The Association between Attachment and Mental Health Symptoms among School-Going Adolescents in Northern Uganda: The Moderating Role of War-Related Trauma

James Okello,Eric Broekaert,Etheldreda Nakimuli-Mpungu,Seggane Musisi,Ilse Derluyn

doi:10.1371/journal.pone.0088494

James Okello, Eric Broekaert + Show 3 more

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https://doi.org/10.1371/journal.pone.0088494

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Journal: PLoS ONE	Publication Date: Mar 10, 2014
Citations: 65	License type: CC BY 4.0

Affiliation: Ghent University, Makerere University, Gulu University

Abstract

BackgroundThe association between attachment and mental health symptoms in adolescents in a post-conflict low resource setting has not been documented.MethodsWe investigated the relationship between parent and peer attachment and posttraumatic stress, depression and anxiety symptoms in a sample of 551 adolescents aged 13–21 years old. Attachment quality was assessed using the Inventory of Parent and Peer Attachment (IPPA). Post-traumatic stress, depression and anxiety symptoms were assessed using the Impact of Events Scale Revised (IESR) and Hopkins Symptom Checklist for Adolescents (HSCL-37A) respectively. Gender differences in attachment relationships were determined using independent t-tests. Multivariate logistic regression was used to assess whether attachment relationships were independently associated with posttraumatic stress, depression and anxiety symptoms. Hierarchical linear regression analyses were conducted to explore the moderating role of war-related trauma.ResultsOur analyses revealed gender differences in attachment to parents, with males reporting stronger attachment than females. Parental attachment was protective against depression and anxiety symptoms but not posttraumatic stress symptoms after adjusting for potential confounders. Alienation by parents was independently associated with an increase in these mental health symptoms while peer attachment was not associated with any of these symptoms. However, in situations of severe trauma, our analyses showed that peer attachment was significantly protective against post-traumatic stress symptoms.ConclusionsSecure parental attachment is associated with better psychosocial adjustment in adolescents affected by war. Further, adolescents with secure peer attachment relationships in situations of severe war trauma may be less likely to develop posttraumatic stress symptoms. Interventions to enhance peer support in this post conflict setting would benefit this vulnerable population.

Highlights

There is worldwide recognition of adolescence as a period of rapid significant transformation in all aspects of functioning
Much of the information regarding the association between attachment and mental health symptoms is provided by research studies from developed countries [2,3,4,5,6,7]
On the day of the interviews, research assistants explained the purpose of the study to each head teacher and adolescents saying that the study was trying to understand adolescents’ experiences during the war and their effects

Summary

Introduction

There is worldwide recognition of adolescence as a period of rapid significant transformation in all aspects of functioning. Several studies have shown that parental influence is important for psychosocial adjustment [2]. Insecure attachment is associated with a greater level of mental health symptoms following negative life events [4]. These studies show that attachment research in adolescence is especially important in understanding the relationship between interpersonal trauma and psychopathology. The extent to which this information would apply in say, a post-conflict, low-resource country is unknown. The association between attachment and mental health symptoms in adolescents in a post-conflict low resource setting has not been documented

Methods

Results

Conclusion