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. Author manuscript; available in PMC: 2024 Mar 15.
Published in final edited form as: J Affect Disord. 2023 Jan 19;325:695–700. doi: 10.1016/j.jad.2023.01.059

Avoidant Attachment Transmission to Offspring in Families with a Depressed Parent

Robert A Tumasian III 1, Hanga C Galfalvy 1,2,3, Meghan R Enslow 2,3, David A Brent 4, Nadine Melhem 4, Ainsley K Burke 2,3, J John Mann 2,3, Michael F Grunebaum 2,3,*
PMCID: PMC9911374  NIHMSID: NIHMS1867981  PMID: 36681306

Abstract

Background:

Insecure attachment is associated with mental health morbidity. We explored associations between parent and offspring attachment style in a longitudinal study of families with a depressed parent.

Methods:

Parents (N=169) with a DSM-IV mood disorder and their adult offspring (N=267), completed the Adult Attachment Questionnaire at one or more time points during up to 9.7 years of follow-up. Linear mixed effects models explored associations between parent and offspring anxious and avoidant attachment scores. Residualized models accounted for parent and offspring depression severity.

Results:

Avoidant attachment scores were associated between parents and offspring with (p=.034) and without (p=.012) adjustment for baseline age and sex of parent and offspring. Depressed father-offspring relationships showed more avoidant attachment in offspring compared to depressed mother-offspring pairs (p=.010). After accounting for depression severity, parent average residualized avoidant attachment scores did not significantly correlate with those of offspring (unadjusted p=.052; adjusted p=.085), though the effect sizes did not change substantially, and 75% of the correlation was retained. Parent-son relationships exhibited stronger avoidant attachment correlations compared to parent-daughter pairs (p=.048).

Limitations:

Small sub-sample of fathers, parent and offspring assessments not always completed at the same time, and use of a self-report attachment style instrument.

Conclusions:

Familial transmission of insecure avoidant attachment, a risk factor for negative mental health outcomes, merits research as a potential treatment target. In this preliminary study, its transmission to offspring seemed mostly independent of depression. Depressed fathers and their sons may deserve focus to reduce insecure avoidant attachment and improve clinical course.

Keywords: Attachment, depression, major depressive disorder, familial transmission

INTRODUCTION

Intergenerational transmission of depression is a replicated finding (Hammen and Brennan, 2003)(Weissman et al., 2016), but the relationship of parent and offspring insecure attachment style is less understood. Studies suggest parent and offspring attachment style are correlated (Main et al., 1985; van IJzendoorn, 1995; Verhage et al., 2016). Less is known about how depression influences the intergenerational transmission of insecure attachment (Ip et al., 2018; McMahon et al., 2006; Risi et al., 2021; Toth et al., 2009).

A review found a lack of robust statistical analyses in existing studies making it difficult to draw conclusions about how parent mental health impacts attachment transmission (Risi et al., 2021). Previous studies find that parental depression is associated with higher rates of insecure attachment, and early difficulty in children’s development of secure attachment to a depressed caregiver increases risk for socioemotional difficulties and psychopathology (Ip et al., 2018; Toth et al., 2009).

Numerous studies have reported that parental insecure attachment is associated with insecure attachment in offspring (Jones et al., 2015; Obegi et al., 2004; Roelofs et al., 2007). This is clinically important because insecure attachment may reduce resilience, impair social adjustment, and contribute to emotional problems, low self-esteem, anxiety, depression onset, and greater depression severity (Bifulco et al., 2003; Conradi and de Jonge, 2009; Gamble and Roberts, 2005; Lee and Hankin, 2009; Mikulincer and Shaver, 2008).

Attachment insecurity is associated with unresponsive, rejecting, and insensitive parenting that occurs at higher rates in depressed parents, suggesting that parental mental health may influence offspring attachment style (Risi et al., 2021). Prenatal and postpartum depressive symptoms are associated with maternal unresponsiveness to offspring (Flykt et al., 2010). If the mother had a secure attachment style in this study, however, it appeared to mitigate the negative impacts of maternal postpartum depressive symptoms on the child. This suggests that depressive disorders and insecure attachment styles may be at least partly independent and synergistic treatment targets within families (McMahon et al., 2006).

Using attachment style data from a longitudinal follow-up study of depressed parents and their offspring of at least 18 years of age, we investigated the association between parent and offspring attachment style, with and without adjustment for depression. We hypothesized there would be a correlation between parent and offspring insecure attachment styles. We explored the effect of depression in parents or offspring on the hypothesized attachment style association.

