Relationship between parental bonding and mood disorder in six European countries
Introduction
There is agreement among both behaviouristic and psychoanalytical researchers that an adverse parental child-rearing style can constitute a risk factor for the occurrence of mental disorder in adulthood in addition to other factors such as divorce, loss of a parent, or abuse during childhood (Blatt and Homann, 1992). The development of the Parental Bonding Instrument (PBI), a measure consisting of 25 items evaluating the subjectively perceived and recalled relationship between respondents and each of their parents, by Parker et al. (1979), allowed the relationship between the different child-rearing styles and the occurrence of mental disorders to be analysed in a systematic way. The PBI proved to be a measure with good psychometric properties (Parker et al., 1979, Parker, 1981, Parker, 1989, Plantes et al., 1988, Mackinnon et al., 1989), including long-term stability as has been demonstrated recently by Wilhelm et al. (2005) in a non-clinical cohort study.
Many of the studies published subsequent to the development of the PBI have explored the association between parental child-rearing style and the development of major depression in adulthood (Parker, 1979, Parker, 1983, Plantes et al., 1988, Mackinnon et al., 1993, Sato et al., 1997, Sato et al., 1998, Patton et al., 2001, Enns et al., 2002). Most of the studies undertaken before the end of the 1990s used the factors ‘care’ and ‘overprotection,’ which were initially found by Parker et al. (1979), as independent variables. A number of studies suggest that ‘care’ has a stronger and more consistent association with the occurrence of mood disorder than ‘overprotection’ (Parker, 1979, Mackinnon et al., 1993, Oakley-Browne et al., 1995, Duggan et al., 1998, Sato et al., 1998, Sakado et al., 1999, Enns et al., 2002). The validity of these results should be considered with caution because the effects of the two PBI dimensions have generally not been examined simultaneously, with some exceptions (Mackinnon et al., 1993, Oakley-Browne et al., 1995, Parker et al., 1995, Sato et al., 1998, Narita et al., 2000, Enns et al., 2002). Furthermore, studies since the early 1990s, which have increasingly focused on the investigation of population samples (Kerver et al., 1992, Mackinnon et al., 1993, Neale et al., 1994, Oakley-Browne et al., 1995, Parker et al., 1995, Rodgers, 1996, Sato et al., 1998, Narita et al., 2000, Enns et al., 2002), found a weaker link between an adverse parental child-rearing style and major depression than did clinical studies. A more promising avenue for research proved to be the use of lifetime diagnoses as the dependent variable instead of a current depressive episode (Mackinnon et al., 1993). Recently, some studies have shown, by means of confirmatory factor analyses, the pre-eminence of three-factor models of the PBI with the additional dimension ‘authoritarianism’ (Kendler et al., 1997, Sato et al., 1999, Cox et al., 2000, Narita et al., 2000). However, the impact of this third dimension on the occurrence of major depression has been investigated only in a few studies (Narita et al., 2000, Enns et al., 2002).
From a cross-cultural perspective, developmental psychology has found variables such as cultural values, independence and interdependence, the value of children, parental goals and practice, and the culture-specific meaning of parenting to be relevant for actual parenting behaviour (Trommsdorff and Kornadt, 2003). While differences in parenting behaviour seem most obvious between individualist and collectivist cultures, evidence for such differences is also being provided among primarily individualist European cultures (Best et al., 1994). In view of these findings and the well-established association between adverse parenting and mood disorder, one may ask if there exist culture-specific aspects in the relationship between parenting and the occurrence of mood disorder. Carter et al. (2001) conducted a study that deals with this issue. Comparing the association between maternal rearing style measured by the PBI and depression as well as anxiety among African and European American college students, they found identical levels of care and overprotection in both groups. However, while anxiety and depression were positively associated with overprotection in European Americans, no association between anxiety and depression on the one hand and overprotection on the other could be found among African Americans. In spite of the fact that the impact of the parental child-rearing style on the occurrence of mood disorders has been investigated in numerous studies in different, primarily individualist Western and highly industrialized countries (Parker, 1979, Plantes et al., 1988, Mackinnon et al., 1989, Duggan et al., 1998, Sakado et al., 1999, Kendler et al., 2000, Narita et al., 2000, Enns et al., 2002), there is a lack of cross-cultural studies examining the relationship between the two in a standardized situation with representative non-clinical data.
