Extensive evidence indicates that adults with experience of childhood trauma and disorganised attachment are at a higher risk of suffering from depressive symptoms, while at the same time dissociation and mentalisation are very important risk and protective factors in this relation. Although mentalisation and dissociation are mentioned as potential mediators of this relationship, very few studies have analysed the mutual relations between these variables. Bearing in mind the importance of creating more specific and effective ways for dealing with depression, especially within vulnerable groups such as the traumatised, the aim of this research is to examine a serial mediation model in which disorganisation is modelled as effecting a decrease in mentalisation, in turn lead to dissociation, thereby resulting in depressive symptoms. Adult respondents (N = 153) with a history of interpersonal childhood trauma were selected from a larger geographical cluster sample from the general population of Serbia. The respondents filled in a battery of instruments, including The Childhood Traumatic Events Scale, Relationship Questionnaire – CV, Patient Health Questionnaire, Short Scale for the Assessment of Stress-Related Dissociation Symptomatology and the Mentalisation Scale. Our findings suggest that disorganisation has an effect on depression by leading to a decrease in the ability to mentalise, which further triggers dissociation, resulting in depressive symptoms as a final consequence (estimated indirect effect = 0.014, 95 percent CI = 0.005 to 0.026). Additionally, the specific indirect effect involving dissociation as the sole mediator was also significant (estimated indirect effect = 0.058, 95 percent CI = 0.030 to 0.091). Targeting dissociative symptoms in the treatment in patients struggling with depression aftermath of traumatic experience could gain a great benefit for recognition and selection of more adequate treatment strategies.

中文翻译：

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童年创伤背景下的无组织依恋、心智化和解离：对抑郁症状的影响

大量证据表明，有童年创伤经历和依恋紊乱的成年人患抑郁症状的风险更高，而同时分离和心理化是这种关系中非常重要的风险和保护因素。尽管心理化和解离被认为是这种关系的潜在中介，但很少有研究分析这些变量之间的相互关系。牢记创造更具体和有效的方法来处理抑郁症的重要性，特别是在受创伤等弱势群体中，本研究的目的是检查一个连续的调解模型，在该模型中，解体被建模为影响心智化的减少，反过来导致解离，从而导致抑郁症状。具有人际关系童年创伤史的成年受访者 (N = 153) 是从塞尔维亚一般人口的较大地理集群样本中选出的。受访者填写了一系列工具，包括儿童创伤事件量表、关系问卷 - 简历、患者健康问卷、压力相关分离症状评估的简表和心理化量表。我们的研究结果表明，组织混乱会导致精神化能力下降，从而对抑郁症产生影响，这会进一步引发分离，最终导致抑郁症状（估计的间接影响 = 0.014，95% CI = 0.005 至 0.026）。此外，涉及解离作为唯一中介的特定间接效应也很显着（估计的间接效应 = 0.058，95% CI = 0.030 至 0.091）。针对创伤经历后抑郁症患者的治疗中的分离症状，可以为识别和选择更适当的治疗策略带来很大好处。