METHODS

Participants

The sample (N=436) was part of a longitudinal family study of parents with a mood disorder and their offspring (Brent et al., 2015). At baseline, parents met DSM-IV criteria (First et al., 1994) for lifetime major depressive disorder (MDD, N=134, 79.3%), lifetime bipolar disorder (N=33, 19.5%), or a lifetime depressive disorder not otherwise specified (DD NOS, N=2, 1.2%). At study end, some offspring also met DSM-IV criteria for lifetime MDD (N=40, 15.0%), lifetime bipolar disorder (N=5, 1.9%), or a lifetime DD NOS (N=8, 3.0%), while the majority of offspring (N=214, 80.1%) did not have any of these diagnoses. Attachment and depression data was collected for parents and offspring at most annually over a span of several years (more detail below in Measures). Attachment styles were assessed in offspring when they were at least 18 years old.

This study sample was selected based on the availability of attachment style data from depressed parents (N=169, 38.8%) and their offspring (N=267, 61.2%). Subjects were recruited from the Western Psychiatric Hospital in Pittsburgh, PA (N=293, 67.2%) and the New York State Psychiatric Institute / Columbia University Medical Center in New York, NY (N=143, 32.8%). After a detailed description of the study, all participants signed informed consent, as required by the institutional review boards of both sites. Parents and offspring were enrolled in the study from 1996–2005 and 1998–2013, respectively. Previous papers have analyzed data from this longitudinal study (Brent et al., 2015) (Brent et al., 2002), including on attachment styles (MacGregor et al., 2014), but this is the first to explore the relationship between parent and offspring attachment styles and to consider the effect of depression severity on that relationship.

Measures

Lifetime MDD, bipolar disorder, and DD NOS were diagnosed using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID)(First et al., 1994) Depressive symptom severity was measured using the 17-item clinician-rated Hamilton Depression Rating Scale (HAM17) (Hamilton, 1960).

Parent and offspring attachment style data was obtained using the original, 13-item Adult Attachment Questionnaire (AAQ), in which subjects rated themselves on 13 statements, using a 7-point Likert scale (“strongly disagree” to “strongly agree”), to measure their general feelings toward romantic partners (Simpson, 1990). These statements include, “I’m not very comfortable having to depend on other people,” “I rarely worry about being abandoned by others,” “I don’t like people getting too close to me,” and “I often worry that my partner(s) don’t really love me.” Subjects’ responses to items 1–3 and 5–9 were added to calculate an avoidant attachment score, and items 4 and 10–13 were used similarly to obtain an anxious attachment score, where higher scores represent greater insecure attachment.

All parent and offspring AAQ data was collected at repeated time points from 1996–2014 and 2003–2014, respectively, for a median of 6.9 years (range=0.4–9.7) among those with longitudinal AAQ data available. The median (range) follow-up times were 7.8 years (0.4–9.5) for parents and 3.6 years (0.7–9.7) for offspring. Data collection for the longitudinal project (Brent et al., 2002) was terminated on January 31, 2014 (MacGregor et al., 2014).

Generally, parent and offspring AAQ data were not collected at the same time point. Offspring assessment dates were usually later than the parent assessment dates (at first time point, N=209, 78.3%; at last time point, N=166, 62.3%). The median time difference between parent and offspring first attachment scores was 3.5 years (range=0–16), whereas the median time difference between parent and offspring last attachment scores was 1.1 years (range=0–16). The median (range) number of assessment points for offspring was 1 (range=1–4) and for parents it was 2 (range=1–4). Most offspring (N=177, 66.3%) had AAQ data available at only one time point (range=1–4), while just over half of parents (N=86, 50.9%) had AAQ data at more than one time point (range=1–4).

Statistical Analysis

First, parent and offspring attachment and depression scores were graphed separately and inspected for outliers and inconsistent values. Summary statistics were calculated and reported for our sample to compare parent and offspring clinical and demographic characteristics.

Within- and between-subject variability in the longitudinal anxious and avoidant attachment scores was assessed using linear mixed effects (LME) models with no fixed effects, built separately for parents (with a parent-level random effect to account for correlation among siblings) and offspring (with an offspring-nested-in-parent random effect that accounts for within-family clustering, since some offspring had the same parent). Then, LME models with a linear time effect were constructed to determine if the attachment scores had a linearly increasing or decreasing trend over time (in years), separately for parents and offspring with longitudinal AAQ data available, adjusting for age at assessment and using the same random effects stated above. The models in the Attachment Score Variability and the Attachment and Depression sections of Results include only subjects with more than one time point of attachment data available. To check for the effect of attrition, sensitivity analysis was conducted for a reduced sample over a five-year time period and we found no evidence of severity-based attrition.

