Attachment anxiety and depressive symptoms in undergraduate medical students The mediating role of emotion regulation strategies

Introduction Several studies report that medical students are at high risk of depression. Despite the variability in students' vulnerability to depression, the role of individual differences in depression risk among medical students has hardly been investigated. Studies outside of medical student populations have shown that individual differences in attachment style and emotion regulation participate in vulnerability to depression. Objectives This study investigates to what extent medical students' depressive symptoms are related to differences in students' insecure attachment styles and their perception of reduced access to emotion regulation strategies. Methods In a cross-sectional quantitative study, undergraduate medical students at the beginning of their second academic year completed online questionnaires measuring their attachment style, difficulties in emotion regulation, and depressive symptoms. Results Out of the 390 medical students invited, 267 participated in the survey. Higher secure attachment was associated with fewer depressive symptoms. Medical students' insecure attachment style and emotion dysregulation were significantly related to depressive symptoms. Difficulties in employing strategies to disengage from one's own negative affect partly mediated the effects of two dimensions of insecure anxious attachment-need for approval and preoccupation with relationships-on depressive symptoms. Discussion Anxious attachment style and limited access to emotion regulation strategies participate in medical students' depressive symptoms. These findings highlight the need for acknowledging medical students' attachment style and students' perceived access to emotion regulation strategies for the early identification of and intervention programs for the risk of depression.