National Comorbidity Survey Research Articles

Correlates of cannabis use and cannabis use disorder among adolescents with major depressive disorder and bipolar disorder in the National Comorbidity Survey-Adolescent Supplement (NCS-A)

BackgroundDespite evidence regarding prevalence and correlates of cannabis use (CU) and cannabis use disorder (CUD) in major depressive disorder (MDD) and bipolar disorder (BD) in adults, little is known about this topic among adolescents. MethodsData is from the 2001–2004 National Comorbidity Survey–Adolescent Supplement, an in-person, cross-sectional epidemiologic survey of mental disorders. Participants included adolescents, ages 13–18 years, with MDD (n = 354 with CU, n = 70 with CUD, n = 688 with no CU), BD (n = 79 with CU, n = 32 with CUD, n = 184 with no CU), or adolescents without mood disorders (n = 1413 with CU, n = 333 with CUD, n = 6970 with no CU). Analyses examined prevalence and correlates of CU and CUD within MDD and BD groups. ResultsCU was most prevalent in adolescents with MDD followed by adolescents with BD then controls. CUD was most prevalent in adolescents with BD followed by adolescents with MDD then controls. In covariate-adjusted ordinal logistic regression models, within MDD and BD, CU and CUD groups had significantly higher odds of lifetime suicidal ideation/attempts, as well as other significant indicators of clinical severity. LimitationsBased on changes in cannabis acceptance, potency, and availability in the two decades since this study was conducted, present findings may underestimate adverse cannabis associations. ConclusionCU and CUD are both associated with adverse clinical characteristics in a community-based sample of adolescents with MDD and BD. Evidence that risks of cannabis use extend across the spectrum of use is important for adolescents with MDD and BD, in whom cannabis-related consequences tend to be more severe.

Evaluating Binary Outcome Classifiers Estimated from Survey Data.

Surveys are commonly used to facilitate research in epidemiology, health, and the social and behavioral sciences. Often, these surveys are not simple random samples, and respondents are given weights reflecting their probability of selection into the survey. We show that using survey weights can be beneficial for evaluating the quality of predictive models when splitting data into training and test sets. In particular, we characterize model assessment statistics, such as sensitivity and specificity, as finite population quantities and compute survey-weighted estimates of these quantities with test data comprising a random subset of the original data. Using simulations with data from the National Survey on Drug Use and Health and the National Comorbidity Survey, we show that unweighted metrics estimated with sample test data can misrepresent population performance, but weighted metrics appropriately adjust for the complex sampling design. We also show that this conclusion holds for models trained using upsampling for mitigating class imbalance. The results suggest that weighted metrics should be used when evaluating performance on test data derived from complex surveys.

Expression of Concern: Induced abortion and anxiety, mood, and substance abuse disorders: Isolating the effects of abortion in the national comorbidity survey

Expression of Concern: Induced abortion and anxiety, mood, and substance abuse disorders: Isolating the effects of abortion in the national comorbidity survey

Good Fit Is Weak Evidence of Replication: Increasing Rigor Through Prior Predictive Similarity Checking.

Replication provides a confrontation of psychological theory, not only in experimental research, but also in model-based research. Goodness of fit (GOF) of the original model to the replication data is routinely provided as meaningful evidence of replication. We demonstrate, however, that GOF obscures important differences between the original and replication studies. As an alternative, we present Bayesian prior predictive similarity checking: a tool for rigorously evaluating the degree to which the data patterns and parameter estimates of a model replication study resemble those of the original study. We apply this method to original and replication data from the National Comorbidity Survey. Both data sets yielded excellent GOF, but the similarity checks often failed to support close or approximate empirical replication, especially when examining covariance patterns and indicator thresholds. We conclude with recommendations for applied research, including registered reports of model-based research, and provide extensive annotated R code to facilitate future applications of prior predictive similarity checking.

Mental Illness, Gun Access and Carrying: A Test of Competing Hypotheses.

