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Child Psychiatry Hum Dev (2013) 44:537548

DOI 10.1007/s10578-012-0347-5

ORIGINAL ARTICLE

Attachment to Parents and Peers as a Risk Factor for Adolescent


Depressive Disorders: The Mediating Role of Emotion Regulation
Angelika Kullik Franz Petermann

Published online: 15 December 2012


! Springer Science+Business Media New York 2012

Abstract This study examined emotion regulation as a


mediator in the relationship of attachment and depression
in adolescents. Participants (N girls = 127; M age = 14.50;
N boys = 121; M age = 14.31) completed self-report
questionnaires of attachment to parents and peers, emotion
regulation and depression. Models with dysfunctional
emotion regulation as a mediation variable were tested via
hierarchical multiple regression analyses and bootstrapping
procedure. Results revealed significant relations between
attachment to parents and peers, dysfunctional emotion
regulation and depression. For girls, internal-dysfunctional
emotion regulation was a mediator in the relation of
attachment to parents and depression and partly mediated
the association of attachment to peers. For boys, internaland external-dysfunctional emotion regulation acted as
partly mediators in association of attachment to parents and
depression. Results indicate important mechanisms that
contribute to the refinement of conceptual models and
provide indications for gender specific prevention and
intervention for depressive disorders.
Keywords Attachment ! Emotion regulation !
Depression ! Adolescence
Introduction
The prevalence of depressive disorders increases substantially in adolescence [1]. While life time prevalence

A. Kullik (&) ! F. Petermann


Center of Clinical Psychology and Rehabilitation, University
Bremen, Grazer Strasse 6, 28359 Bremen, Germany
e-mail: angelika.kullik@uni-bremen.de

in childhood is about 1.1 % [2], there is a significant


increase in adolescence, estimated at 4.0 % [3] to 20 %
[4, 5]. Furthermore, it is well documented that gender
differences in prevalence rates become apparent between
the age of 11 and 13 years [6, 7]. At the age of 15, girls
are twice as likely as boys to have experienced a
depressive disorder [8]. In addition, adolescent depression
is accompanied by a number of serious negative outcomes
such as heightened feelings of loneliness and isolation [9],
academic problems [10] and an increased risk for repeated
suicide attempts [11]. Early-onset depressive disorders are
associated with a heightened risk for mental disorders in
adulthood.
A better understanding of factors that are associated
with the increase of depressive symptoms may be
essential for future prevention and intervention efforts in
adolescence. In previous research, family factors and
their role for the development of depression have
received much attention (e.g., [12, 13]). Attachment is
defined as an affective relationship between a child and
her or his caregivers and is influenced by the responsiveness by the caregivers and their availability for the
childs needs [14]. Based on Bowlbys [14] attachment
theory, children develop a secure attachment bond when
caregivers offer availability and react to them in a
responsive way. This leads to more confidence in the self
and others. The absence of responsive and protective
responding maintains insecurity in the caregiver-child
relationship and leads to an insecure attachment [15].
Unfortunately, while much research has focused on
attachment in infancy and childhood (e.g., [16, 17]) relatively little is known of its effects in adolescence [18].
However, recent research increasingly noted the role of
attachment for the development of psychological wellbeing in adolescents (e.g., [19]).

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Attachment and Depression


Because of an observed stability of attachment styles in
later development [20] and its strong influence on various
negative outcomes [21, 22] attachment also received particular interest for depressive disorders (e.g., [23, 24]).
Compared to adolescents with a secure attachment style
those who report an insecure attachment to their parents
show less support seeking [25] and greater depressive
symptoms [26]. Decreased parental support and negative
parental responses to adolescents affective behaviorsas
precursors of the development of insecure attachment
significantly predict depressive symptoms [27, 28]. In a
study with clinically depressed and non-depressed adolescents Armsden et al. [29] showed that attachment security
to parents was significantly negative related to the severity
of adolescent depressive symptoms. Furthermore, this
relation was also found for attachment to peers. Despite a
strong influence of parenting behavior, close peer relationships become increasingly critical for the development
of depressive disorders in this transitional period [6].
According to Weiss [30], attachment behavior in adolescence is often directed towards peers although they do not
offer a caretaking role. Because of growing conflicts with
parents, adolescents may switch to peers as their primary
attachment figures [31].
Mediating Role of Emotion Regulation
A great number of research shows growing interest in
responsible mechanisms in the relation of attachment and
depressive disorders in adolescents (e.g., [12, 13]). Emotion regulation is often described as those skills, behaviors
and strategies that may initiate, control, modulate, inhibit
or enhance emotional experiences and expressions in order
to adapt to a specific situation [32, 33]. We adopted this
definition and limit emotion regulation to those strategies
that regulate positive and negative emotions as well as its
resulting behaviors, interactions, and physiological states.
Emotion regulation is a goal-oriented process that focuses
the form, intensity, expression or duration of an emotion
[34, 35]. This capacity to self-control emotions is a critical
achievement that develops over the first years of life and in
the following school years [32, 36]. Adolescents generally
can resort to a fundamental repertoire of emotion regulation strategies such as self-distraction, refocusing attention
in emotional situations, and external strategies that can
already be observed earlier in childhood and even become
irreversible in late development [37, 38]. Cognitive strategies, such as cognitive reappraisal or rumination that first
occur in late childhood are among those strategies as well
[39]. In addition, adolescents can seek the help of parents
or peers that act as social regulators [40] as they can offer

