Predicting the Mental Health Based on Attachment Styles in High School

Students
Ali Mostafaei1, Davood Ghaderi2 and Mohiadin Mohammadkhani1
1
Department of Psychology, PayameNoor University, PO BOX 19395-3697,
Tehran, I. R. IRAN.
2
Department of Psychology, Islamic Azad University, Sarab Branch, Sarab, Iran.
DOI : http://dx.doi.org/10.13005/bbra/2329

ABSTRACT: In today's world mental health is an important phenomenon and

can affect physical health and normal daily functioning. Identify the factors
influencing it helps to control the negative factors affecting it. This study was
conducted aimed to predict mental health based on attachment styles in high
schoolgirl students. This study is descriptive and correlational (predictive). The
population consisted of all High school girl students that were enrolled in the
academic year 2014-2015 in the city of Mahabad. 250 students were randomly
selected. To collect the data, attachment questionnaire Collins and Reid and
mental health questionnaire (SCL- 90- R) was used. Data analyzed with software
SPSS-21 and using stepwise regression. The results showed that all three styles:
secure attachment, ambivalent and avoidance are able to predict mental health.
These three components simultaneously can explain 53 percent of variance of
mental health. In explaining of lack of mental health, the role of secure
attachment style is more than other components (-0.498). The role of component
ambivalent attachment style (0.352) and the style of avoidant (0.158),
respectively second and third.
KEYWORDS: secure attachment; ambivalent; avoidant; mental health