Access to firearms among individuals with mental health problems has been a source of protracted debate among policymakers, the media, and the public, writ large. At the center of this controversy are questions about the nature and consequences of gun access in the context of mental illness. The lack of substantial empirical evidence, due in part to limited access to quality data, plays a significant role in perpetuating ongoing debate. To address this problem, this study uses data from the National Comorbidity Survey Replication to evaluate the relative importance of several clinical, cultural, and criminological factors in explaining gun access and carrying among adults with and without mental illnesses. Multivariate analyses reveal that, whereas past year disorder (of any type or severity) and other clinical characteristics were unrelated to firearm access, several cultural factors such as childhood rurality (e.g., ORrural vs. urban: 3.59; 95% CI: 2.52, 5.12) and the criminological experience of early intimate partner violence (e.g., ORvictim only vs. noexp: 1.84; 95% CI: 1.50, 2.26) were. None were predictive of carrying. Further, none of the relationships observed were conditioned on any of the clinical characteristics. These results indicate that people with mental illnesses likely own and carry guns for the same reasons and in the same contexts as others. Additional updated and quality data is needed to further explore these issues; however, these finding suggest that suicide and violence prevention efforts targeting people with mental illnesses need to be sensitive to the cultural and personal significance of guns.

Measurement invariance and response consistency of single-item assessments for suicidal thoughts and behaviors.

The present study aimed to expand the literature on single-item assessments for suicidal thoughts and behaviors (STBs) by examining measurement invariance of commonly used single-item assessments of suicidal ideation (SI), planning (SP), and attempts (SA) with respect to race and ethnicity. Predictive invariance with respect to depression, and multi-item measures of passive and active SI were also explored. Measurement invariance was examined across (a) Black and White respondents and (b) Hispanic/Latinx and non-Hispanic/-Latinx respondents. Participants (N = 1,624; 51.66% male) were recruited from Mechanical Turk and Prime Panels. Participants were administered four distinct single-item measures each for SI, SP, and SA across three timeframes (past month, past year, lifetime). Items were drawn from well-known large-scale studies (e.g., National Comorbidity Survey) and common suicide risk assessments. Multiple group confirmatory factor analysis was used to examine measurement invariance; regression with group by measure interactions were used to evaluate predictive invariance. Measurement invariance was observed for both Black (N = 534) and White (N = 1,089) respondents as well as Hispanic/Latinx (N = 335) and non-Hispanic/-Latinx (N = 1,288) respondents across single-item outcomes. Thus, SI, SP, and SA rates can be defensibly compared between Black and White and Hispanic/Latinx and non-Hispanic/-Latinx respondents within studies; however, comparison of SI and SP rates across studies with differing assessment prompts should be met with caution. Multiple single-item STB measures demonstrated predictive bias across race and ethnicity suggesting potential differential screening capabilities. Elevated SI, SP, and SA rates for Hispanic/Latinx individuals were also observed. Findings reiterate the importance of minor language differences in single-item STB assessments. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Associations between Shyness and Victimization with Substance Use Outcomes in the National Comorbidity and Collaborative Psychiatric Epidemiological Surveys

Background : There is a lack of consensus among researchers on the association between shyness and substance use. This may be due to unexamined modifiers of this association, such as childhood victimization. Objective : The purpose of this study was to examine if experiencing different types of victimization (emotional, physical, sexual, and poly-victimization) modifies the association between shyness and substance use outcomes in adults. In this study, we performed moderation analyses to investigate whether victimization moderates the association between shyness and substance use/abuse. Data came from the National Comorbidity Survey Baseline (NCS-1; 1990-1992) and the Collaborative Psychiatric Epidemiological Surveys (CPES; 2001-2003). Substance use outcomes included were binge drinking, tobacco use, other drug use, and DSM-III-R (NCS-1)/DSM-IV (CPES) classifications of alcohol and drug abuse. Results : Results from NCS-1 supported a moderating role of childhood victimization on the relationship between shyness and tobacco use only, specifically for emotional (p = .031) and physical (p < .001) victimization, and poly-victimization (p < .001). Results from CPES showed a moderating role of lifetime sexual abuse for binge drinking (p = .017), other drug use (p = .028), and alcohol abuse (p = .004). For both datasets, the associations between shyness and substance use outcomes were stronger when there were no victimization histories. Conclusion : These findings give insight on the complexity of the interaction between shyness and victimization. Future research could focus on mechanisms, such as cognitive processes, that may contribute to interactions between shyness and victimization history on substance outcomes.

