Social Anxiety Mediates Depression Vulnerability in Individuals With Attachment Insecurity

anxiety autism depression
anxiety autism depression

According to a study published in the Journal of Affective Disorders, social anxiety plays a significant role in mediating the relationship between attachment avoidance and depression severity, and improvements in anxiety and attachment insecurities can predict lower levels of depression.

The investigators of this longitudinal study sought to examine the mediating role of social anxiety disorder over time in the relationship between attachment insecurity and depression. The investigators further assessed the impact that changes in attachment and/or social anxiety had on depression severity over a 1-year period.

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The study included 162 adults with major depressive disorder (n=44), depression with social anxiety (n=56), and healthy controls (n=62) who completed baseline measures, including the Structured Clinical Interviews from the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Hamilton Rating Scale for Depression, Beck Depression Inventory-II, Liebowitz Social Anxiety Scale, and Experiences in Close Relationships Scale. After 1 year, a subsample of 77 participants (21 with depression, 28 with comorbid social anxiety, and 28 controls) completed the same follow-up measures. The investigators performed mediation analysis to understand the mediating effects of social anxiety on attachment and depression, and multivariate linear regression analysis to examine the ability of social anxiety and attachment insecurity to predict depression severity.

Participants reported significant differences in depression severity and attachment insecurity between baseline and follow-up, in which mean Beck Depression Inventory-II scores decreased from 19.5 to 13.5 (P <.001) and total attachment anxiety scores decreased from 3.8 to 3.5 (P =.03). At baseline, social anxiety was identified as a full mediator in the relationship between attachment avoidance and depression, but it was identified only as a partial mediator at follow-up. Social anxiety was also found to partially mediate the relationship between attachment anxiety and depression severity at both baseline and follow-up. Lower levels of depression at follow-up were predicted by lower depression scores at baseline and by improvement in social anxiety and attachment avoidance at the 1-year follow-up.

Limitations to the study included the lack of information on psychological and/or pharmacological treatments received by participants during the study, which could potentially contribute to the observed relationships. Furthermore, the subsample selection was limited by the fact that the baseline assessment took place of the course of 3 years, which restricted the number of individuals meeting the follow-up time criteria.

Researchers of the study concluded that both attachment avoidance and attachment insecurity can create vulnerability towards depression, and social anxiety plays a significant role in mediating the risk for depression severity in these individuals. Treatment targeting avoidant attachment and social anxiety in younger individuals may prevent or decrease the severity of future depression.


Adams GC, Wrath AJ, Le T, Alaverdashvili M. A longitudinal exploration of the impact of social anxiety and individual attachment on depression severityJ Aff Disord. 2019;257:250-256.