Failure to resolve loss and compromised mentalizing in female inpatients with major depressive disorder

ABSTRACT

Attachment and mentalizing are central concepts in research on the etiology, course, and treatment of depression. The goal of this cross-sectional study was to clarify the unique value of these constructs in characterizing the presence, severity, and chronicity of depression. We examined 50 female inpatients suffering from Major Depressive Disorder (MDD) in comparison to 47 matched healthy controls regarding their attachment states of mind, mentalizing capacities, and clinical variables indicating depression severity and chronicity (e.g. illness duration, number of hospitalizations). In the group of depressed patients, unresolved attachment with regard to loss was significantly overrepresented. Dimensionally, patients were more disorganized and more insecure, whereas there was no difference on the dismissing-preoccupied dimension between the two groups. Mentalizing was significantly lower in patients than in healthy controls. Logistic regression analysis revealed attachment insecurity, mentalizing deficits, and unresolved loss to be incrementally relevant to predict MDD. Correlations with clinical parameters in the group of depressed patients showed positive associations between mentalizing deficits, attachment insecurity, and variables indicating illness chronicity. Our findings highlight the relevance of the inability to resolve or reappraise loss experiences in depressive states.

KEYWORDS:

• Adult attachment interview
• unresolved attachment
• reflective functioning
• depression
• chronicity

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Notes

1. Inpatient treatment at these hospitals is usually short (2–4 weeks) and may but does not necessarily include psychotherapeutic sessions. Whether patients had psychotherapeutic treatment is not part of this study.

2. The term “treatment resistance” usually refers to inadequate response to at least one antidepressant trial of adequate doses and duration (Fava, 2003).

3. The augmentation of atypical neuroleptics is a common therapeutic option for treatment resistant depression (in Austria) and well documented by a series of studies (i.e.: Spielmans et al., 2013; Zhou et al., 2015).

4. This finding may appear in contradiction to the categorical results in Table 2 where a higher prevalence of dismissing categories was reported. However, unresolved and secure patients’ AAI sub-scale scores also contribute to the dimensional results, thereby shifting the group mean towards the preoccupied pole.

Additional information

Funding

This study was supported by grant [15360] from the Jubiläumsfonds of the Austrian National Bank.