A third set of LME models tested longitudinally how depression symptom severity (HAM17) influenced the two insecure attachment styles among parents and offspring separately, again adjusting for age at assessment and using the previously mentioned random effects. Corresponding polynomial models with second and third order HAM17 terms were also built to determine if there was a nonlinear relationship between depression severity and each attachment style for parents and offspring separately; however, none significantly outperformed the corresponding LME model, indicating a stronger linear association in all four cases.

Due to the lagged data collection described above, the longitudinal attachment data could not be compared between parents and offspring by aligning their time points. Instead, average anxious and avoidant attachment scores were calculated over all time points for each subject and were used for all analyses described hereafter.

Unadjusted LME models were used to evaluate the association between parent and offspring attachment style. Then, these models were adjusted for sex and baseline age of parent and offspring. Interactions between parent and offspring sex and parent average attachment score were also included in the adjusted models to gain insights into differential intergenerational transmission of attachment style by sex.

To investigate how the parent and offspring attachment associations identified by the models above were impacted by depression severity, the attachment scores were residualized to detect the effect of depression on the attachment associations and maximize the longitudinal nature of the depression data. The residualization procedure was applied for parents and offspring separately for each attachment style as follows. From the LME models above with longitudinal attachment score as the outcome and longitudinal HAM17 as the predictor, adjusting for baseline age, residuals for each attachment score, by time point, were extracted (i.e., the variance in attachment not explained by depression). Then, these residualized attachment scores were averaged across all time points for each subject, as with the non-residualized analyses. Final LME models using residualized attachment scores adjusted for parent and offspring sex and not age, which was accounted for in the residualization process. Effect sizes reported from all LME models are the beta coefficients for the covariates, where some are standardized using the standard deviations of the independent and the dependent variable to facilitate model comparison. All analyses utilized R (v4.1.2).

RESULTS

Sample characteristics

Parents (N=169) were 88% female, 68% white, and 11% Hispanic. At baseline, average parent age was 42.9 years (SD=8.9, range=24–76), average education was 14.1 years (SD=2.8, range=5–20), 47% were married, and 28% were divorced. The means of the parent average anxious and avoidant attachment scores were 17.1 (SD=5.8, range=5–34) and 24.5 (SD=8.3, range=6–42), respectively, and the mean of the parent average HAM17 scores was 10.5 (SD=7.0, range=0–32).

Offspring (N=267) were 54% male, 63% white, and 9% Hispanic. At baseline, the average offspring age was 21.0 years (SD=4.9, range=18–44), average education was 12.4 years (SD=2.1, range=3–18), and 89% were single. The means of the offspring average anxious and avoidant attachment scores were 14.7 (SD=5.5, range=5–32) and 20.5 (SD=8.0, range=6–42), respectively, and the mean of the offspring average HAM17 scores was 3.8 (SD=4.5, range=0–21).

Sample characteristics are summarized in Table 1. Compared to offspring, on average, parents had notably higher mean anxious and avoidant attachment scores. As expected, on average, parents also had substantially higher mean HAM17 scores compared to offspring, since as a study eligibility requirement all parents were diagnosed with a lifetime mood disorder at baseline. The average number of offspring per parent was 1.6; specifically, one parent had five offspring, one parent had four offspring, 16 parents had three offspring, 59 parents had two offspring, and 92 parents had one offspring. All offspring only had one parent in the data set.

Table 1.

Baseline Clinical and Demographic Characteristics

Variable Offspring
(n=267)		 Parents
(n=169)
Female, n (%) 124 (46.4) 148 (87.6)
Age, mean (SD) 21.0 (4.9) 42.9 (8.9)
Years of education, mean (SD) 12.4 (2.1) 14.1 (2.8)
Race, n (%)
 White 167 (62.5) 115 (68.0)
 Black 81 (30.3) 47 (27.8)
 More than one race 14 (5.2) 5 (3.0)
 Unknown/not reported 5 (1.9) 2 (1.2)
Ethnicity, n (%)
 Hispanic 25 (9.4) 18 (10.7)
 Non-Hispanic 241 (90.6) 151 (89.3)
 Unknown/not reported 1 (0.4) 0 (0.0)
Marital status, n (%)
 Single 237 (89.8) 13 (7.7)
 Married 25 (9.5) 80 (47.3)
 Divorced 0 (0.0) 48 (28.4)
 Separated 2 (0.8) 23 (13.6)
 Widowed 0 (0.0) 5 (3.0)
 Unknown/not reported 3 (1.1) 0 (0.0)
Site, n (%)
 New York State Psychiatric Institute 85 (31.8) 58 (34.3)
 Western Psychiatric Institute and Clinic 182 (68.2) 111 (65.7)
Lifetime diagnosis*
 Major depressive disorder, n (%) 40 (15.0) 134 (79.3)
 Bipolar disorder, n (%) 5 (1.9) 33 (19.5)
 Depressive disorder not otherwise specified, n (%) 8 (3.0) 2 (1.2)
 None of the above 214 (80.1) 0 (0.0)
Average anxious attachment score, mean (SD)** 14.7 (5.5) 17.1 (5.8)
Average avoidant attachment score, mean (SD)** 20.5 (8.0) 24.5 (8.3)
Average HAM17 score, mean (SD)** 3.8 (4.5) 10.5 (7.0)
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Abbreviations: HAM17 = 17-item Hamilton Depression Rating Scale