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Child Psychiatry Hum Dev (2013) 44:537548

support in frustrating situations or care for distraction in


case of a personal loss.
Due to the importance of early experiences and interactions for childrens development of emotion regulation
skills, it is natural to assume that parentchild interactions
form important precursors for the development of emotion
regulation problems [41]. In the past, attachment was
identified as being important in dealing with emotional situations. For instance, a study by Wolfradt et al. [42] showed
that adolescents who perceived parental warmth used active
problem-focused coping strategies that are described as
adaptive. Furthermore, higher parental attachment was a
predictor for more reappraisal and less suppression of
emotional experiences as core emotion regulation strategies
in adolescents [43]. According to these findings, Schore and
Schore [44] concluded that early dyadic emotion regulation
implemented in early attachment patterns builds the basic
fundament for the development of emotion regulation skills.
In sum, adolescents with a secure attachment style appear to
be able to regulate high emotional states by using functional
regulation strategies [45].
In recent years, a number of studies focused their
attention on problems concerning emotion regulation skills
and their role for psychopathology (e.g. [46, 47]). Taking
an emotion regulation perspective depressive disorders are
a result of impaired ability to effectively regulate negative
emotions [48]. Recent research indicates a fundamental
role of emotion regulation for the development of depressive disorders [49]. In their theoretical assumptions, Durbin
and Shafir [50] prefer a predispositional model that designates the ability to regulate emotions as a precursor for
the development of depression. A few studies recently
began to investigate emotion regulation in adolescent
depression [39, 51, 52]. Hughes et al. [53] compared
adolescents with high scores on the Childrens Depression
Inventory (CDI; [54]) to a sociodemographically matched
group of adolescents with low CDI scores. In comparison
to adolescents with low depressive symptomatology, participants with high CDI scores were significantly designated by a greater use of expressive suppression as well as
less emotional control and use of cognitive reappraisal.
According to the authors, those results are in line with
current theories that propose an essential relation between
the dysregulation of emotions and depressive symptoms
[51].
The Present Study
Two major limitations remain in prior studies. First, recent
studies do not allow consistent conclusions about the role
of different types of functional and dysfunctional internal
as well as external emotion regulation strategies for
depressive disorders in adolescence. For example, Hughes

Child Psychiatry Hum Dev (2013) 44:537548

et al. [53] were able to identify specific strategies that were


related to the severity of depressive symptoms in adolescents (i.e. less cognitive reappraisal and more suppression).
Nonetheless, these studies are limited to specific regulation
strategies or copinga construct that does not fully explain
the ability to regulate emotions [55]. Second, the analysis
of recent research on the relation between risk factors and
depressive disorders with few exceptions [12, 19] lacks a
systematic analysis of mediators that constitute fundamental mechanisms. Especially emotion regulation, as
accentuated for psychopathology, is a possible mechanism
that to our knowledge was not yet analyzed as a mediator in
the relation between attachment to parents and peers and
depressive disorders. A few studies, however, found significant mediating functions for specific regulation strategies (e.g. rumination; [12, 56]).
The primary objective of this study was to systematically
analyze internal and external as well as functional and
dysfunctional strategies in adolescents in order to generate a
more detailed understanding of the role of emotion regulation in depression. Secondly, this study sought to investigate
specific mechanisms through which attachment to parents
and peers as primary risk factors may carry out their influence on depressive disorders to further inform preventative
efforts. In line with previous research findings (e.g., [19]),
we firstly expect attachment to parents and peers to be
negatively related to depressive symptomatology regardless
of gender. Secondly, we hypothesize that the use of emotion
regulation strategies is significantly associated with
depressive symptoms for girls and boys. Because adolescence constitutes the earliest period in which most individuals possess a well matured repertoire of emotion
regulation strategies, we expect that individual differences
of those strategies emerge during this period. We furthermore expect a positive relation for dysfunctional emotion
regulation strategies and a negative relation for functional
strategies with an increase of depressive symptoms. By
analyzing the core mechanisms that are responsible for the
relationship of risk factors and depression, our third
hypothesis suggests that emotion regulation constitutes a
significant mediator for the relation of attachment to parents
and peers and depression in adolescent girls and boys.