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Introduction
One of the most important features of human is the ability to form interpersonal
relationships and maintain it. This relationship that is absolutely necessary for
each of us to survive, reproduction, love, jobs and so on take different forms.
Most satisfying relationships will be done with family, friends and relatives. These
mental-emotional cycle of relationships, takes place through the emotional bond
called attachment. Attachment theory is a psychological model that attempts to
describe the dynamics of long-term and short-term interpersonal. However,
“attachment theory is not formulated as a general theory of relationships. It
addresses only a specific facet”: how human beings respond within relationships
when hurt, separated from loved ones, or perceiving a threat (Fraley, Shaver,
2000). Essentially, attachment depends on the person’s ability to develop basic
trust in their caregivers and self (Levy, Terry, Michael, 2014).
In infants, attachment as a motivational and behavioral system directs the child
to seek proximity with a familiar caregiver when they are alarmed, with the
expectation that they will receive protection and emotional support. Four
different attachment classifications have been identified in children: secure
attachment, anxious-ambivalent attachment, anxious-avoidant attachment, and
disorganized attachment. In the 1980s, the theory was extended to attachment
in adults. Four styles of attachment have been identified in adults: secure,
anxious-preoccupied, dismissive-avoidant and fearful-avoidant. These roughly
correspond to infant classifications: secure insecure-ambivalent, insecure-
avoidant and disorganized/disoriented.Two main aspects of adult attachment
have been studied. The organization and stability of the mental working models
that underlie the attachment styles is explored by social psychologists interested
in romantic attachment.
Developmental psychologists interested in the individual’s state of mind with
respect to attachment generally explore how attachment functions in
relationship dynamics and impacts relationship outcomes. The organization of
mental working models is more stable while the individual’s state of mind with
respect to attachment fluctuates more. Some authors have suggested that adults
do not hold a single set of working models. Instead, on one level they have a set
of rules and assumptions about attachment relationships in general.
Mental health is a level of psychological well-being, or an absence of a mental
disorder;it is the “psychological state of someone who is functioning at a
satisfactory level of emotional and behavioral adjustment”. From the perspective
of positive psychology or holism, mental health may include an individual’s
ability to enjoy life, and create a balance between life activities and efforts to
achieve psychological resilience.
According to various studies, mental health is affected by different aspects of
emotional, cognitive and personality (Ashuri, Vakili, Ben-Saeed, Novei, 2010;
Rajaei, Bayazi, Habibi Pour, 2010).People attached insecure due to psychological
problems much more benefit from health care, and attachment have a predictive
role in utilizes of mental health services (Meng, Arcy, Adams, 2015). Kaya (2010)
showed that factors such as age, psychological characteristics of siblings,
economic status and personal characteristics of parents are involved in the
attachment and his longitudinal study showed that insecure attachment style of
nursing students decreased over time. Self-esteem, life satisfaction and hope
also play a role in predicting mental health (Rezaei, Bayani, Shariat-Nia, 2015). It
seems that an early childhood relationship with their care due to subsequent
psychological security that provides mental health is an important factor.
According to Bowlby, attachment relationships always exist and are active
throughout the cycle of life; so attachment bonds in adulthood life are important
and influential on the activities of adult life.
The results of many researches, confirms the continuity of attachment to the life
cycle(Rahimian-Boger, Asgar-Nejad, Rahimi-Nejad, 2009). People secure,
avoidant, and ambivalent, apply completely different strategies for regulating
emotions and emotional information processing transactions (Mikulincer, shaver,
2004). Two major factors that have been related to psychopathology are
theCapacity for emotional regulation and attachment style (Dozier, Stovall-
McClough, &Albus, 2008; Campbell-Sills, Ellard, & Barlow,2014). Insecure
attachment styles, formed in childhood,set patterns of maladaptive strategies for
maintaining relationships with others that involve the regulation ofemotional
distress (Dozier et al., 2008).Attachment theory (Bowlby, 1982; Cassidy &
Shaver, 2008) offers frameworks for understanding how Internalized working
models of relationships affect the development of self. Mental representations of
the selfand beliefs in the availability of significant others influences cognitive
appraisals of personal and interpersonalexperiences and creates patterns
emotional and behavioral functioning that underscore well-being and
mentalhealth (Bretherton&Munholland, 2008). Secure and insecure attachment
styles have been associated withmental health and psychopathology
respectively. Attachment styles have been studied in relationship
topsychopathology in children and adults (DeKlyen& Greenberg, 2008; Dozier et
al., 2008; Mikulincer&Shaver, 2007), psychotherapy (Leiberman&Zeanah, 1999;
Slade, 2008), couples and family therapy(Byng-Hall, 1999; Johnson, 2008),
adolescent development (Allen, 2008) and adult romantic relationships(Feeney,
2008).
The direct connection between attachment styles and emotional regulation
processes has been described(Mikulincer& Shaver, 2008). Intense emotions such
as fear or anxiety will bearoused in response to psychological threat (i.e.,
abandonment, rejection). In such moments, an individual’sattachment system is
activated usually leading to the primary attachment strategy which is seeking