Social anxiety disorder is a risk factor for alcohol use problems in the National Comorbidity Surveys

BackgroundAccording to the self-medication and biopsychosocial models, individuals with social anxiety disorder (SAD) are at increased risk of developing an alcohol use disorder (AUD) as alcohol represents a maladaptive coping mechanism for some sufferers of SAD. The SAD-to-AUD causation was earlier supported in Norwegian longitudinal twin data and later questioned using longitudinal data from the USA. MethodsWe re-analyzed partly the same USA-based data (National Comorbidity Surveys, n = 5001), conducting theoretical and simulation analyses on different formulations of temporality and using real-data Logistic regression analysis to investigate whether baseline SAD was associated with AUD at the follow-up. ResultsUpon proper analysis of temporality, SAD preceded AUD. Specifically, SAD was the only one of the seven anxiety disorders that predicted 10-year later AUD after adjusting for all other anxiety disorders and AUD at the baseline (odds ratio was 1.70% and 95% confidence interval 1.12–2.57). SAD was also associated with incident AUD (OR = 1.64, 95% CI = 1.14–2.37). We provide formal, simulation-based, and data-based arguments on how certain flawed models of incidence attenuate the temporal association. ConclusionsWe demonstrated temporality and specificity in SAD-to-AUD association, which are considered signs of causation. We further identified and discussed problems in previous statistical analyses with different conclusions. Our findings add support for models positing causal effects of SAD on AUD, such as the self-medication and biopsychosocial models. The available evidence suggests that treating SAD should incur better chances of preventing AUD compared to treating other anxiety disorders, which lack comparable evidence on causation.

Interpersonal Well-Being and Suicidal Outcomes in a Nationally Representative Study of Adolescents: A Translational Study.

Adolescent suicide continues to rise despite burgeoning research on interpersonal risk for suicide. This may reflect challenges in applying developmental psychopathology research into clinical settings. In response, the present study used a translational analytic plan to examine indices of social well-being most accurate and statistically fair for indexing adolescent suicide. Data from the National Comorbidity Survey Replication Adolescent Supplement were used. Adolescents aged 13-17 (N = 9,900) completed surveys on traumatic events, current relationships, and suicidal thoughts and attempts. Both frequentist (e.g., receiver operating characteristics) and Bayesian (e.g., Diagnostic Likelihood Ratios; DLRs) techniques provided insight into classification, calibration, and statistical fairness. Final algorithms were compared to a machine learning-informed algorithm. Overall, parental care and family cohesion best classified suicidal ideation, while these indices and school engagement best classified attempts. Multi-indicator algorithms suggested adolescents at high risk across these indices were approximately 3-times more likely to engage in ideation (DLR = 3.26) and 5-times more likely to engage in attempts (DLR = 4.53). Although equitable for attempts, models for ideation underperformed in non-White adolescents. Supplemental, machine learning-informed algorithms performed similarly, suggesting non-linear and interactive effects did not improve model performance. Future directions for interpersonal theories for suicide are discussed and clinical implications for suicide screening are demonstrated.

Cannabis Use Is Associated With Depression Severity and Suicidality in the National Comorbidity Survey−Adolescent Supplement

To investigate the association of cannabis use with major depression and suicidal behavior in adolescence. Data are from the National Comorbidity Survey-Adolescent Supplement , a nationally representative survey of adolescents aged 13 to 18 years. Weighted logistic regression and ordinal regression analyses of major depression and suicidal behavior outcomes were conducted on cannabis variables, incorporating sociodemographic characteristics. Adolescents with lifetime cannabis use have 2.07 times higher odds of mild/moderate (adjusted odds ratio [aOR]; 95% ) and 3.32 times higher odds of severe major depressive disorder (MDD; aOR; 95% ). Cannabis use (aOR 6.90, 95% ), mild/moderate MDD (aOR 4.10, 95% ), and severe MDD (aOR 13.97, 95% CI = 7.59, 25.70) were associated with higher odds of suicide attempt. Past 12-month cannabis use (aOR 3.70, 95% CI = 2.16, 6.32), mild/moderate major depressive episodes (MDE) (aOR 7.85, 95% ), and severe MDE (aOR 36.36, 95% ) were associated with higher odds of suicide attempt. The frequency of past 12-month cannabis use was associated with higher odds of suicide attempt and with MDE severity, with higher odds among individuals who use cannabis 3 or more days than among individuals who use cannabis less frequently, suggesting a dose effect. Among cannabis users, older age of onset of cannabis use was associated with lower odds of suicidal behaviors. Cannabis use is associated with higher odds of depression and depression severity in adolescence. Furthermore, depression and cannabis use are independently associated with higher odds of suicide attempt. We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group.

