Peer Attachment Theory

In 1990, Armsden, McCauley, Greenberg, Burke, and Mitchell published an article in the Journal of Abnormal Child Psychology called, “Parent and Peer Attachment in Early Adolescent Depression” (p. 683-697). Understanding the cause of parent-depressed child relations would help in a comprehensive theory of childhood depression. Also, examining social influences like peer relations for contributions to the risk of depressive disorder. “Attachment theory provides a valuable conceptual model for understanding the role parent-child relations play as a risk factor for depression” (p. 684). The purpose of this study was to examine self-reported parent and peer attachment in a sample of depressed adolescents and the relationship between attachment and

severity of depression (p. 685).
The sample was recruited from out/in patient psychiatric services of a children’s hospital. Participants included symptoms of depressed mood, school refusal, or suicidal behavior. From that sample, patients presenting without depressive symptoms for the psychiatric control group were separated. “The final sample was made up of all subjects who completed the inventory of parent and peer attachment” (p. 686). The sample was made up of twenty nine adolescents who met the criteria for major depression at the time of evaluation (Depressed), twelve who went through and episode of depression within the last twelve months (Depressed-resolved), and fourteen children with psychiatric disorders (Non-depressed) (p. 686). “The children in the Depressed and Depressed-resolved groups were living with both natural parents (39% and 42%, respectively) or with their mothers in a single-parent or mother and stepfather home (50%, 42%)” (p. 686).
The child and parent in the sample completed the Schedule for Affective Disorders and Schizophrenia for School Age Children (KIDDIE-SADS; Puig-Antich & Chambers, 1978) diagnostic interview. For the interview data, “Research Diagnostic Criteria (RDC; Spitzer, Endicott & Robins, 1978) and the Diagnostic and Statistical Manual of Mental Disorders (DSM-III; American Psychiatric Association, 1980) criteria was used to determine diagnosis” (p. 687).
Findings supported the hypothesis that security of attachment may be decreased in children with depressive disorders. “The depressed children endorsed less secure parental attachment than the Non-depressed psychiatric and the Non-psychiatric controls” (p. 693). Also, less secure attachment was associated with more severity of depression as reflected in the severity index resulting from the clinical interview (KIDDIE-SADS). This study stated that difficulty with peer relations was one of the most common features of children who are referred for psychological services. With that it appears depressed adolescents begin to perceive their peer relationships as less satisfactory or more rejecting and begin to withdraw due to change or mood experiencing frank peer rejection (p. 695).
A strength is the associations found with security of parent attachment, presence of depressive disorders are consistent with a conceptual model linking insecure attachment with the manifestation of depression through the promotion of depress genic cognitive representations. Some implications included the sample sizes being small. A replication with larger samples is necessary. While the numbers are small, it is also possible that the two subgroups will yield quite different clinical trajectories. “Prospective, longitudinal study is necessary in order to clarify connections between current or past quality of attachments and the development and course of depressive disorder” (p. 694).

Quantitative Article
Brent, D.

A., Kolko, D. J., Birmaher, B., Baugher, M., Bridge, J., Roth, C., & Holder, D. (1998). Predictors of treatment efficacy in a clinical trial of three psychosocial treatments for adolescent depression. Journal of the American Academy of Child & Adolescent Psychiatry, 37(9), 906-914.
In 1998, Brent, Kolko, Birmaher, Baugher, Bridge, Roth and Holder published a clinical trial in the Journal of the American Academy of Child and Adolescent Psychiatry called, “Predictors of Treatment Efficacy in a Clinical Trial of Three Psychosocial Treatments for Adolescent Depression” (p. 906-914). The main objective of this clinical trial was to “assess the predictors of treatment outcome across treatments, as well as those associated with differential treatment response” (p. 907).
The sample consisted of adolescents between the ages of thirteen and eighteen, who met the criteria for DSM-III-R (American Psychiatric Association, 1987), major depression and with the Beck Depression Inventory (Beck et. al., 1988) score greater than or equal to 13 (p. 907). All participants were nonpsychotic, non-bipolar, without obsessive-compulsive disorder, eating disorder, substance abuse, or ongoing physical and/or sexual abuse. There were 122 adolescents who were eligible for the study but only 107 (87.7%) participants agreed to randomization. One third (32.7%) of participants were chosen through

advertisement.
This tedious process consisted of “12 to 16 sessions delivered in 12 to 16 weeks in each of the three cells by experienced therapists” (p. 907). CBT was utilized from Beck’s CBT (Beck et. al., 1979). “SBFT combined functional family therapy (Alexander and Parsons, 1982) and problem-solving model of Robin and Foster” (Robin and Foster, 1989). The nondirective supportive therapy (NST) was made to regulate nonspecific effects of psychotherapy and involved of the delivery on support, affect clarification and active listening (Brent et. al., 1997). Out of the 107 participants, four never entered the protocol, eight of which dropped out of treatment, and seven were removed and placed in open treatment, 10 participants were found to have preexisting exclusionary conditions that were not detected through randomization. Assessments included the following variables: demographic, clinical, child cognitive, family-environmental, and parental psychopathology (p. 908).
At the end of the treatment, major depression was associated with having come into the study from a clinical referral rather than from an advertisement. Over-anxious disorder also predicted depression at the end of acute treatment (p. 908). “The odds of association between clinical referral and depression at the end of acute treatment decreased significantly after controlling for the relationships between clinical referral and hopelessness, and between hopelessness and depression, indicative of significant medication” (p.909). The three predictors or failure to achieve clinical reduction include high levels of initial self-reported depression, higher levels of cognitive distortion and higher hopelessness scores (p. 910).
Adolescents participating via advertisement were less pessimistic and more adaptable to the efforts of treatment compared to those through referral.

“Patients with comorbid anxiety responded much better to CBT than to the other two treatments because SBFT and NST did more poorly with comorbid anxious patients” (p. 912). Strength of this clinical trial would be the results might help explain the failure of treatments developed in research clinics to generalize to community settings (912).
Limitations include concern of the trial being university-based and lack of generalizability to the “real world”. Also, participants tend to be homogeneous and less complex than patients seen in clinical practice (p. 913). Nonetheless, these findings have implications for further research for entry criteria, stratification of subjects, and treatment modification. “Improvement in the outcome of adolescent depression may be achieved by more aggressively targeting comorbid anxiety disorder, hopelessness and other cognitive distortions, and parental psychopathology” (p.

913).