*

At baseline for parents and at study end for offspring

**

Calculated over all time points available

Attachment Score Variability

Among both parents (N=85) and offspring (N=90) with attachment data available at more than one time point, there was notably high within-subject variability in the longitudinal anxious (parents, within SD=4.7 points, between SD=3.3 points; offspring, within SD=4.5, between SD=3.7) and avoidant (parents, within SD=6.3, between SD=6.0; offspring, within SD=6.1, between SD=6.3) attachment scores. We did not find statistically significant changes over linear time in the anxious (parents, linear time effect b= −.189, SE=.098, t= −1.922, DF=114, p=.057; offspring, linear time effect b= − .073, SE=.108, t= −.676, DF=141, p=.500) or avoidant (parents, linear time effect b=.002, SE=.135, t=.012, DF=114, p=.990; offspring, linear time effect b= −.018, SE=.149, t= −.123, DF=135, p=.902) attachment scores.

Attachment and Depression

Depression severity correlated with both insecure attachment styles over time among parents (N=85) and offspring (N=90) with longitudinal depression (HAM17) data available (Table 2). These relationships indicated the need for a secondary analysis to adjust for depression severity in the association test between the parent and offspring attachment scores.

Table 2.

Parent and Offspring Attachment and Depression Associations

ANXIOUS (Parents)
Measure Effect size (95% CI) P value
HAM17 score 0.234 (0.132 to 0.335) <0.001
Age −0.007 (−0.131 to 0.117) 0.911
ANXIOUS (Offspring)
Measure Effect size (95% CI) P value
HAM17 score 0.367 (0.169 to 0.568) <0.001
Age 0.052 (−0.183 to 0.289) 0.666
AVOIDANT (Parents)
Measure Effect size (95% CI) P value
HAM17 score 0.263 (0.115 to 0.412) 0.001
Age −0.065 (−0.261 to 0.131) 0.513
AVOIDANT (Offspring)
Measure Effect size (95% CI) P value
HAM17 score 0.710 (0.428 to 1.001) <0.001
Age 0.159 (−0.187 to 0.507) 0.373
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Abbreviations: HAM17 = 17-item Hamilton depression rating scale

Relationship of Attachment Styles between Parents and Offspring: unadjusted models

Average avoidant attachment scores were correlated between parents and offspring (linear effect b=.163, SE=.064, t=2.554, DF=167, p=.012). However, there was no association between parent and offspring average anxious attachment scores (linear effect b=.047, SE=.064, t=.740, DF=167, p=.460).

Relationship of Attachment Styles between Parents and Offspring: sex and age-adjusted models

The adjusted model results yielded similar conclusions, where sex of parent was also significant in the avoidant model (Table 3A). Specifically, father-offspring relationships showed stronger avoidant attachment correlations compared with mother-offspring relationships (Table 3A).

Table 3.

Parent-Offspring Attachment Associations

(A) Non-Residualized (B) Residualized
ANXIOUS ANXIOUS
Measure Effect size (95% CI) P value Measure Effect size (95% CI) P value
Parent average anxious attachment score 0.052 (−0.073,0.177) 0.415 Parent average anxious attachment score 0.010 (−0.123,0.143) 0.885
Parent sex 2.309 (−0.114,4.732) 0.062 Parent sex 1.904 (0.572,3.236) 0.005
Offspring sex −0.720 (−2.020,0.579) 0.274 Offspring sex −0.730 (−1.472,0.011) 0.053
Parent age −0.056 (−0.156,0.044) 0.273
Offspring age 0.043 (−0.128,0.215) 0.618
AVOIDANT AVOIDANT
Measure Effect size (95% CI) P value Measure Effect size (95% CI) P value
Parent average avoidant attachment score 0.136 (0.011,0.262) 0.034 Parent average avoidant attachment score 0.120 (−0.017,0.257) 0.085
Parent sex −4.520 (−7.965,−1.074) 0.01 Parent sex −1.563 (−3.179,0.053) 0.058
Offspring sex −0.951 (−2.858,0.955) 0.324 Offspring sex −0.942 (−1.874,−0.010) 0.048
Parent age −0.154 (−0.295,−0.013) 0.033
Offspring age 0.157 (−0.090,0.404) 0.209
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Parent age was inversely associated with avoidant attachment in offspring; in other words, offspring with older parents had lower average avoidant attachment scores compared to offspring with younger parents (Table 3A). All interaction terms between parent and offspring sex and parent average attachment score were insignificant and removed from the final models reported in Table 3A.