proximity toa stable and supportive attachment figure. The security from an
attachment figure can be in theform of a real person or an internalized mental
representation (i.e., image, memory, and schema) from a past orcurrent
relationship (Mikulincer& Shaver, 2008). The absence of a real or internalized
attachment figureand/or the uncertainty of such a figure’s availability for support
will increase the intensity of emotions thusleading to a greater need for
emotional regulation.
Secondary attachment strategies involve the hyper-activation or the deactivation
of attachment behaviorsand correspond to Anxious and Avoidant insecure
attachment styles respectively. Insecure attachmentstrategies have been
described “along the dimension of attempts to minimize or maximize the
expression ofattachment needs” (Dozier et al., 2008) and are related
respectively to externalizing and internalizingclinical disorders due to the
direction of attention away or toward conflicted emotional states in the self
andcaregiver relationship. The Avoidant and Anxious attachment styles involve
strategies to regulate emotionsthrough dismissive or preoccupied focus on
internal affect.
Unlike individuals with secure attachments who are generally capable of
reducing anxiety and feeling safein response to threats, insecurely attached
individuals must contend with greater emotional arousal, a relativelymore
extensive history of unavailable attachment figures, and less effective strategies
for attaining security.
The results showed that among attachment styles, only ambivalent insecure
style could predict mental health(Sedigh-Arfaei, Rahimi, Ghodusi, 2014). Insecure
attachment styles, ambivalent and avoidance negatively and significantly predict
social adjustment. In addition, the relationship between insecure attachment
styles, emotional intelligence and social adjustment is a mediating role (Sabri,
Khoshbakht, Golzar, 2014). According to the results, attachment style has
important role in predicting of mental health in adulthood. The study of female
college students has shown that there is a significant relationship between
attachment style, anxious or resistant neuroticism (Teimuri, Bakhshi, 2009).Also,
it is reported that students have secure attachment, experience feelings of
happiness higher than students with insecure attachment (Mani, 2003). Besharat
and Shalchi (2008) showed that there is positive correlation between secure
attachment with emotion and problem-focused coping styles, while have a
negative correlation with negative emotion-focused style.
Considering the importance of adolescence and youth, and also the issue of
mental health in students conduct research in understanding the role of
attachment in mental health is important. Therefore, this study will be conducted
to determine the share of each of attachment styles in predicting the mental
health of female students. The main question that each of the attachment styles
(secure, ambivalent and confused / avoidant) have what role in predicting of the
mental health in female students?
Materials and Methods
The research method is descriptive and correlational (predictive). The study
population consisted of all female high school students in the city of Mahabad
who are enrolled in the academic year 2014-2015.The population is all high
school girl and pre university students (3334 students) by multi-stage cluster
sampling method were chosen. By default probability of loss due to lack of
satisfaction to participate in research or incompletely filled questionnaire 312
persons were entered the study and 250 completed questionnaires were
returned.
Attachment Questionnaire Collins and Read: The scale contains three subscales,
each composed of six items. The three subscales are CLOSE, DEPEND, and
ANXIETY. The CLOSE scale measures the extent to which a person is comfortable
with closeness and intimacy. The DEPEND scale measures the extent to which a
person feels he/she can depend on others to be available when needed. The
ANXIETY subscale measures the extent to which a person is worried about being
abandoned or unloved.
Average the ratings for the six items that compose each subscale as indicated
below.
Scale Items
CLOSE 1 6 8* 12 13* 17*
DEPEND 2* 5 7* 14 16* 18*
ANXIETY 3 4 9 10 11 15
_________________________________
* Items with an asterisk should be reverse scoredbefore computing the subscale
mean.
Cronbach’s alpha coefficient in 3 samples of undergraduates:
________________________________________________
n Close Depend Anxiety
________________________________________________
173 .81 .78 .85
130 .80 .78 .85
100 .82 .80 .83
________________________________________________
SCL-90-R
The SCL-90-R includes three global index scales and nine symptom scales that
were based on factor analysis and that include diagnostic-specific and non-
specific symptoms. The symptom scales include the Somatization, Obsessive-
Compulsive, Interpersonal Sensitivity, Depression, Anxiety, Hostility, Phobic
Anxiety, Paranoid Ideation, and Psychoticism scales. The SCL-90-R index scales
include the Positive Symptom Total, Positive Symptom Distress Index, and Global
Severity Index.
All SCL-90-R scale scores are calculated using gender-specific normative data
that adjust
for the higher rates of self-reported symptoms for females than males (Derogatis,
1994). SCL-
90-R index and symptom scale scores are represented as T-scores, with a mean
of 50 and
a standard deviation of 10. Higher T-scores reflect greater number and/or
severity of patient
self-reported symptoms. We defined a “clinically significant” or “elevated” scale
score to be a T-score of 63 or higher, based on recommendations of the SCL-90-R
author (Derogatis, 1994).
Results
In this research, secure attachment styles, ambivalent and insecure as predictor
variables, and mental health was chosen as the dependent variable. Using step-
by-step the most important factors affecting mental health of subjects in order of
priority, were studied.
Table 1: results of Stepwise regression model based on predictive
variables of mental health secure attachment, avoidant, and ambivalent