Using an abbreviated version of the PBI, Heider et al. (2005) were able to substantiate the existence of a cross-nationally invariant three-factor structure (care, overprotection, and authoritarianism) of the PBI in the six European countries under study. The primary aim of the present work was to address whether the relationship between each of the three parenting styles, to be found in all six countries, and the occurrence of mood disorder differs in these countries. Furthermore we assessed which of the three PBI dimensions has the strongest association with mood in general (regardless of the single countries). Finally: we assessed whether there are any differences between the influence of maternal and paternal parenting styles on the occurrence of mood disorder.
Section snippets
Sample
The ESEMeD is a cross-sectional study in a stratified multi-stage random sample of 21,425 adult respondents (aged 18 years and older) living in non-institutional settings in six European countries (Belgium N = 2419, France N = 2894, Germany N = 3555, Italy N = 4712, Netherlands N = 2372, Spain N = 5473) (Alonso et al., 2002, ESEMeD/MHEDEA 2000 investigators, 2004). With the use of computer-assisted interview (CAPI) techniques, the respondents were interviewed at their homes with a revised version of the
Results
Table 2 contains the results for the four nested logistic regression models. In a first step the sociodemographic variables were tested. Only gender and education showed significant effects. The risk of a mood disorder was more than twice as high for women than for men.
In the second step, it was tested whether or not the prevalence of mood disorders is different for the six countries. Adding the countries as predictors resulted in an LR test χ2 = 190.03, df = 5, P < 0.001 which is highly significant.
Discussion
With regard to the association between parental child-rearing styles and the occurrence of mood disorders, practically no differences were found among the six European countries as indicated by non-significant interaction effects. In line with results from earlier studies (Mackinnon et al., 1993, Duggan et al., 1998, Kendler et al., 2000, Narita et al., 2000, Enns et al., 2002), the dimension “care” turned out to have the most prominent effect on subsequent mood disorder. No significant
Acknowledgments
This project was funded by the European Commission (Contract QLG5-1999-01042); the Piemont Region (Italy), Fondo de Investigacion Sanitaria, Instituto de Salud Carlos III, Spain (FIS 00/0028), Ministerio de Ciencia y Tecnologia, Spain (SAF 2000-158-CE), Department de Sanitat, Generalitat de Catalunya, Spain, other local agencies, and an unrestricted educational grant from GlaxoSmithKline.
The ESEMeD is carried out in conjunction with the World Health Organization's World Mental Health (WMH)
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The ESEMeD/MHEDEA 2000 Investigators are:
Jordi Alonso; Matthias Angermeyer; Sebastian Bernert, Ronny Bruffaerts, Traolach S. Brugha; Heather Bryson, Giovanni de Girolamo; Ron de Graaf; Koen Demyttenaere; Isabelle Gasquet; Josep Maria Haro; Steven J. Katz; Ronald C. Kessler; Viviane Kovess; Jean Pierre Lépine; Johan Ormel; Gabriella Polidori, Leo J. Russo, and Gemma Vilagut.
Additional project investigators:
Josué Almansa; Saena Arbabzadeh-Bouchez; Jaume Autonell; Mariola Bernal; Martine A. Buist-Bouwman; Miquel Codony; Antònia Domingo-Salvany; Montserrat Ferrer; Sam S. Joo; Montserrat Martínez-Alonso; Fausto Mazzi; Zoe Morgan; Pierluigi Morosini; Concepció Palacín; Josep M. Puigvert; Nick Taub; and Wilma A.M. Vollebergh.