Relationship of Attachment Styles between Parents and Offspring: depression-adjusted models

After residualizing the attachment scores with regard to parent and offspring depression severity, there was still no correlation between the average residualized anxious attachment scores of parents and offspring (linear effect b=.002, SE=.070, t=.035, DF=167, p=.972). Compared to the model not adjusted for depression, the correlation between average residualized avoidant attachment scores was no longer statistically significant, though the effect size was not greatly reduced (linear effect b=.137, SE=.070, t=1.959, DF=167, p=.052, standardized effect β=.123).

The age- and sex-adjusted residualized model results (Table 3B) also showed no significant effect for avoidant attachment (linear effect adjusted for parent and offspring sex and baseline age b=.120, SE=.069, t=1.734, DF=166, p=.085, standardized effect β=.108), but suggested stronger correlations in father-offspring (linear effect b=–1.563, SE=.819, t=–1.910, DF=166, p=.058) and parent-son (linear effect b=–.942, SE=.470, t=–2.007, DF=97, p=.048) relationships compared to mother-offspring and parent-daughter relationships. As with the non-residualized analyses, all interaction terms were not statistically significant and removed from the models in Table 3B.

Differential intergenerational transmission by parent sex was not identified for either attachment style in the age- and sex-adjusted models, irrespective of residualization. Comparing the models with and without depression adjustment, and with no age or sex adjustments, accounting for depression severity of parents and offspring explained about a quarter of the association between parent and offspring avoidant attachment (residualized model, standardized effect size β=.123; non-residualized model, standardized effect size β=.163; ratio=75%).

DISCUSSION

In a sample of parents diagnosed with a lifetime mood disorder and their adult offspring, we found evidence that parent avoidant attachment is associated with offspring avoidant attachment, mostly (75%) independently of parent and offspring depression severity. After accounting for depression severity, the parent-offspring avoidant attachment correlation was not statistically significant but the effect size was not greatly reduced. Parent and offspring depression severity explained 25% of the inter-generational transmission of insecure avoidant attachment. Further studies are needed to confirm these associations, including the impact of mood on recall of attachment states, and the study of attachment scores within and between depressive disorder episodes.

Our findings, if replicated, are clinically meaningful because insecure avoidant attachment is associated with negative outcomes, including risk of suicide attempt and more severe anxiety and depression (Grunebaum et al., 2010; Widom et al., 2018). Parental avoidant attachment is associated with offspring impulsivity, MDD, and greater intent and number of attempts among offspring suicide attempters (MacGregor et al., 2014). In a study of college students, avoidant attachment was associated with the NEO-Personality Inventory traits of low agreeableness, high neuroticism (especially depression), and low openness to feelings, and a tendency to “deny or suppress attachment-related negative emotions,” which may increase rates of anxiety and depression (Shaver and Brennan, 1992) and reduce resilience to interpersonal stress.

We found exploratory evidence that avoidant attachment in depressed fathers was associated with more avoidant attachment in offspring than in depressed mother-offspring relationships. A caveat is that our sample was 88% mothers, which may in part be due to mother-centric models which have dominated attachment and child psychopathology research (Deneault et al., 2021; Ip et al., 2018; Lamb, 2013). Under-diagnosis of depression in men – resulting partly from lack of inclusion of male-typical depressive symptoms, such as aggression and substance use, in the DSM criteria for depression – may also contribute (Call and Shafer, 2018). As fathers take up more active roles in child-rearing over time (Cabrera et al., 2000; Condon, 2006), father-child attachment and paternal depression effects on offspring mental health deserve more research.

The finding that parent-son relationships exhibit stronger avoidant attachment correlations compared to parent-daughter relationships is more meaningful in that offspring sex in this sample was nearly evenly divided. The result is consistent with a meta-analysis suggesting males may report higher avoidance than females (Del Giudice, 2011).