Method

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(M age = 14.41, SD = 1.39; age range = 1217 years)


with 127 girls (M age = 14.50, SD = 1.41) and 121 boys
(M age = 14.31, SD = 1.36). Participants came from various German school types. 38 students (15.32 %) attended
high school preparing students for university, 186 (75.00 %)
attended a form of high school which integrates all possible
school types, and 24 (9.68 %) went to vocational school. 17
students (6.85 %) were not born in Germany; three were born
in Turkey and three in Russia (each 1.21 %), two in Belgium,
Iran and Kazakhstan (each .81 %), and one in Bulgaria,
Kosovo, Croatia, Poland and Togo (each .40 %). Furthermore, 78 adolescents (31.45 %) claimed that German was
not their native language; 31 named Turkish (12.5 %), eleven Kurdish (4.44 %), eight Russian (3.23 %), five Arabic
and Polish (each 2.02 %), three Albanian, Farsi and Lebanese (each 1.21 %), two French (.81 %), and one Bosnian,
Bulgarian, Indian, Serbian, Urdu and Vietnamese (each
.40 %) as their primary language.
Procedures
48 principals of local schools in Bremen (northern
Germany) were contacted via phone and invited to participate in the study. In case the school was interested introductory letters of the study were sent. Permission to conduct
the study in the schools was granted by the senator of education and science. Eleven schools agreed to take part in the
study and to inform five classes of students between 12 and
17 years. The research team informed the schools and their
teachers about the study procedure. Adolescents were given
a pamphlet with detailed information about the study, voluntary participation conditions, and confidentiality of their
responses. In addition, the students parents received a
consent form to agree that their daughter or son was allowed
to participate. All adolescents with parental consent agreed
to participate. With agreement of the respective school
management dates for the assessments were arranged. In a
group setting of max. 30 students, 281 adolescents filled out
the questionnaires under the supervision of at least two
researchers in a separate room. Approximately 18.5 % of the
students who initially agreed to participate (N = 345) missed the survey dates because of illness and absence. Examiners assisted adolescents in case of questions for
comprehension and minded that all questions were answered
individually. The completion of all study questionnaires took
approximately 45 minutes.

Participants
Measures
Adolescents and their parents were recruited via school
advertisement. Of 1,460 initially addressed students, 345
adolescents and their parents returned their consent to participate in the study. The subsample consisted of 248 adolescents who provided full data for the analyses

Depressive Symptoms
The German version of the Center for Epidemiological
Studies-Depressionscale (CES-D; German version

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Allgemeine Depressionsskala, ADS; [57]) was administered to measure depressive symptoms in adolescents. The
ADS is a 20-item self-report of various depressive symptoms over the past week. Items are rated on a 4-point
Likert-Scale, ranging from not at all to mostly. The
items can be combined to provide a total score which was
used for the current study. Correlations with other measures of depressive symptoms (Beck Depression Inventory,
BDI-2; Child Depression Inventory, CDI; [54, 58]) ranged
between r = .43 and r = .81. Mean correlations resulted
with subscales of anxiety symptoms and self-doubt and the
total score of the Child Behavior Checklist (CBCL; [49,
57]). For this study, self-reports of depressive symptoms
showed good internal consistency (a = .87).
Emotion Regulation
The Regulation of Emotion Questionnaire (REQ; [59]) was
administered to assess emotion regulation strategies in
adolescents. Due to a lack of comprehensive measures of
emotion regulation abilities in adolescence REQ was
developed on the basis of a theoretical model that categorizes
emotion regulation strategies both, as functional or dysfunctional (depending on acceptance or rejection of emotional experiences), and as internal (e.g. reappraisal) or
external (e.g. physical assault; [60, 61]). According to the
literature-based model, the REQ consists of four subscales
containing different emotion regulation strategies: Internaldysfunctional emotion regulation strategies (5 items; e.g. I
harm or punish myself in some way), internal-functional (5
items; e.g. I plan what I could do better next time),
external-dysfunctional [5 items; e.g. I take my feelings out
on other people verbally (e.g. shouting, arguing)] and
external-functional (6 items; e.g. I talk to someone about
how I feel). 21 items are rated on a 5-point Likert-Scale
ranging from never to always and indicate the frequency for the use of different emotion regulation strategies.
Two independent experts translated the items of the German
version of the REQ forward and reserve with close adjustment to the original questionnaire. Dysfunctional emotion
regulation was negatively correlated with quality of life in
adolescents (r = -.27 to r = -.47) and showed positive
correlations with psychosomatic difficulties (r = .29 to
r = .58; [59]). Positive relations were found for functional
emotion regulation and quality of life (r = .31 to r = .46;
[59]). Livingstone et al. [61] showed that adults with psychosis or anxiety/mood disorders used significantly more
internal-dysfunctional and less internal-functional emotion
regulation strategies than their non-patient peers. In the
current study, internal consistencies of the four scales ranged
between a = .44 (internal-dysfunctional), a = .58 (internal-functional), a = .71 (external-functional), and a = .80
(external-dysfunctional).

