A longitudinal exploration of the impact of social anxiety and individual attachment on depression severity

Background: Research suggests that insecure attachment and early onset of social anxiety disorder (SAD) create vulnerability for future depression. The current study explores the mediating role of social anxiety symptoms in the relationship between attachment and depression at baseline and one year later. The study also looks at the longitudinal impact of changes in attachment and social anxiety, on depression severity. Methods: Participants (n = 162) completed structured clinical interviews and measures of depression, social anxiety, and adult attachment. A subsample of the participants (n = 77) returned for a follow-up one year later and repeated the measures. Mediation analysis and multivariate linear regression were performed to examine the relationships between depression, social anxiety, and attachment. Results: Social anxiety was a full mediator of the relationship between attachment avoidance and depression severity at baseline but only a partial mediator at one-year follow-up. Social anxiety was a partial mediator of the relationship between attachment anxiety and depression severity at both baseline and follow-up. Lower baseline depression levels, improvement in social anxiety and improvement in attachment avoidance over the next year, predicted lower levels of depression at follow-up. Limitations: The study did not gather information regarding the treatments received between baseline and follow-up. Conclusions: Social anxiety plays a significant role in mediating the vulnerability towards severe depression in insecurely attached individuals. Treating social anxiety, particularly in individuals with avoidant attachment, might decrease the severity of future depression. In addition, interventions targeting attachment avoidance in youth might aid primary prevention strategies.