Comorbidities of anxiety disorders in bipolar patients: therapeutic complexity

IntroductionNumerous clinical and epidemiological studies show that the rate of comorbidity of anxiety disorders is high in bipolar patients compared to the general population. This is associated with a poorer prognosis, poorer functioning and higher suicidal risk. Anxiety comorbidity should therefore be carefully investigated.ObjectivesOur main objectives are to explore the therapeutic complexity of anxiety disorders in patients with bipolar disorder To investigate the existence of psycho-pathological links and vulnerabilities between bipolar disorder and anxiety disorders.Methodsthrough a clinical vignette and a review of the existing literature on the comorbidity of anxiety disorders and bipolar disorders, and the resulting therapeutic issuesResultsAnxiety comorbidity is quite common in the bipolar population. In the American National Comorbidity Survey (NCS), lifetime comorbidity is close to 90%. Two recent French clinical studies show the existence of at least one anxiety disorder in approximately 25% of bipolar subjects (24% and 27.2%), which will have an impact on the course of the bipolar disorder, with a particular increase in the risk of suicide, hence the importance of adequate treatment. This treatment faces two obstacles: the risk of manic episodes under antidepressants and the risk of dependence on benzodiazepines. Emphasis is also placed on non-drug approaches, including cognitive-behavioural and psycho-educational therapies.ConclusionsAnxiety comorbidity is not without consequence on the evolution of bipolar disorder. Its particularly high prevalence means that it cannot be neglected or ignored in current practice.Disclosure of InterestNone Declared

Resiliency from violent victimization for people with mental disorders: An examination of multiple resiliency models

Research examining prevalence rates and risk factors related to victimization for people with mental disorders has procured considerable attention. Despite this increased attention, why a subset of this population is not victimized, despite elevated risk, is less understood. That is, there is a group of people with mental disorders who are effectively resilient from victimization, but the ways in which resiliency is produced is not known. Using the National Comorbidity Study–Adolescent supplement data, the applicability of numerous resiliency models is examined to identify and understand how the resiliency from victimization process operates for people with mental disorders. Building off previous work, factors specific to mental illness are also included in additional models to examine whether the same factors relate to resiliency for people with mental illness as they do for other samples. Results indicate support for the compensatory and protective-protective resilience models when mental health-specific factors are excluded from the analyses. Results change, however, when mental health-specific variables are included in the analyses, suggesting the need for continued research on resiliency for this population.

Dimensions of Early Adversity and Sexual Behavior in a US Population-Based Adolescent Sample

PurposeEarly life adversity (ELA) is associated with sexual risk, but ELA dimensions—and potential mechanisms—have been less examined. We evaluated associations between threat and deprivation—two key ELA dimensions—and sexual behaviors in adolescents. Secondary analyses investigated age at menarche as a mechanism linking ELA with sexual outcomes in girls. We predicted associations between threat and sexual behaviors, with younger age at menarche as a pathway. MethodsData were from the National Comorbidity Survey, Adolescent Supplement. Adolescents and caregivers reported on youths' ELA experiences, which were categorized as threat- or deprivation-related. Adolescents reported if they engaged in sex (N = 9,937) and on specific sexual risk indicators, including age at first sex, number of past-year sexual partners, and condom use consistency (“always” vs. “not always” used). Girls reported age at menarche. ResultsThreat (odds ratio [OR] = 1.76 [95% confidence interval [CI], 1.62–1.92]) and deprivation (OR = 1.51 [95% CI, 1.24–1.83]) were each linked with engagement in sex, ps<.05. Threat-related experiences were associated with multiple sexual risk markers, even when accounting for deprivation: earlier age at first sex (b = −0.20 [95% CI, −0.27 to 0.13]), greater number of partners (b = 0.17 [95% CI, 0.10–0.25]), and inconsistent condom use (OR = 0.72 [95% CI, 0.64–0.80]), ps <.001. Deprivation was not associated with sexual risk when adjusting for threat. We observed no significant indirect effects through age at menarche. DiscussionAlthough threat and deprivation were related to engagement in sexual activity, threat-related experiences were uniquely associated with sexual risk. Screening for threat-related ELA may identify adolescents at-risk for poor sexual health.

