心理学Essay模板：Child Development Pathways for Developing Depression in Adulthood

本文是心理学专业的留学生Essay范例，题目是“Child Development Pathways for Developing Depression in Adulthood（儿童发展路径与成年期抑郁症的发展）”,童年时期建立的发展途径被认为对个人一生的幸福有帮助。这篇文章的主要焦点将是评估证据，说明不安全的依恋风格，儿童逆境和创伤是在成年后发展抑郁的途径。

Developmental pathways established during childhood are considered to be instrumental for the wellbeing of the individual across the lifespan. The main focus of this essay will be evaluating evidence illustrating that insecure attachment style, child adversity and trauma are pathways for developing depression later in adulthood.

Depression is a mood disorder characterised by: depressed mood, lack of interest in daily activities, disrupted diet, inability to concentrate, fatigue, extreme feelings of guilt and worthlessness (American Psychiatric Association, 2013).

抑郁症是一种情绪障碍，其特征是:情绪低落、对日常活动缺乏兴趣、饮食紊乱、无法集中精力、疲劳、极度内疚和一无是处(美国精神病学协会，2013)。

Suffering from depressive symptoms during childhood predicts a continuity of struggling with the same disorder in adulthood (Copeland et al.,2009). Childhood adversity and trauma are divided into four categories containing a total number of 12 types of adversities:

interpersonal loss (parental divorce),

parental maladjustment (family violence),

maltreatment (abuse, neglect),

and other childhood adversities (illness) (Kessler et al., 2010).

Moreover, the attachment theory illustrates the development of an emotional connection between the infant and its primary caregiver as a means to regulate behaviour and emotion, especially during times of distress and the exploration period (Bowlby 1969).

Child maltreatment is one of most prominent determinant for the development of psychiatric disorders in adolescence and adulthood (McLaughlin, 2015). According to the sensitization theory individuals who suffered from adversity and trauma during childhood are more prone to developing Depression later in life as a result of daily stressors (Bandoli, et al.,2017). Research examining the stress sensitization theory has focused primarily on modifications to the hypothalamic- pituitary-adrenal (HPA) axis as a result of trauma. However, differences in type of adversity suffered, duration and time of the incident have led to inconsistent results in concretely identifying how a certain adversity determines a particular malformation of the HPA axis (Nemeroff, 2004).

儿童虐待是青少年和成年期精神障碍发展的最重要决定因素之一(McLaughlin, 2015)。根据敏化理论，童年时期遭受逆境和创伤的人更容易在日后的生活中由于日常压力而发展成抑郁症(Bandoli等人，2017)。检查应激致敏理论的研究主要集中在由于创伤对下丘脑-垂体-肾上腺(HPA)轴的修改。然而，由于遭遇的逆境类型、持续时间和时间的不同，导致在具体确定某种逆境如何决定HPA轴的特定畸形方面的结果不一致(Nemeroff, 2004)。

The HPA axis is part of the neuroendocrine stress response system which aims to ensure adaptation of the organism to its current circumstances, therefore, preserving health and stability (McEwen, 2004). Hyperactivity of the HPA axis has been found as one of the most significant brain changes in Major Depression (Heim, et al., 2008). Alterations to the HPA axis are associated with childhood adversity such as insecure attachment and abuse (Hammen et al., 2000). Heim et al., (2008) reviewed several studies concluding childhood adversities can cause a sensitization of the stress response system, which would lower the individuals’ tolerance to stress thus explaining the link between trauma and Depression. Early childhood trauma is associated with a number of neuroanatomical and neuroendocrine changes (corticotropin- releasing factor (CRF) systems), which are similar to those described in animal studies. There are certain determinants that additionally increase the risk of depression such as being female and genetic factors.

HPA轴是神经内分泌应激反应系统的一部分，其目的是确保机体适应当前环境，从而保持健康和稳定(McEwen, 2004)。HPA轴的过度活跃被发现是重度抑郁症患者最重要的大脑变化之一(Heim, et al.， 2008)。HPA轴的改变与儿童逆境相关，如不安全依恋和虐待(Hammen et al.， 2000)。Heim等人(2008)回顾了几项研究，得出童年逆境会导致应激反应系统敏感化的结论，这将降低个体对压力的耐受性，从而解释了创伤和抑郁症之间的联系。早期儿童创伤与许多神经解剖学和神经内分泌变化(促肾上腺皮质激素释放因子(CRF)系统)有关，这些变化与动物研究中描述的相似。还有一些因素会增加患抑郁症的风险，比如女性身份和遗传因素。

Hammen, et al., (2000) conducted a longitudinal study aimed to assess depressive episodes, caused by stressful file events in young women who were transitioning into adulthood. Women who have suffered from childhood adversities are more likely to suffer from depressive episodes when exposed to a lower threshold of stress than women without a traumatic background. The obtained results are consistent with the views expressed by the developmental psychopathology model, illustrating that childhood adversity and trauma is a pathway to depression (Cicchetti & Schneider-Rosen, 1986). Amirkhan and Marckwordt, (2017) comes in support of the previous study, as they uncovered that individuals who have suffered from childhood adversity are more likely to suffer from a greater level stress, caused by current life events as well as, avoid the stressful issues.

