Attachment impacts cortisol awakening response in chronically depressed individuals

Area of Science:

• Neuroscience
• Psychology
• Endocrinology

Background:

• Early life experiences influence attachment styles, impacting emotional regulation and HPA axis function.
• Attachment insecurity is linked to depression vulnerability and HPA axis alterations.
• The relationship between attachment, HPA axis, and depression, particularly the cortisol awakening response (CAR), remains unclear, especially in chronic depression with or without anxiety.

Purpose of the Study:

• To compare the CAR in individuals with chronic major depressive disorder (cMDD) with and without comorbid anxiety disorders against healthy controls.
• To investigate the relationship between attachment dimensions and the CAR in individuals with cMDD.
• To explore the predictive role of attachment and CAR for future depression severity.

Main Methods:

• Recruited 120 participants: 63 with cMDD and 57 healthy controls (HC).
• Assessed depression severity (BDI-II, HDRS) and attachment (ECR) via clinical interviews and questionnaires.
• Collected salivary cortisol samples over two consecutive days to calculate CAR metrics (S1, AUCg, AUCi).
• Follow-up assessments of depression and attachment were conducted one year later for a subset of participants.

Main Results:

• The cMDD group exhibited significantly lower S1 cortisol and AUCg compared to HC (p ≤ 0.02).
• No significant differences in CAR were found between cMDD and cMDD with comorbid anxiety groups.
• Depression severity and attachment dimensions interacted to predict lower S1 and AUCg cortisol.
• Attachment avoidance positively correlated with S1 cortisol at low attachment anxiety levels, but negatively at high anxiety levels.
• Higher baseline depression severity and attachment anxiety predicted higher depression scores at one-year follow-up.

Conclusions:

• Depression severity is associated with a blunted CAR, irrespective of comorbid anxiety.
• Attachment avoidance may buffer CAR blunting in individuals with low attachment anxiety, but high levels of both anxiety and avoidance may exacerbate CAR blunting.
• Attachment anxiety is a significant predictor of future depression severity.