The Association between Attachment and Mental Health Symptoms among School-Going Adolescents in Northern Uganda: The Moderating Role of War-Related Trauma

PLOS ONE, Dec 2019

Background The association between attachment and mental health symptoms in adolescents in a post-conflict low resource setting has not been documented. Methods We investigated the relationship between parent and peer attachment and posttraumatic stress, depression and anxiety symptoms in a sample of 551 adolescents aged 13–21 years old. Attachment quality was assessed using the Inventory of Parent and Peer Attachment (IPPA). Post-traumatic stress, depression and anxiety symptoms were assessed using the Impact of Events Scale Revised (IESR) and Hopkins Symptom Checklist for Adolescents (HSCL-37A) respectively. Gender differences in attachment relationships were determined using independent t-tests. Multivariate logistic regression was used to assess whether attachment relationships were independently associated with posttraumatic stress, depression and anxiety symptoms. Hierarchical linear regression analyses were conducted to explore the moderating role of war-related trauma. Results Our analyses revealed gender differences in attachment to parents, with males reporting stronger attachment than females. Parental attachment was protective against depression and anxiety symptoms but not posttraumatic stress symptoms after adjusting for potential confounders. Alienation by parents was independently associated with an increase in these mental health symptoms while peer attachment was not associated with any of these symptoms. However, in situations of severe trauma, our analyses showed that peer attachment was significantly protective against post-traumatic stress symptoms. Conclusions Secure parental attachment is associated with better psychosocial adjustment in adolescents affected by war. Further, adolescents with secure peer attachment relationships in situations of severe war trauma may be less likely to develop posttraumatic stress symptoms. Interventions to enhance peer support in this post conflict setting would benefit this vulnerable population.

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The Association between Attachment and Mental Health Symptoms among School-Going Adolescents in Northern Uganda: The Moderating Role of War-Related Trauma

Derluyn I (2014) The Association between Attachment and Mental Health Symptoms among School- Going Adolescents in Northern Uganda: The Moderating Role of War-Related Trauma. PLoS ONE 9(3): e88494. doi:10.1371/journal.pone.0088494 The Association between Attachment and Mental Health Symptoms among School-Going Adolescents in Northern Uganda: The Moderating Role of War-Related Trauma James Okello 0 Etheldreda Nakimuli-Mpungu 0 Seggane Musisi 0 Eric Broekaert 0 Ilse Derluyn 0 Ulrike Schmidt, Max Planck Institute of Psychiatry, Germany 0 1 Department of Psychiatry, Makerere University College of Health Sciences , Kampala , Uganda , 2 Department of Psychiatry, Gulu University , Gulu , Uganda , 3 Department of Orthopedagogics, Ghent University , Ghent , Belgium , 4 Department of Social Welfare Studies and Centre for Children in Vulnerable Situations, Ghent University , Ghent , Belgium Background: The association between attachment and mental health symptoms in adolescents in a post-conflict low resource setting has not been documented. Methods: We investigated the relationship between parent and peer attachment and posttraumatic stress, depression and anxiety symptoms in a sample of 551 adolescents aged 13-21 years old. Attachment quality was assessed using the Inventory of Parent and Peer Attachment (IPPA). Post-traumatic stress, depression and anxiety symptoms were assessed using the Impact of Events Scale Revised (IESR) and Hopkins Symptom Checklist for Adolescents (HSCL-37A) respectively. Gender differences in attachment relationships were determined using independent t-tests. Multivariate logistic regression was used to assess whether attachment relationships were independently associated with posttraumatic stress, depression and anxiety symptoms. Hierarchical linear regression analyses were conducted to explore the moderating role of warrelated trauma. Results: Our analyses revealed gender differences in attachment to parents, with males reporting stronger attachment than females. Parental attachment was protective against depression and anxiety symptoms but not posttraumatic stress symptoms after adjusting for potential confounders. Alienation by parents was independently associated with an increase in these mental health symptoms while peer attachment was not associated with any of these symptoms. However, in situations of severe trauma, our analyses showed that peer attachment was significantly protective against post-traumatic stress symptoms. Conclusions: Secure parental attachment is associated with better psychosocial adjustment in adolescents affected by war. Further, adolescents with secure peer attachment relationships in situations of severe war trauma may be less likely to develop posttraumatic stress symptoms. Interventions to enhance peer support in this post conflict setting would benefit this vulnerable population. - Funding: This study was supported by a doctoral scholarship from the Belgian Technical Cooperation to James Okello. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist. There is worldwide recognition of adolescence as a period of rapid significant transformation in all aspects of functioning. Changes in psychosocial function include increasing reliance on peers for intimacy and social support and decreasing time spent with parents [1]. Nonetheless, several studies have shown that parental influence is important for psychosocial adjustment [2]. The absence of secure parental attachment has been associated with more engagement in high risk behaviors and more mental health symptoms in adolescence [3]. Much of the information regarding the association between attachment and mental health symptoms is provided by research studies from developed countries [27]. For example, secure attachment in adolescence appears to be a protective factor against the development of posttraumatic stress disorder (PTSD) in adolescents in three Nordic countries (Iceland, Finland and Faroe Islands) [6] and against the development of anxiety in Chinese university students [7]. In contrast, insecure attachment is associated with a greater level of mental health symptoms following negative life events [4]. These studies show that attachment research in adolescence is especially important in understanding the relationship between interpersonal trauma and psychopathology. The extent to which this information would apply in say, a post-conflict, low-resource country is unknown. For example, the brutal civil war between the Ugandan Government forces and the Lords Resistance Army (LRA) rebels over a twenty year period targeted children and adolescents who were forcefully abducted and forced to commit atrocities [8,9]. In post-war northern Uganda, established outcomes among adolescents include most commonly PTSD, depression and anxiety [8 11] as well (...truncated)


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James Okello, Etheldreda Nakimuli-Mpungu, Seggane Musisi, Eric Broekaert, Ilse Derluyn. The Association between Attachment and Mental Health Symptoms among School-Going Adolescents in Northern Uganda: The Moderating Role of War-Related Trauma, PLOS ONE, 2014, 3, DOI: 10.1371/journal.pone.0088494