Associations Between Childhood Neglect and Depressive Symptoms: The Mediating Effect of Avoidant Coping.

Background: Individuals with a history of childhood neglect may be vulnerable to develop depression, as they may more often use avoidant strategies to cope with the stressors. This study examined (1) whether a history of childhood neglect was associated with higher levels of depressive symptoms and (2) whether avoidant coping behaviors mediated this association. Methods: In total, N = 2245 German adults (mean age = 41.1 years, age range = 18-82 years, 70.2% female) were recruited from the general population between June and September 2020 during the COVID-19 pandemic. Childhood neglect (Adverse Childhood Experience Questionnaire [ACE]), depressive symptoms (Patient Health Questionnaire [PHQ-9]), and three avoidant coping behaviors (substance use, behavioral disengagement, and self-blame; Brief Coping Orientation to Problems Experienced [COPE]) were assessed. Using structural equation modeling (SEM), we examined the direct pathway from childhood neglect to depressive symptoms in a simultaneous parallel multiple mediation model and the possible mediating paths of avoidant coping behaviors. Results: Childhood neglect was positively and significantly associated with depressive symptoms (β = 0.24, p < 0.01) while controlling for the presence of childhood abuse. The three avoidant coping behaviors significantly mediated this association (substance use: bias-corrected 95% confidence intervals [BC 95% CI], 0.02, 0.05; behavioral disengagement: BC 95% CI, 0.04, 0.12; and self-blame: BC 95% CI, 0.16, 0.19). Post hoc contrasts between the mediators showed that self-blame had a significantly stronger indirect effect than substance use (BC 95% CI, -0.12, -0.01). Conclusions: This study provides evidence that avoidant coping behaviors mediate the association between childhood neglect and depressive symptoms in adults. Avoidance coping behaviors may be a promising target for psychological interventions to reduce depressive symptoms.