Social Determinants Associated With Exposure to Childhood Parental Bereavement and Subsequent Risk for Psychiatric Disorders

Prevalence of childhood parental death varies by race and ethnicity and socioeconomic status, yet whether similar variation persists in the association with lifetime psychiatric disorder is unknown. To assess whether race and ethnicity and parental educational attainment are associated with the risk of death of a parent; to determine whether the risk for lifetime psychiatric disorder associated with death of a parent was moderated by race and ethnicity and highest parental educational attainment; and to examine a potential intersection of race and ethnicity with parental educational attainment in the risk of lifetime psychiatric disorder associated with death of a parent. This retrospective cohort study used data from the National Comorbidity Study: Adolescent Supplement (NCS-A), 2001 to 2004. Participants included youth aged 13 to 18 years, restricted to Black, Hispanic, and White youth due to power limitations. Data were analyzed from February 26, 2021, to April 21, 2022. Death of a parent during childhood. The primary study outcome was any lifetime Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) psychiatric disorder, assess via assessed via structured clinical interviews. Among 9501 youth (mean [SD] age, 15.2 [1.5] years; 50.9% female), including 511 youth who had experienced parental death and 8990 youth who had not, the cumulative hazard of parental death by age 18 years was approximately doubled for Hispanic (10.1%; 95% CI, 6.9%-14.7%) and Black (14.0%; 95% CI, 10.6%-18.4%) youth compared with White youth (6.0%; 95% CI, 4.7%-7.8%). Similar patterns were noted by parental educational attainment: the cumulative hazard of parental death for youth of parents with less educational attainment was nearly double (10.1%; 95% CI, 8.1%-12.6%) compared with youth of parents with more education (6.6%; 95% CI, 5.2%-8.4%). Death of a parent was positively and significantly associated with risk of any lifetime psychiatric disorder (aOR, 1.34; 95% CI, 1.03-1.75) compared with youth who had not experienced death of a parent. However, this association was not moderated by race and ethnicity (aOR, 1.05; 95% CI, 0.58-1.92) or parental educational attainment (aOR, 1.19; 95%, 0.70-2.04), although power analyses suggest that larger sample sizes are needed. In this cross-sectional study, Black and Hispanic youth experienced elevated parental death compared with White youth, yet the risk for any lifetime psychiatric disorder after parental death was not significantly moderated by race and ethnicity or parental education. Both individual- and population-level interventions may be needed to address the increased risk of psychiatric disorders, although additional studies with larger sample sizes are needed.

Men's Depression, Externalizing, and DSM-5-TR: Primary Signs and Symptoms or Co-occurring Symptoms?

Men's Depression, Externalizing, and DSM-5-TR: Primary Signs and Symptoms or Co-occurring Symptoms?

The relationship between culture-related grief beliefs, prolonged grief disorder and suicide ideation among Shidu parents in rural China.

There are many one-child families in China due to the one-child policy. Parents who have lost their only child and are unable to conceive another child or unwilling to adopt a child are called Shidu parents in China. The death of an only child puts Shidu parents at the risk of mental illness and even suicide. Few studies have explored the influence of cultural beliefs and prolonged grief disorder on suicide ideation. This study involved rural Shidu parents from Sujiatun district of Shenyang, China. Questionnaires consisted of the Prolonged Grief questionnaire - 13 (PG-13), the Culture-related Grief Beliefs of Shidu Parents Questionnaire (CBSQ), one question from the baseline National Comorbidity Survey (NCS) to measure suicide ideation and demographic and bereavement-related information. Bivariate logistic regression analyses were conducted to explore associated factors of suicide ideation. Sixty-nine (28.8%) of the 240 Shidu parents reported having suicide ideation. Having chronic disease (OR = 5.509, p < 0.01), having religious belief (OR = 3.923, p < 0.05) and having a grandchild (OR = 2.552, p < 0.05) were associated with an increased risk of suicide ideation. Destiny belief (a subscale of CBSQ) was negatively associated with suicide ideation (OR = 0.818, p < 0.05). Prolonged grief disorder (OR = 9.280, p < 0.01) and perceived stigma (a subscale of CBSQ) (OR = 1.200, p < 0.05) was positively associated with suicide ideation after adjusting for controlling variables. Suicide ideation is prevalent in rural Shidu parents. Reducing perceived stigma and alleviating prolonged grief disorder may decrease the risk of suicide among rural Shidu parents.