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Attachment to Parents and Peers


A German short version of the Inventory of Parent and
Peer Attachment (IPPA; [62, 63]) consisting of 24 items
was used to assess perceived attachment to parents and
peers. Each parent and peer scale consisted of 12 items that
were rated on a 4-point Likert scale (almost never or
never to almost always or always). Within the two
scales, three subscales ask for communication (4 items;
e. g. I tell my parents about my problems and troubles),
trust (4 items; e.g. My parents respect my feelings) and
alienation (4 items; e.g. I get upset a lot more than my
friends know). In previous studies, the IPPA has been
used for different samples of adolescents [13, 64] and has
shown good psychometric properties for its short version
[63, 65]. High correlations were observed between the
IPPA attachment to parents (Family Environmental Scale;
[66]) and familial and social self-concept (Tennessee Self
Concept Scale; [62]). Depression and anxiety showed
negative relations with both forms of attachment (parents
and peers; [62]). Recent studies revealed good reliabilities
and support the factorial validity of the questionnaire
(parents scale Cronbachs a = .82; peers scale Cronbachs
a = .80; [67, 68]).

Results
Initial Analyses
All cases included provide complete data with less than
20 % missing values on each scale. Statistical analyses of
the current study were performed by using SPSS 18 and
STATA/SE 11.0. Before analyzing the correlations
between the total scores of the main scales some establishments need to be mentioned. Internal consistency of the
REQ subscale representing internal-dysfunctional emotion
regulation was low (Cronbachs a = .44) which may be
the result of limited item-set of the subscale or alternatively
indicates a heterogeneous scale (a fact that cannot be
confirmed by theoretical considerations). Furthermore,
initial analyses revealed that internal-dysfunctional and
external-dysfunctional scales were not normally distributed. This appears to be in line with theoretical assumptions. To prevent violations of the requirements for
mediation analyses (i.e. regression models) we classified
adolescents as high or low in dysfunctional emotion regulation. Participants scoring one standard deviation above
the median highly use dysfunctional emotion regulation
strategies compared to participants below this cut-off.
To control for the influence of sociodemographic variables, t-tests and correlation analyses were conducted.
Interactions with gender were examined on all variables

Child Psychiatry Hum Dev (2013) 44:537548

541

Table 1 Means, standard deviations and correlations for the various questionnaires

1. IPPA parents
2. IPPA peers
3. Int.-dysf. ER
4. Int.-func. ER

.40**

-.32**

.23**

-.26**

.34**

-.31**

32.65 (5.27)

-.20**

.25**

-.22**

.45**

-.16*

35.63 (4.97)

.22**

.20**

5. Ext.-dysf. ER

-.06

-.01

6. Ext.-func. ER

M (SD)

.44**

.40**

.09

-.03

7. ADS

.22**

9.60 (2.80)
14.86 (3.59)
7.58 (2.92)

-.01

16.56 (4.52)

13.52 (8.45)

Int.-dysf. ER REQ internal-dysfunctional emotion regulation, Int.-func. ER REQ internal-functional emotion regulation, Ext.-dysf. ER REQ
external-dysfunctional emotion regulation, Ext.-func. ER REQ external-functional emotion regulation, ADS depression scale, N = 248,
* p \ .05, ** p \ .01

(attachment to parents and peers, emotion regulation, and


depressive symptoms) due to expected sex differences for
depressive symptoms and emotional functioning. For this
purpose, Bonferroni correction was accomplished to counteract the problem of multiple comparisons [69]. Girls had
significant higher scores on the external-functional emotion
regulation scale than boys (t = -3.86, p \ .001). No more
gender differences occurred for emotion regulation. Furthermore, girls scored higher on attachment to peers (t =
-6.01, p \ .001) and also reported more depressive symptoms measured via ADS compared to boys (t = -4.14,
p \ .001). Therefore, adolescent gender was entered into the
following analyses as a covariate. There were a few age
differences in the variables for girls only. With regard to the
main analyses this age effect was controlled. All other
background variables showed marginal influence and
therefore were neglected for main analyses.
Descriptive analyses were conducted to examine the
relations between the variables of attachment to parents
and peers, emotion regulation, and depressive symptoms.
Means and standard deviations as well as intercorrelations
of the variables are portrayed in Table 1. Results reveal
several relationships in the expected directions. Attachment
to parents is positively correlated to internal- and externalfunctional emotion regulation. Significant negative
correlations were found with internal- and externaldysfunctional emotion regulation as well as depressive
symptoms. All correlations are significant in the same
direction for attachment to peers. As expected, internaldysfunctional emotion regulation strategies correlate positively with external-dysfunctional emotion regulation and
depressive symptoms. The current sample shows a positive
correlation coefficient of internal-functional and internaldysfunctional emotion regulation and no correlation between
internal-dysfunctional regulation and external-functional
strategies. Internal-functional strategies show significant
positive correlations with external-functional strategies, but
no significant correlation with external-dysfunctional emotion