There is debate whether attachment style represents a stable trait versus a more variable state that changes over time, across different relationships or contexts such as a depressive episode. In this study, we found a high level of within-person variability over time in the avoidant and anxious attachment scores. While the linear change over time was not statistically significant, there was a negative trend for parent anxious attachment, which may have been related to improvement in depression. Our results are consistent with other reports of only moderate stability of attachment style over time, with change observable in response to new experiences, in different relationships, or during fluctuations in well-being such as a depressive episode (La Guardia et al., 2000; Zhang and Labouvie-Vief, 2004).

In addition to the small number of father probands noted above, limitations include that all data were self-reported and thus subject to bias. Additionally, the AAQ evaluates adult attachment in romantic relationships, not between parents and offspring. Thus, another limitation is that we assume it is reasonable to use an instrument designed for romantic relationships as a proxy for attachment style traits. We believe this is a reasonable approximation given offspring were assessed only if at least 18 years of age. The time lag issue described in Methods prevented us from conducting analyses using the longitudinal attachment scores directly, which would have been a stronger method than our use of scores averaged across time points, since the latter disregards the within-subject variability that we detected. We hope that our findings can be validated by a future study with a more regular assessment schedule for parents and offspring using the more intuitive, longitudinal analysis. Another concern is measurement error. For example, a 25-year review found that most attachment instruments were rated as having adequate reliability and validity, but only a few rated excellent (Ravitz et al., 2010). A meta-analysis of 47 studies reported a Cronbach’s alpha for AAQ avoidant attachment style of 0.785 demonstrating reasonable (cross-sectional) reliability (≥0.70 is considered good in practice)(Graham and Unterschute, 2015). A review of adult attachment measures, including the AAQ, noted that factor analyses supported its two-dimensional, avoidant and anxious, structure (Ravitz et al., 2010). Since this was a post hoc investigation, we did not do a priori a specific power calculation. Within the limits of our dataset, we attempted to use rigorous statistical methods to adjust for potential confounding effects of parental or offspring depression. We lacked data to explore the effect of marital quality, an important factor (Luz et al., 2017), on the associations studied. Additionally, parent-offspring attachment relationships in same-sex couples and single parent families merit further research.

In summary, we found that parent and offspring depression explained about a quarter of the association between parent and offspring avoidant attachment styles. Thus, depression influences, but does not fully explain the observed familial transmission of insecure avoidant attachment, a risk factor for mental health morbidity. The apparently stronger intergenerational transmission of avoidant attachment in father-offspring compared with mother-offspring relationships, and to sons compared with daughters, are intriguing exploratory findings that warrant more study. Rates of insecure attachment among offspring may be partly reduced by implementing depression screenings and referral/treatment for expectant parents (Ip et al., 2018). Positive parenting programs have been effective in improving social, emotional and behavioral outcomes for children, while also benefitting parents, and could feasibly improve parent-child attachment style transmission (Sanders et al., 2014). Further research on these associations may identify other treatment targets within families to prevent the intergenerational transmission of risk for insecure avoidant attachment, depression, and their negative mental health consequences.

Highlights.

  • Insecure attachment is associated with mental health morbidity and merits research

  • Insecure avoidant attachment was transmitted from depressed parents to offspring

  • Depression explained only 25% of this transmission effect

  • The effect appeared to be stronger in fathers and sons than mothers and daughters

Acknowledgements

Funding

This work was supported by the National Institute of Mental Health [MH056612 (David Brent, MD) and MH056390 (J. John Mann, MD)].

Potential conflicts of interest:

Dr. Brent receives royalties from Guilford Press, from the electronic self-rated version of the C-SSRS from eRT, Inc., and from duties as an UptoDate Psychiatry Section Editor, consulting fees from Healthwise, and Honoraria from the Klingenstein Third Generation Foundation for scientific board membership and grant review. Drs. Mann and Burke receive royalties from the Research Foundation for Mental Hygiene for the commercial use of the Columbia Suicide Severity Rating Scale, which was not part of this work. All other authors declare they have no conflicts of interest.

Footnotes

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Additional Information

The original data set is available from the corresponding author.