What makes sexual violence different? Comparing the effects of sexual and non-sexual violence on psychological distress

Although drawing an equivalence between sexual and non-sexual violence has been critical to the feminist analysis of rape, the distinction between the two has not been the subject of much empirical research. Using the longitudinal component of the National Comorbidity Survey this study compares the long-term associations of sexual and non-sexual physical violence with psychological distress. In addition, it explores associations of sexual and physical violence with perceptions of self and others. The results reveal similarities and differences between the two types of violence. For psychological distress, the associations are statistically equivalent—both are positively associated with distress. But only sexual violence is associated with self-esteem, self-criticism, and attachment style. Survivors of sexual violence report much lower self-esteem and much more self-criticism. They are also much less likely to report a secure attachment style and, instead, report more interpersonal avoidance and anxiety. The association between sexual violence and perceptions of self and others explains much of the association between sexual violence and psychological distress, and differences in the associations are not driven by other measured characteristics of violence.

Web-based exercise therapy for the treatment of depression

Web-based exercise therapy for the treatment of depression

Pathological Dissociation in The National Comorbidity Survey Replication (NCS-R): Prevalence, Morbidity, Comorbidity, and Childhood Maltreatment

ABSTRACT Our aim was to examine U.S. national prevalence of pathological dissociation (PD) likely indicative of dissociative disorder, and associated morbidity, comorbidity, and childhood maltreatment. PD was assessed in 6,644 participants in the National Comorbidity Survey Replication, a nationally representative adult survey. Seven of the eight pathological dissociation taxon items were inquired about over the past month and scored on a 4-point scale. A conservative PD cutoff score was applied, with 100% specificity against healthy individuals and 84% sensitivity for Depersonalization Disorder which lies at the less severe end of the dissociative disorder spectrum; it yielded a national PD prevalence of 4.1%. The PD group had diminished physical and mental health, marked comorbidity with most major psychiatric disorders, and high likelihood of psychiatric hospitalization. Over half of PD members had attempted suicide, significantly more than individuals with lifetime major depression. Childhood maltreatment was quantified for physical abuse, witnessing domestic violence, physical neglect, emotional abuse, and emotional neglect. Total childhood trauma significantly positively predicted PD severity, as well as severity of all three pathological dissociative experiences (amnesia, depersonalization / derealization, identity alteration). Furthermore, each childhood trauma category significantly predicted PD severity uniquely and additively. Childhood maltreatment in the PD group was significantly greater than in lifetime major depression, except for similar emotional neglect, and was comparable to lifetime PTSD. The study reinforces the validity of prior PD findings across clinical and community samples, and highlights the need for increased attention toward diagnosing and treating these quite common and highly morbid disorders and their traumatic antecedents.

Witnessing interparental violence and leader role occupancy: the roles of insecure attachment and gender

PurposeGiven the role leaders play in organizational effectiveness, there is growing interest in understanding the antecedents of leader emergence. The authors consider parental influence by examining how witnessing interparental violence during adolescence indirectly affects adult leader role occupancy. Drawing on the work–home resources (W-HR) model, the authors hypothesize that witnessing interparental violence serves as a distal, chronic contextual demand that hinders leader role occupancy through its effects on constructive personal resources, operationalized as insecure attachment. Based on role congruity theory, the authors also predict that the relationship between attachment style and leader role occupancy will differ for women and men.Design/methodology/approachTo test the hypotheses, the authors used data from the National Comorbidity Survey Replication (NCS-R) (n = 1,665 full-time employees).FindingsAfter controlling for age, education, childhood socioeconomic status and experienced violence, results showed that the negative indirect effects of witnessing interparental violence on leader role occupancy through avoidant attachment was significant for females only, while the negative effects of anxious attachment hindered leader role occupancy across sexes.Originality/valueResults identify novel distal (interparental violence) and proximal (attachment style) barriers to leader role occupancy, showing empirical support for the life-span approach to leadership and the persistent effects of home demands on work.