Hammen等人(2000年)进行了一项纵向研究，旨在评估由压力档案事件引起的年轻女性成年期抑郁发作。与没有创伤背景的女性相比，童年经历过逆境的女性在受到较低的压力阈值时更有可能出现抑郁发作。所获得的结果与发展精神病理学模型所表达的观点一致，说明童年逆境和创伤是通向抑郁的途径(Cicchetti & Schneider-Rosen, 1986)。Amirkhan和Marckwordt，(2017)支持之前的研究，因为他们发现，遭受童年不幸的人更有可能遭受更大程度的压力，由当前生活事件造成，以及避免压力问题。 

Bandoli et al., (2017) uncovered that childhood maltreatment increases the risk of developing Depression in a sample consisting of new US army soldiers. The said effect may occur because, in addition to childhood trauma, military personnel also experience great levels of stress, resulting in an interaction that is detrimental to their psychological wellbeing and mental health. The results of the study align with the stress sensitization theory as they depict the influences of childhood adversity on stress sensitivity. Soldiers who have suffered from maltreatment are at greater risk of suffering from Major Depression, when compared to soldiers who benefited from a healthy upbringing.

Furthermore, attachment is divided into 3 categories:

secure,

disorganised,

and insecure (anxious or avoidant.)

Insecure attachment patterns are the product of inconsistent caregiving, lack of attention towards the child, neglect and rejection (Dagan et al.,2018). The interaction between the infant and the caregiver shapes into a representational model of self and others (McLaughlin et al., 2013). From an attachment theory point of view, psychopathology (Depression) illustrates maladaptive modifications from the heathy developmental pathway, in order to adapt to the current environment in the short term, at the expense of normal adaptation in the long term (Carson and Sroufe, 1995). Bowlby (1973) considered attachment a dynamic theory of development, suggesting that attachment styles are not stable (dependent on past events), therefore they may change over time as a result of new experiences and relationships as well as, have the power to influence and give a negative meaning to the said experiences (Sroufe et al., 2005).

不安全的依恋模式是不一致的照顾、对孩子缺乏关注、忽视和拒绝的产物(Dagan et al.，2018)。婴儿和照顾者之间的互动形成了自我和他人的表征模型(McLaughlin et al.， 2013)。从依恋理论的角度来看，精神病理学(抑郁症)从健康的发展路径出发，以牺牲长期的正常适应为代价，在短期内适应当前的环境(Carson and Sroufe, 1995)。鲍比(1973)认为附件动态理论的发展,认为依恋风格是不稳定的(依赖于过去的事件),因此它们可能随时间变化的结果以及新的经验和关系,有能力影响和给一个消极意义的经历(Sroufe et al ., 2005)。

Attachment as a pathway to Depression can best assessed for both avoidant and anxious attachments. Duggal et al., (2001) conducted a longitudinal study which uncovered that both anxious and avoidant attachments are moderately related to depression. Perhaps, the reason for this is that infants presenting anxious attachment are becoming hyper-vigilant in order to ensure that they will attract the attention of the caregiver, whose responsiveness towards the needs of the child is usually inconsistent. Sroufe et al (2005) proposed two explanatory routes of depression from an attachment perspective: avoidant attachment, leads to feelings of rejection and hopelessness caused by the emotional unavailability of the caregiver, as well as a disconnection of interpersonal relationships. While anxious attachment causes feelings of hopelessness and anxiety, due to inconsistent caregiving, which generates a hypervigilant child, as the caregiver is deemed unreliable.

Dagan et al., (2018) conducted a meta-analysis analysing a number of studies examining attachment as a pathway to depression. The study uncovered that insecurely attached individuals regardless of the sub-type are more likely to suffer from depression as opposed to those who are securely attached. One of the major limitation of the study is represented by the fact that both clinical and non-clinical samples were assessed, therefore, the obtained results do not illustrate a pure depiction of attachment as a pathway to clinically diagnosed Major Depression, but rather to long term prevalence of depressive symptoms. In addition, it is difficulty to infer causality due to the fact that, although insecure attachment representation may predict depression, it is also possible that some individuals develop insecure attachment styles because they suffer from depressive symptoms.