REFERENCES

  1. Bifulco A, Mahon J, Kwon J, Moran P, Jacobs C, 2003. The Vulnerable Attachment Style Questionnaire (VASQ): An interview-based measure of attachment styles that predict depressive disorder. Psychological medicine 33, 1099–1110. [DOI] [PubMed] [Google Scholar]
  2. Brent DA, Melhem NM, Oquendo M, Burke A, Birmaher B, Stanley B, Biernesser C, Keilp J, Kolko D, Ellis S, Porta G, Zelazny J, Iyengar S, Mann JJ, 2015. Familial pathways to early-onset suicide attempt: a 5.6-year prospective study. JAMA Psychiatry 72, 160–168. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Brent DA, Oquendo M, Birmaher B, Greenhill L, Kolko D, Stanley B, Zelazny J, Brodsky B, Bridge J, Ellis S, Salazar JO, Mann JJ, 2002. Familial pathways to early-onset suicide attempt: risk for suicidal behavior in offspring of mood-disordered suicide attempters. Arch Gen Psychiatry 59, 801–807. [DOI] [PubMed] [Google Scholar]
  4. Cabrera N, Tamis-LeMonda CS, Bradley RH, Hofferth S, Lamb ME, 2000. Fatherhood in the Twenty-First Century. Child Development 71, 127–136. [DOI] [PubMed] [Google Scholar]
  5. Call JB, Shafer K, 2018. Gendered Manifestations of Depression and Help Seeking Among Men. Am J Mens Health 12, 41–51. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Condon J, 2006. What about dad? Psychosocial and mental health issues for new fathers. Aust Fam Physician 35, 690–692. [PubMed] [Google Scholar]
  7. Conradi HJ, de Jonge P, 2009. Recurrent depression and the role of adult attachment: a prospective and a retrospective study. J Affect Disord 116, 93–99. [DOI] [PubMed] [Google Scholar]
  8. Del Giudice M, 2011. Sex differences in romantic attachment: a meta-analysis. Pers Soc Psychol Bull 37, 193–214. [DOI] [PubMed] [Google Scholar]
  9. Deneault AA, Bakermans-Kranenburg MJ, Groh AM, Fearon PRM, Madigan S, 2021. Child-father attachment in early childhood and behavior problems: A meta-analysis. New Dir Child Adolesc Dev. [DOI] [PubMed] [Google Scholar]
  10. First M, Spitzer R, Gibbon M, Williams J, 1994. Structured Clinical Interview for DSM-IV Axis I Disorders (SCID). [DOI] [PubMed]
  11. Flykt M, Kanninen K, Sinkkonen J, Punamäki R-L, 2010. Maternal depression and dyadic interaction: the role of maternal attachment style. Infant and Child Development 19, 530–550. [Google Scholar]
  12. Gamble SA, Roberts JE, 2005. Adolescents’ Perceptions of Primary Caregivers and Cognitive Style: The Roles of Attachment Security and Gender. Cognitive Therapy and Research 29, 123–141. [Google Scholar]
  13. Graham JM, Unterschute MS, 2015. A reliability generalization meta-analysis of self-report measures of adult attachment. J Pers Assess 97, 31–41. [DOI] [PubMed] [Google Scholar]
  14. Grunebaum MF, Galfalvy HC, Mortenson LY, Burke AK, Oquendo MA, Mann JJ, 2010. Attachment and social adjustment: relationships to suicide attempt and major depressive episode in a prospective study. J Affect Disord 123, 123–130. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Hamilton M, 1960. A rating scale for depression. J Neurol Neurosurg Psychiatry 23, 56–62. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Hammen C, Brennan PA, 2003. Severity, chronicity, and timing of maternal depression and risk for adolescent offspring diagnoses in a community sample. Arch Gen Psychiatry 60, 253–258. [DOI] [PubMed] [Google Scholar]
  17. Ip P, Li TMH, Chan KL, Ting AYY, Chan CY, Koh YW, Ho FKW, Lee A, 2018. Associations of paternal postpartum depressive symptoms and infant development in a Chinese longitudinal study. Infant Behav Dev 53, 81–89. [DOI] [PubMed] [Google Scholar]
  18. Jones JD, Cassidy J, Shaver PR, 2015. Parents’ self-reported attachment styles: a review of links with parenting behaviors, emotions, and cognitions. Pers Soc Psychol Rev 19, 44–76. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. La Guardia JG, Ryan RM, Couchman CE, Deci EL, 2000. Within-person variation in security of attachment: a self-determination theory perspective on attachment, need fulfillment, and well-being. J Pers Soc Psychol 79, 367–384. [DOI] [PubMed] [Google Scholar]
  20. Lamb ME, 2013. The changing faces of fatherhood and father-child relationships: From fatherhood as status to father as dad, Handbook of family theories: A content-based approach. Routledge/Taylor & Francis Group, pp. 87–102. [Google Scholar]
