Background Although existing research has suggested an association between insecure attachment styles and mental health difficulties, these studies often have small sample sizes, use cross-sectional designs, and measure attachment as a discrete variable at a single point. It is also unclear whether these associations persist into late adolescence. In this prospective study we aimed to determine whether insecure attachment style in early childhood is associated with depression and self-harm at 18 years. Methods We used data from the Avon Longitudinal Study of Parents and Children cohort. Mothers completed attachment related questionnaires when their child was 18, 30, and 42 months old. Offspring depression and lifetime self-harm was assessed at 18 years using the Clinical Interview Schedule-Revised. Attachment was derived as a latent variable in a structural equation modelling framework. Logistic regression was performed on participants with complete attachment data (n=7032) to examine the association between attachment style and depression and self-harm, with adjustment for potential confounders. Differential dropout was accounted for using multiple imputation. Results We found some evidence for an association between attachment quality and depression and self-harm. In the fully adjusted imputed model, a one standard deviation increase in insecure attachment was associated with a 13% increase in the odds of depression at age 18 (OR=1.13; 95%CI=1.00 to 1.27) and a 14% increase in the odds of self-harm at age 18 (OR=1.14; 95%CI=1.02 to 1.25). Conclusions Our findings strengthen the evidence suggesting that an insecure attachment style assessed in early childhood is associated with mental health difficulties in late adolescence. If this association is causal, policies to support parenting or attachment-based interventions to improve attachment quality could help reduce mental health difficulties in adolescence/young adulthood. Keywords ALSPAC, attachment, depression, self-harm, longitudinal, structural equation modelling Abbreviations ALSPAC: Avon Longitudinal Study of Parents and Children; SEM: Structural Equation Modelling
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