regulation and depressive symptoms. External-dysfunctional


strategies positively correlate with depressive symptoms, but
not external-functional strategies. Finally, external-functional
strategies are not significantly correlated with depressive
symptoms.
Mediation Analyses
In order to examine whether emotion regulation mediated
the relationship between attachment to parents and peers
and depressive symptoms, we used the Baron and Kenny
[70] procedures in line with recent research (e.g., [13, 21,
71]). According to the authors, mediation exists when
(a) the independent variable (parent and peer attachment) is
significantly correlated to the dependent variable (depressive symptoms); (b) the independent variable (parent and
peer attachment) is significantly related to the mediator
(emotion regulation); (c) the mediator (emotion regulation)
is significantly related to the dependent variable (depressive symptoms) while controlling for the independent
variable (parent and peer attachment); and (d) the relationship of the independent variable (parent and peer
attachment) with the dependent variable (depressive
symptoms) decreases significantly when controlled for the
mediator (emotion regulation). Before examining
the Baron and Kenny [70] procedures, we asserted that the
usual assumptions of the regression analyses were met.
Normally distributed data, independence of residuals and
rejection of multicollinearity allowed for further analyses.
In order to support the first two criteria of Baron and
Kenny [70], separate simple linear regression analyses
were conducted for girls and for boys to control for gender
influences. Because internal- and external-functional
emotion regulation shows no association with depressive
symptoms in descriptive analyses only dysfunctional
emotion regulation patterns were analyzed. First, in line
with correlational data attachment to parents was significantly related to girls adolescent depressive symptoms

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Child Psychiatry Hum Dev (2013) 44:537548

Table 2 Hierarchical multiple regression analyses for attachment to parents and emotion regulation predicting adolescent depressive
symptomatology
Predictor variables

Girls n = 127
b

Boys n = 121
SE B

Step 1
Attachment parents
Step 2
Attachment parents
Int.-dysf. ER

.07
-.27**

.14

-.16

.13

.23
.41***

.07

Ext.-dysf. ER

SE B

9.46**
-.33***

.12

-.25**

.12

18.29***
.36***

1.84

-.33***

.12

9.46**

-.27**

.14

-.23**

.15

-.26**

.12

.14

2.31

.25**

1.29

Step 2
Attachment parents

Fmodel

1.85

Step 1
Attachment parents

.09

6.10**

R2

Fmodel

.11

14.80***

.23

17.64***

.11

14.80***

.17

11.81***

** p \ .01, *** p \ .001

(b = -.27, p \ .01); and also attachment to peers showed a


significant relation (b = -.31, p \ .001). Attachment to
parents was significantly related to internal-dysfunctional
emotion regulation (b = -.26, p \ .01) and external-dysfunctional emotion regulation (b = -.22, p \ .05). A significant relation was also revealed for attachment to peers
and internal-dysfunctional emotion regulation (b = -.25,
p \ .01), but not for attachment to peers and external-dysfunctional emotion regulation (b = -.13, p = .16). Second,
boys attachment to parents was significantly related to selfreported depressive symptoms (b = -.33, p \ .001);
attachment to peers also showed a significant relation (b =
-.21, p = \ .05). Attachment to parents was further related
to internal-dysfunctional (b = -.24, p \ .01) and externaldysfunctional emotion regulation (b = -.29, p \ .001).
Attachment to peers was not related to internal-dysfunctional
(b = -.16, p = .08) or external-dysfunctional emotion
regulation (b = -.10, p = .28).
Table 2 presents hierarchical multiple regression analyses with attachment to parents as the predictor in the test
for Baron and Kenny Criteria (c) and (d). For girls, results
reveal a full mediational effect for internal-dysfunctional
emotion regulation. For boys, the relation between attachment to parents and depressive symptoms was partially
mediated by internal- and external-dysfunctional emotion
regulation. Furthermore, results of the hierarchical multiple
regression analyses with attachment to peers as a predictor
of depression are presented in Table 3. Given that the
assumptions for significant relations between predictor and
mediator were not met (e. i. Baron and Kenny (b) criterion), only a partial mediation effect can be observed for
internal-dysfunctional emotion regulation in the relation of
attachment to peers and depressive symptoms in girls.
Although assumptions for regression models were generally met, a nonparametric resampling procedure was