  21. Lee A, Hankin BL, 2009. Insecure attachment, dysfunctional attitudes, and low self-esteem predicting prospective symptoms of depression and anxiety during adolescence. J Clin Child Adolesc Psychol 38, 219–231. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Luz R, George A, Vieux R, Spitz E, 2017. ANTENATAL DETERMINANTS OF PARENTAL ATTACHMENT AND PARENTING ALLIANCE: HOW DO MOTHERS AND FATHERS DIFFER? Infant Ment Health J 38, 445. [DOI] [PubMed] [Google Scholar]
  23. MacGregor EK, Grunebaum MF, Galfalvy HC, Melhem N, Burke AK, Brent DA, Oquendo MA, Mann JJ, 2014. Depressed parents’ attachment: effects on offspring suicidal behavior in a longitudinal family study. J Clin Psychiatry 75, 879–885. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Main M, Kaplan N, Cassidy J, 1985. Security in Infancy, Childhood, and Adulthood: A Move to the Level of Representation. Monographs of the Society for Research in Child Development 50, 66–104. [Google Scholar]
  25. McMahon CA, Barnett B, Kowalenko NM, Tennant CC, 2006. Maternal attachment state of mind moderates the impact of postnatal depression on infant attachment. J Child Psychol Psychiatry 47, 660–669. [DOI] [PubMed] [Google Scholar]
  26. Mikulincer M, Shaver PR, 2008. Adult attachment and affect regulation, Handbook of attachment: Theory, research, and clinical applications, 2nd ed. The Guilford Press, New York, NY, US, pp. 503–531. [Google Scholar]
  27. Obegi J, Morrison T, Shaver P, 2004. Exploring intergenerational transmission of attachment style in young female adults and their mothers. Journal of Social and Personal Relationships 21, 625–638. [Google Scholar]
  28. Ravitz P, Maunder R, Hunter J, Sthankiya B, Lancee W, 2010. Adult attachment measures: a 25-year review. J Psychosom Res 69, 419–432. [DOI] [PubMed] [Google Scholar]
  29. Risi A, Pickard JA, Bird AL, 2021. The implications of parent mental health and wellbeing for parent-child attachment: A systematic review. PLoS One 16, e0260891. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Roelofs J, Meesters C, Muris P, 2007. Correlates of Self-reported Attachment (In)security in Children: The Role of Parental Romantic Attachment Status and Rearing Behaviors. Journal of Child and Family Studies 17, 555. [Google Scholar]
  31. Sanders MR, Kirby JN, Tellegen CL, Day JJ, 2014. The Triple P-Positive Parenting Program: A systematic review and meta-analysis of a multi-level system of parenting support. Clinical Psychology Review 34, 337–357. [DOI] [PubMed] [Google Scholar]
  32. Shaver PR, Brennan KA, 1992. Attachment Styles and the “Big Five” Personality Traits: Their Connections with Each Other and with Romantic Relationship Outcomes. Personality and Social Psychology Bulletin 18, 536–545. [Google Scholar]
  33. Simpson JA, 1990. Influence of attachment styles on romantic relationships. Journal of personality and social psychology 59, 971. [Google Scholar]
  34. Toth SL, Rogosch FA, Sturge-Apple M, Cicchetti D, 2009. Maternal depression, children’s attachment security, and representational development: an organizational perspective. Child Dev 80, 192–208. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. van IJzendoorn MH, 1995. Adult attachment representations, parental responsiveness, and infant attachment: a meta-analysis on the predictive validity of the Adult Attachment Interview. Psychol Bull 117, 387–403. [DOI] [PubMed] [Google Scholar]
  36. Verhage ML, Schuengel C, Madigan S, Fearon RMP, Oosterman M, Cassibba R, Bakermans-Kranenburg MJ, van IMH, 2016. Narrowing the transmission gap: A synthesis of three decades of research on intergenerational transmission of attachment. Psychol Bull 142, 337–366. [DOI] [PubMed] [Google Scholar]
  37. Weissman MM, Wickramaratne P, Gameroff MJ, Warner V, Pilowsky D, Kohad RG, Verdeli H, Skipper J, Talati A, 2016. Offspring of Depressed Parents: 30 Years Later. Am J Psychiatry 173, 1024–1032. [DOI] [PubMed] [Google Scholar]
  38. Widom CS, Czaja SJ, Kozakowski SS, Chauhan P, 2018. Does adult attachment style mediate the relationship between childhood maltreatment and mental and physical health outcomes? Child Abuse Negl 76, 533–545. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Zhang F, Labouvie-Vief G, 2004. Stability and fluctuation in adult attachment style over a 6-year period. Attach Hum Dev 6, 419–437. [DOI] [PubMed] [Google Scholar]

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