Dagan等人(2018)进行了一项荟萃分析，分析了一些研究依恋作为抑郁的途径。研究发现，与安全型依恋的人相比，不安全型依恋的人无论属于哪种亚型，都更容易患抑郁症。该研究的一个主要局限性在于，临床和非临床样本都进行了评估，因此，所获得的结果并没有说明依恋作为临床诊断重度抑郁症的途径的纯描述，而是反映了抑郁症症状的长期流行。此外，虽然不安全依恋表征可以预测抑郁，但也有可能一些个体因为患有抑郁症状而发展出不安全依恋风格，因此很难推断其因果关系。

Despite the fact that attachment pattern during infancy was adaptive to the respective situation, it is particularly likely to become precarious across the lifespan, as it will be applied to other relationships. Studies have identified that insecurely attached individuals are more attentive to negative affective information in comparison to securely attached people (Maier et al.,2005). Moreover, it may determine insecurely attached individuals to misinterpret the behaviour of others, deeming it as hostile, unreliable or rejecting (Dykas & Cassidy, 2011). Consequently, insecure attachment is likely to cause difficulties in forming, preserving as well as, emotionally investing in interpersonal relationships (Pietromaco & Beck,2015). As such, insecurely attached individuals are suffering from interpersonal stress, which has been shown to be a significant predictor of Depression.

Tsachi et al., (2018) found that avoidant attachment had higher levels epigenetic markers such as OXTR and NR3C1. These results illustrate that in the case of avoidant attachment, the OXTR factor causes an inability to regulate stress through positive social relationships, therefore illustrating a maladaptation to the gene environment interactions. Respectively, the NR3C1 factor indicates towards dysfunctions of the HPA axis, which results in a reduced regulation of stress and emotions. There were no significant results between these two epigenetic markers and anxious attachment. Causality between these results cannot be inferred as the study was cross-sectional.

Tsachi et al.，(2018)发现回避依恋具有更高水平的表观遗传标记，如OXTR和NR3C1。这些结果表明，在回避依恋的情况下，OXTR因子无法通过积极的社会关系调节压力，因此说明了对基因环境交互作用的不适应。NR3C1因子分别表明HPA轴功能失调，导致压力和情绪调节的减少。这两种表观遗传标记与焦虑依附之间没有显著性差异。这些结果之间的因果关系不能推断，因为这项研究是横断面的。

Lastly, Kessler et al., (2010) concluded that childhood adversity and trauma has a strong influence on the development of any kind of mental health issues across the life-span, regardless of the country of origin. Attachment represents the first interpersonal relationship humans build therefore, being particularly important for a healthy growth from a psychological point of view. In addition, insecure attachment can be considered a type of childhood maltreatment. Consequently, there is some overlap between the two developmental pathways as both are highly related to stress, thus, leading to alterations of the HPA axis (Hammen, et al.,2000;; Tsachi et al., 2018). The evidence regarding their influence on development of depression in adulthood is not sufficient when it comes to the processes by which they lead to depression and there is a clear need for further investigations.

Perhaps, more longitudinal studies are needed for assessing these processes in order to systematically investigate attachment and maltreatment as pathways for depression through observation, as well as, having the possibility to establish causation. The majority of studies have focused on self-report retrospective measures which are somewhat unreliable and biased. Despite this a number of studies have found that both insecure attachment and childhood adversity lead to suffering from depressive symptoms from childhood but mostly in adulthood. Major depression affects 2.8% of children under 13 years’ old, but these statistics increase to 5.6% for adolescents, reaching 16.2% in adulthood (McLaughlin et al., 2013) therefore it can be considered a significant mental health problem. Given the results of a great number of studies, there is sufficient evidence to conclude that childhood attachment and adversities are pathways to developing depression in adulthood, even though the precise mechanisms by which they happen are yet to be determined.

也许，还需要更多的纵向研究来评估这些过程，以便通过观察系统地调查依恋和虐待作为抑郁的路径，并有可能建立因果关系。大多数研究都集中于自我报告的回顾性测量，这在某种程度上是不可靠和有偏见的。尽管如此，一些研究发现，不安全的依恋和童年时期的逆境都导致了童年时期的抑郁症状，但主要是在成年时期。13岁以下儿童中有2.8%患有重度抑郁症，但青少年的这一数据增加到5.6%，成年时达到16.2% (McLaughlin et al.， 2013)，因此可以认为重度抑郁症是一种重要的心理健康问题。鉴于大量研究的结果，有足够的证据可以得出这样的结论:童年的依恋和逆境是形成成年抑郁症的途径，尽管它们发生的确切机制尚未确定。

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