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added and applied to the mediation effects in the model,


using 5,000 bootstrap resamples [72]. This procedure does
not rely on the assumption of normally distributed data and
is considered more powerful compared to the conventional
Sobels Test [73]. Results of the bootstrapping procedure
support an indirect effect for a mediation model if the 95 %
confidence interval of the unstandardized regression coefficients (b) for the proposed mediator does not include
zero. For girls, results support the mediator effect of
internal-dysfunctional emotion regulation in the relation of
attachment to parents and depressive symptoms (4.71 B
b B 13.91; see Fig. 1) and the partial indirect effect of
attachment to peers (4.43 B b B 13.72). In confirmation to
the results of the hierarchical multiple regression, externaldysfunctional emotion regulation had no mediational
function in the relation of attachment to parents and
depression (-1.75 B b B 9.23). For boys, bootstrapping
indicated partial mediation via internal-dysfunctional
(3.04 B b B 12.71) and external-dysfunctional emotion
regulation (.85 B b B 6.44) in the relation of attachment to
parents and depression. As an example to illustrate mediation, Fig. 1 presents full mediation by internal-dysfunctional emotion regulation in the relation of attachment to
parents and depression in girls.

Discussion
The central aim of the current study was to investigate a
mediational model in which emotion regulation serves as a
mediator in the relation between attachment to parents and
peers and depressive disorders in adolescents. First, results
supported hypothesized associations between attachment to
parents and peers and depressive symptoms in adolescents.
Less attachment (i.e. less communication and trust and

Child Psychiatry Hum Dev (2013) 44:537548

543

Table 3 Hierarchical multiple regression analyses for attachment to peers and emotion regulation predicting adolescent depressive
symptomatology
Predictor variables

Girls n = 127
b

Boys n = 121
SE B

Step 1

.10

Attachment peers
Step 2
Attachment peers
Int.-dysf. ER

-.31***

.17

-.21**

.16

.25
.40***

1.82

-.31***

.17

-.29**

.17

.16

1.85

.10

Step 2

.12

Attachment peers
Ext.-dysf. ER

SE B

13.11***
-.21*

.14

-.15

.13

20.20***
.39***

Step 1
Attachment peers

Fmodel

Fmodel

.05

5.62*

.19

14.18***

.05

5.62*

.14

9.39***

1.8

13.11***
-.21*

.14

-.18*

.13

8.39***
.31***

R2

1.3

* p \ .05, ** p \ .01, *** p \ .001


internal-dysfunctional
emotion regulation

= .41***

= -.26**
= -.16 n. s.
attachment to parents

= -.27**

girls depressive
symptoms

Fig. 1 Girls internal-dysfunctional emotion regulation mediates the


relationship between attachment to parents and adolescent depressive
symptoms. Note: **p \ .01; ***p \ .001. The dashed line b
indicates the association of attachment to parents and girls depressive
symptoms prior to the inclusion of the mediator

more alienation) to both, parents and peers, indicated more


depression in adolescents. Second, internal- and externaldysfunctional emotion regulation were positively related to
depressive symptoms. Contrary to our hypothesis, functional emotion regulation showed no relation to depression,
neither internal nor external strategies. Finally, results
partly supported the mediational role of emotion regulation. For girls, internal-dysfunctional emotion regulation
served as a full mediator in the relation of attachment to
parents and depressive symptoms. Furthermore, internaldysfunctional regulation appeared as a partial mediator for
the association of attachment to peers and depression. For
boys, no full mediation effect was found. However, internal- and external-dysfunctional emotion regulation strategies partially mediated the relation of attachment to parents
and depressive disorders.
Meaningful relationships between the variables justified
the investigation of a mediational model. In line with previous
research the current findings supported negative relations of
attachment to parents and to peers and depressive disorders
[29]. In adolescence, parents still take the function of

