The findings validateattachment theory– identifying attachment insecurity as a risk factor for poor mental health outcomes, especially anxiety and loneliness, during the upheaval of a pandemic. Loneliness appears to be a key mechanism linking insecure attachment to depressive and anxious symptoms.
attachment working models
Key Points
Rationale
The COVID-19 pandemic created immense disruption and stress globally. Research suggests the pandemic led to worse population mental health, including increased rates of depression, anxiety, and loneliness (Pierce et al., 2020; Vindegaard & Benros, 2020).
However, not everyone experienced poor mental health to the same degree. Individual differences likeattachment stylemay help explain variance in pandemic-related mental health outcomes (Vowels, Carnelley, & Stanton, 2022).
Prior studies found insecure attachment associated with worse mental health during the pandemic, especially attachment anxiety (Carbajal et al., 2021; Mazza et al., 2021; Moccia et al., 2020). However, these were observational studies unable to make causal claims.
This study aimed to elucidate the causal relationships between adult attachment styles, adherence to pandemic public health guidelines, and mental health using innovative statistical techniques. Understanding causal pathways can inform interventions to support at-risk groups during public crises.
Method
This secondary analysis used data from a longitudinal COVID-19 psychological survey of UK adults (C19PRCS) during the early months of pandemic restrictions (McBride et al., 2021).
The baseline nationally representative sample included 1325 adults who completed measures of attachment style, social distancing behaviors, depression, anxiety, and loneliness at wave 2 (April-May 2020) during lockdown.
A subset of 950 participants completed follow-up mental health measures at wave 3 (July-August 2020) when restrictions had eased.
Attachment style was measured categorically via the Relationship Questionnaire (Bartholomew & Horowitz, 1991). Participants selected one of four styles: secure, anxious, avoidant, or fearful-avoidant.
Social distancing adherence was assessed via a 16-item scale about following government guidelines in the past week.
Depression and anxiety were measured using validated scales – the Patient Health Questionnaire-9 (Kroenke et al., 2001) and the Generalized Anxiety Disorder scale (Spitzer et al., 2006). The 3-item UCLA Loneliness Scale (Hughes et al., 2004) assessed loneliness.
The researchers used cutting-edge causal discovery and inference techniques. The causal discovery algorithm SAM identified putative causal relationships among variables (Kalainathan et al., 2020).
Targeted learning then estimated specific causal effects, like the effect of attachment anxiety on depression (van der Laan & Rose, 2011).
Sample:
Statistical measures:
Results
Implications
Future Research
Strengths & Limitations
The study had many methodological strengths, including:
However, this study was limited in a few ways:
Conclusion
This research elucidates attachment style as a causal risk factor for poor mental health outcomes during the pandemic, specifically heightened depression, anxiety, and loneliness. Loneliness appears central in linking insecure attachment to symptomatology.
The advanced causal methodology enables stronger inferences to guide intervention. However, further research should replicate findings using dimensional attachment measures and behavioral observations.
This study highlights the need for proactive mental health support for insecurely attached individuals prone to isolation during public crises. Fostering social connections and addressing loneliness may mitigate mental health risks.
Population-wide disruptions like pandemics will likely continue to occur. Understanding causal factors linked to distress can inform policies to support at-risk groups.
While pandemics create collective stress, they do not uniformly impact mental health, due to individual differences. Attachment theory offers a valuable framework for identifying those most vulnerable.
References
Primary Paper
Vowels, L. M., Vowels, M. J., Carnelley, K. B., Millings, A., & Gibson-Miller, J. (2023). Toward a causal link between attachment styles and mental health during the COVID-19 pandemic.The British Journal of Clinical Psychology,62(3), 605–620.https://doi.org/10.1111/bjc.12428
Other References
Bartholomew, K., & Horowitz, L. M. (1991). Attachment styles among young adults: A test of a four-category model.Journal of Personality and Social Psychology, 61(2), 226-244.https://doi.org/10.1037/0022-3514.61.2.226
Carbajal, J., Ponder, W. N., Whitworth, J., Schuman, D. L., & Galusha, J. M. (2021). The impact of COVID-19 on first responders’ resilience and attachment.Journal of Human Behavior in the Social Environment, 32,781-797.https://doi.org/10.1080/10911359.2021.1962777
Hughes, M. E., Waite, L. J., Hawkley, L. C., & Cacioppo, J. T. (2004). A short scale for measuring loneliness in large surveys: Results from two population-based studies.Research on Aging, 26(6), 655-672.