ANOVAa

Sum of Mean
Model R R2 df F Sig.
Squares Square

Regressi 1839927. 0.3 1839927. 1469.3 .000

058 1 b
on 18 4 18 4

310548.4
1 Residual 248 1252.21
2

2150475.
Total 249
6

Regressi 1957136. 0.4 1250.1 .000

065 2 978568.2 c
on 4 2 7

2 Residual 193339.2 247 782.75

2150475.
Total 249
6

Regressi 1964791. 0.5 .000

073 3 654930.6 867.67 d
on 7 3

185683.8
3 Residual 246 754.81
7

2150475.
Total 249
6

a. Dependent Variable: mental health

b. Predictors: (Constant), secure attachment
c. Predictors: (Constant), secure attachment, ambivalent
d. Predictors: (Constant), secure attachment, ambivalent, avoidant
According to Schedule 1 the amount of F in three steps is equal to 0.0001, Could
be claimed that the above test is significant at a confidence level of 0.99. Results
showed that in the first model, secure attachment style had the highest share in
predicting mental health. The effect of regression was estimated F =164934
which at level 0.01 with degrees of freedom (2, 248) is significant. Correlation
coefficient of this variable with mental health is 0.58 and predicts 34 percent of
the variance of mental health. In the second model, after secure attachment
styles, ambivalent attachment has been entered into the equation. The
regression effect of two variables secure attachment and insecure estimated
F=1250.17 that is significant at level 0.01 with degrees of freedom (2, 247). The
correlation coefficient of two variables with mental health is 0.65 and predicts 53
percent of the variance mental health. Entry of ambivalent attachment style
could increases predict 0.08 percent. The effect of regression three variables
secure attachment, avoidant, and ambivalent estimated F=867.67, that is
significant at level of0.01 with degrees of freedom (2, 246). The correlation
coefficient of three variables with mental health is 0.73 and predicts 53 percent
of the variance of mental health. Entry ambivalent attachment style could
increase predicts 11% higher.
Table 2: Results of regression coefficients for the prediction of mental
health

Coefficientsa

Standardiz
Unstandardized ed
Coefficients Coefficient
Model s t Sig.

Std.
B Beta
Error

(Constant) 111.008 15.966 6.953 .000

-
1 Secure -8.841 .842 -.498 .000
10.498

ambivalent 818 .783 .352 1044 .000

Avoidant 2.948 .926 .158 3.185 .002

a. Dependent Variable: mental health

Findings of Table 2 shows that all three models based on the denotative
coefficients (beta) and a significant level (p≥ .001) are significant. Therefore, the
standard regression equation will be as follows:
Mental health= (-.498 * secure)-(.352* ambivalent)-(.158*avoidant)
According to the column standardized coefficients (weight of β) we can see that
the share of component of secure attachment style (-.498) in explaining mental
health is more than other styles, and Thereafter, the components ambivalent
attachment style (.352) ranked second and then avoidant attachment style
(.158) is ranked third.Standardized Beta (β) offers to evaluate the contribution of
each of the variables in the model size in terms of standard deviation.β
anticipated changes in standard deviation criterion variable to change a standard
deviation of predictor variables. So if secure and insecure attachment style one
standard deviation increase, we can predict that mental health respectively to
decrease or increase the size of -0.498 and a standard deviation of 0.158. Also, if
ambivalent attachment style one standard deviation increase, we can predict
that mental health will increase the size of 0.352 standard deviations.
Discussion
Stepwise regression analysis showed that among attachment styles, all three of
secure attachment, avoidant and ambivalent have the ability to stay in the
regression model, So that these three components simultaneously explain 53
percent of variance in mental health. The share component of secure attachment
style (-0.498) is higher than other factors in explaining lack of mental health,
Thereafter, the component ambivalent attachment style (.352) and avoidant
style (.158) Rating the second and third respectively. Research results with the
findings of Schmidt, Blank, Bellizzi and Park (2012) is consistent. Their results
showed Secure attachment was significantly associated with active coping,
positive reframing, and religion, and these were all associated with PTG. Insecure
types of attachment and social support variables were unrelated to PTG.
Regression analysis suggests that positive reframing and religion as coping
strategies may mediate the relationship between secure attachment and PTG..
Rahimian-Boger, Asgar-Nejad, Rahimi-Nejad (2009) showed that Secure
attachment style have a negative and significant relationship with mental health,
and styles avoidant, and ambivalent positive and significant relationship with
mental health. Carr, Colthurst, Coyle, Elliott (2013) Showed that high score
indimention of insecure attachment predicts the negatively psychological well-
being and mental health. This means that whatever the score of unsecure
dimention is lower, well-being and mental health is higher and vice versa.
Karreman and Vingerhoets research (2012) showed that ssecure attachment was
associated with higher reappraisal and resilience, partly mediating the effect on
well-being. Complete mediation was found for dismissing attachment via higher
reappraisal and resilience, and for preoccupied attachment via lower reappraisal
and resilience. Remarkably, fearful attachment had indirect positive effects on
well-being through higher reappraisal and resilience. Suppression failed to
function as a mediator between attachment and well-being.
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