important attachment figures andin case of low attachment


qualitymay exert their influence on psychological problems
of their child. Furthermore, adolescents begin to develop
attachment relationships with friends and romantic partners
who fulfill comparable attachment functions [74].
Dysfunctional emotion regulation was found to be
associated with depressive symptomatology which appears
consistent with previous findings for children and adolescents [75, 76]. Current etiological models of mood disorders assume that psychopathological problems of this
group of disorders are localized in difficulties with emotional processes (i.e. comprised cognitive control of emotions and problems with regulating negative emotional
information), of which emotion dysregulation takes a
central part [77]. Thus, emotion dysregulation can offer a
manifest explanation for some symptoms in depressive
disorders [50]. Interestingly, functional regulation strategies were not related to depression. This lack of association
was unexpected and contrary to hypothesis. For instance,
Kim and Cicchetti [46] revealed that functional emotion
regulation (i.e. emotional self-awareness, socially appropriate emotional displays and empathy) protracted children
and adolescents from internalizing symptoms. It is possible
that the use of functional regulation strategies is not sufficient to reduce symptoms in depression and other factors
can be more protective (e.g. functional information processing [78]). Alternatively, the measurement of functional
emotion regulation via REQ [59] may lack different strategies (e.g. distraction from negative stimuli) which would
contribute to a significant reduction in depression.
However, it seems reasonable to assume that emotional
functioning takes a central role in the relationship of
attachment and depression in adolescence [79]. Consistent
with expectations and previously found gender differentiation at the age of 13 years [80], girls had significantly

123

544

higher depressive symptoms than boys. For girls, the


findings implicate that the way the quality of attachment to
parents can exert its influence on depressive disorders
appears to be by affecting their use of internal-dysfunctional emotion regulation strategies. Furthermore, the
effect of attachment to peers on depressive symptoms in
girls indicated merely partial mediation by internal-dysfunctional emotion regulation strategies only.
As depression counts among internalizing disorders that
are characterized by poor emotional competency [81] and
internalizing symptoms such as repeatedly blaming oneself
[82], results partly confirm theoretical assumptions.
Nonetheless, a critical explanation for mediation refers to
potential overlap of internal-dysfunctional strategies and
diagnostic criteria of depressive disorders concerning the
question of sufficient delineation of the two constructs.
Strategies such as I harm or punish myself in some way
appear alike central criteria. However, assessed emotion
regulation strategies are more specific in that they ask for
particular behavior in a situation with positive or negative
emotional arousal.
Contrary to theoretical expectations external-dysfunctional regulation did not mediate the relationship of
attachment and depression in girls. This lack of findings
was unexpected and may be especially due to methodological issues. External-dysfunctional emotion regulation
was mainly assessed by asking for aggressive behavior
strategies (e.g. I take my feelings out on other people
physically (e.g. fighting, lashing out); [59]) which in fact
do not function as a mediating mechanism for girls. Yet,
the concept of external-dysfunctional regulation may also
adhere to strategies like extensive crying or obsessive
behavior [48]. This fact emphasizes the need for further
validation of the concept of emotion regulation to
strengthen conclusions about its potential role for depression [32]. By clarifying definitional issues it will be possible to assure significance of the mediating role of
external-dysfunctional emotion regulation in future studies.
For boys, internal- and external-dysfunctional emotion
regulation strategies were in parts responsible for the relation
of attachment to parents and depressive symptomatology. In
line with findings for girls, results for internal-dysfunctional
emotion regulation partly support theoretical assumptions of
a mediating function. As external-dysfunctional regulation
mainly appears to account for aggressive behavior strategies,
its partial mediating function can be explained by higher
prevalence of externalizing problems in adolescent boys
(e.g., [83]). Depression is a frequent comorbid disorder for
externalizing disorders in adolescence [84] so that it is possible to assume that externalizing problems can serve as a
(second) mediator in the analyzed relation. In case of future
improvement in measurement validity the mediating function of external-dysfunctional emotion regulation may

123

Child Psychiatry Hum Dev (2013) 44:537548

become even more distinctive. Attachment to peers was not


related to dysfunctional emotion regulation in boys. Despite
methodological issues, this suggests other mechanisms to be
responsible for the influence of attachment to friends,
classmates, and romantic partners on depressive symptoms.
Eventually, with regard to only partial mediation effects of
internal-dysfunctional emotion regulation in girls and boys,
it should be noted that the present study revealed poor
internal consistency for the internal-dysfunctional regulation
subscale. It is reasonable to assume that limited reliability of
the REQ [59] restricted the current results for mediation
models. A consistent set of items could have detected more
powerful mediation effects of internal-dysfunctional emotion regulation in the context of attachment and depression.
Past research leaves major gaps on the role of the concept of emotion regulation as a mechanism of risk factors
for depression in adolescence. First important findings exist
for specific regulation strategies without consideration of
gender specific emotion processes [12, 56]. The current
results indicate critical functions of an emotion regulation
construct which should be considered differentially for
girls and boys. Nonetheless, reaching definitional consistency in emotion regulation research remains a fundamental challenge. If it is possible in the future to provide a
valid and comprehensive measurement of emotion regulation in adolescence, further insights may become apparent
about the extent to which emotion regulation exerts its
influence.
Nonetheless, the results of the current study contribute to
conclusions for prevention and treatment of depression.
Cognitive-behavioral intervention approaches for depressive
disorders are among the most common treatment methods in
adolescents [85]. Although affect regulation skills are outlined
as one characteristic aspect of the Cognitive Behavior Therapy
(CBT; [86]) there is no specific focus on a substantial change
of dysfunctional regulation strategies. Kovacs et al. [40] presented the Contextual Emotion Regulation Therapy (CERT)
that focusses emotion regulation as a central construct. The
aim of the CERT is to identify dysfunctional emotion regulation strategies and in order to reduce them to further decrease
affective stress as a risk factor for the onset of depressive
disorders. Parents are also involved in the therapy and obtain
the role of central assistants. However, whilst the CERT was
developed for children the transformation of its content to
adolescents may not be easy. Moreover, adolescent prevention and intervention programs that focus on dysfunctional
emotion regulation would further benefit from a gender-specific approach. Results revealed different patterns of relationships between attachment, emotion regulation, and
depression for girls and boys. As such, for girls the current
findings assign a fundamental role to internal-dysfunctional
emotion regulation only. Girls-specific prevention and intervention of depression should therefore primarily focus on

