Attachment insecurity moderates the relationship between disease activity and depressive symptoms in ulcerative colitis

Background: Among people with ulcerative colitis, depression occurs more frequently when inflammation is active. We hypothesized that individual differences in interpersonal style affect the risk that active disease will be accompanied by depressive symptoms. Methods: In this study, disease activity, depressive symptoms, and 2 dimensions of interpersonal style, attachment anxiety and attachment avoidance, were measured in 146 ulcerative colitis outpatients at time 1 and in 99 of these patients at a second time-point, 7 to 37 months later. Test-retest correlations of attachment anxiety (r=0.83, P < 0.001) and attachment avoidance (r = 0.76, P < 0.001) confirmed that these dimensions are stable. Results: There was a stepwise increase in the correlation between time 2 disease activity and depression from the lowest tercile of attachment anxiety (r = 0.00, P = 0.99), through the middle tercile (r = 0.36, P = 0.05), to the highest tercile (r = 0.52, P = 0.002). For attachment avoidance, disease activity and depression were only significantly correlated in the highest tercile (r = 0.49, P = 0.005). Conclusions: Attachment anxiety meets all tested criteria as a moderator of the relationship between disease activity and depressive symptoms. Further attention to interpersonal style as a moderator of depressive risk in ulcerative colitis is warranted.