural therapy (RFCBT) has been developed as a treatment form for chronic and recurrent depression. In this treatment, rumination is conceptualized as a form of avoidance and is replaced with more helpful approach behaviours. Recent experimental research suggests that there are distinct styles of rumination. Concrete process-focused rumination is considered a helpful style, whereas abstract, evaluative thinking is thought of as a maladaptive style (see Watkins et al.
). A number of techniques can be used to stimulate concrete, process-focussed rumination and to reduce abstract, evaluative thinking. Thus, RFBCT places a greater emphasis on the modification of the process of thinking rather than attempting to change the content of thoughts as is done in standard cognitive-behaviour therapy.
This study suffered from a number of shortcomings. First, the study is cross-sectional in nature making it impossible to draw any conclusion about cause-effect relationships. The mediation analysis should be interpreted with some caution. That is, one can only speak in terms of indirect effects. Longitudinal research may shed some light on temporal relationships between attachment, rumination, and symptoms of depression, whereas experimental studies may gain insight into the causal mechanisms by which attachment variables may influence depressive symptoms through rumination. Second, no information with regard to socioeconomic status and family composition were collected. However, the sample was representative of the various school levels, indicating that the current study included adolescents who are functioning at different levels. Finally, the study relied solely on self-report questionnaires. Future research should include other methods as well such as observational procedures to obtain information about the quality of the interaction between youngsters and their parents. Despite these limitations, the present study adds to our understanding of contributing and mediating mechanisms in relation to depressive symptoms in adolescents. It clearly advocates a theoretical point of view and clinical practice that highlights the importance of the complex relationships between quality of attachment relations with parents and peers, rumination, and depressive symptoms.