Child Psychiatry Hum Dev (2013) 44:537548

identification and modification of internal-dysfunctional


strategies. In contrast, concentration on external strategies
appears not to be effective in modifying the influence of risk
factors on depressive symptoms. For boys, a meaningful
function is attributed to both, internal- and external-dysfunctional regulation patterns. Compared to girls, a negligence of
external-dysfunctional strategies in depression may reduce
treatment effects. By identifying gender-specific components
future programs have the potential to optimize long-term
treatment outcomes.
Limitations and Future Directions
Some limitations of the current study need to be considered. First, the study was limited to cross-sectional relationships and causal effects need to be validated in further
prospective designs. Certainly, the confirmation that differences in attachment quality to parents and peers precede
dysfunctional emotion regulation and that the latter predicts depressive symptoms is not possible to assure. It is
necessary to ensure temporal precedence to define risk
factors and its mechanisms. Second, sample response rate
was low. Due to this fact, the current sample may be biased
in that only highly motivated or stressed students participated. A bias could have restricted variance in the main
variables and hence undermine significant relationships in
the mediating models. It will be the aim for future studies
to meet this methodological issue. Furthermore, depressive
symptoms were assessed using a self-report instrument
which restricts interpretation and at best indicates or precedes a depressive disorder [87]. Nonetheless, previous
research points out that different methodologies in measuring depression (e.g. self-report questionnaires for
symptomatology or clinical diagnostic assessments) result
in relatively consistent prevalence rates, which in fact
legitimates the term depression for different methodologies [88]. At best, it should be the aim for future work to
replicate these findings with a clinical sample. In addition,
all other constructs of this study were also assessed using
self-report questionnaires. Certainly, self-reports serve as
appropriate instruments for assessing subjective and internal constructs such as attachment quality and emotional
experiences and processes. Research indicates that in
adolescence cognitive maturity allows to assess reliable
data [89]. However, a future reduction of shared variance
may be achieved by the adoption of other assessment tools
and informants. It should also be noted that only limited
validation data exist for measures of emotion regulation.
As already emphasized in discussion of missing mediation
effects in the current study, additional validity reports need
to support the findings and conclusions for the emotion
regulation construct [90]. For internal- and external-dysfunctional emotion regulation scales cut-off scores were

545

generated to identify adolescents highly using dysfunctional strategies versus those who use them less frequent.
This approach suggests a certain dependence on the sample
in the study and results may somewhat vary depending on
the cut-off used.
For a better understanding of the function of emotion
regulation processes in the context of risk factors for
depression, future research is particularly needed to make
use of prospective designs with clinical and non-clinical
adolescents. In order to support the establishments of better
prevention and intervention programs a detailed insight into
mechanisms of emotion regulation as a significant factor of
depressive disorders in girls and boys is necessary.

Summary
In adolescence, impaired attachment to parents and peers
increases risk for depressive symptoms and therefore presents a substantial risk factor for psychopathology. Moreover, recent research revealed that the construct of emotion
regulation plays a crucial role for the development of
depressive disorders.
The current study investigated relations between
attachment to parents and peers, emotion regulation, and
depression in adolescent girls and boys. Based on significant relations between the constructs, internal-dysfunctional emotion regulation fully mediated the relation
between attachment to parents and depression in girls.
Furthermore, internal-dysfunctional emotion regulation
partially mediated the association between attachment to
peers and depressive symptoms. In boys, internal- and
external-dysfunctional emotion regulation partially mediated the relation between attachment to parents and
depression. The findings advance our understanding of the
relationship of risk factors and depressive symptoms in
adolescents. Furthermore, they indicate a gender-specific
consideration of dysfunctional emotion regulation in prevention and intervention of depression, with an emphasis
on internal-dysfunctional regulation in girls compared to
internal- and external-dysfunctional emotion regulation in
boys.

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