Kalainathan, D., Goudet, O., Guyon, I., Lopez-Paz, D., & Sebag, M. (2020). Structural agnostic modeling: Adversarial learning of causal graphs.arXiv:1803.04929v3.
Kroenke, K., Spitzer, R. L., & Williams, J. B. (2002). The PHQ-15: Validity of a new measure for evaluating the severity of somatic symptoms.Psychosomatic Medicine, 64(2), 258-266.
McBride, O., Murphy, J., Shevlin, M., Gibson-Miller, J., Hartman, T. K., Hyland, P., Levita, L., Mason, L., Martinez, A. P., McKay, R., Stocks, T. V. A., Bennett, K., Vallières, F., Karatzias, T., Valiente, C., Vazquez, C., & Bentall, R. P. (2021). Monitoring the psychological, social, and economic impact of the COVID-19 pandemic in the population: Context, design and conduct of the longitudinal COVID-19 psychological research consortium (C19PRC) study.International Journal of Methods in Psychiatric Research, 30(1),e1861.https://doi.org/10.1002/mpr.1861
Mikulincer, M., & Shaver, P. R. (2016).Attachment in adulthood: Structure, dynamics, and change(2nd ed.). Guilford Press.
Moccia, L., Janiri, D., Pepe, M., Dattoli, L., Molinaro, M., De Martin, V., Chieffo, D., Janiri, L., Fiorillo, A., Sani, G., & Di Nicola, M. (2020). Affective temperament, attachment style, and the psychological impact of the COVID-19 outbreak: An early report on the Italian general population.Brain, Behavior, and Immunity, 87,75-79.https://doi.org/10.1016/j.bbi.2020.04.048
Pierce, M., Hope, H., Ford, T., Hatch, S., Hotopf, M., John, A., Kontopantelis, E., Webb, R., Wessely, S., McManus, S., & Abel, K. M. (2020). Mental health before and during the COVID-19 pandemic: A longitudinal probability sample survey of the UK population.The Lancet Psychiatry, 7,883-892.https://doi.org/10.1016/S2215-0366(20)30308-4
Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7.Archives of Internal Medicine, 166(10),1092-1097.https://doi.org/10.1001/archinte.166.10.109
van der Laan, M. J., Polley, E. C., & Hubbard, A. E. (2007). Super learner.Statistical Applications of Genetics and Molecular Biology, 6(25).https://doi.org/10.2202/1544-6115.1309
van der Laan, M. J., & Rose, S. (2011).Targeted learning—Causal inference for observational and experimental data.Springer International.
Vindegaard, N., & Benros, M. E. (2020). COVID-19 pandemic and mental health consequences: Systematic review of the current evidence.Brain and Behavior: A Cognitive Neuroscience Perspective, and Immunity, 89,531-542.https://doi.org/10.1016/j.bbi.2020.05.048
Vowels, L. M., Carnelley, K. B., & Stanton, S. C. E. (2022). Attachment anxiety predicts worse mental health outcomes during COVID-19: Evidence from two longitudinal studies.Personality and Individual Differences, 185,111256.https://doi.org/10.1016/j.paid.2021.111256
Learning Check
How might attachment style interact with other demographic factors like socioeconomic status to influence mental health during crises? What subgroups might be especially vulnerable?To what extent are attachment styles stable versus susceptible to change across situations or over time? How might this influence the implications of this research?What are some ethical considerations in identifying certain groups as being “at risk” based on psychological traits like attachment style? How can we avoid contributing to stigma?How could insights from this study inform public policy decisions during public health emergencies? What changes to existing protocols or communication strategies might better support mental health?What are some ways we could foster greater social connection and reduce loneliness for insecurely attached individuals during periods of prolonged isolation? How might technology assist?How well do conclusions based on self-report surveys during a crisis period generalize to normal circumstances? In what ways might methodology be improved in future crisis research?
Olivia Guy-Evans, MSc
BSc (Hons) Psychology, MSc Psychology of Education
Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.
Saul McLeod, PhD
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
