Childhood maltreatment and depression in adult patients: The mediator role of personality functioning

Abstract Background Childhood maltreatment (CM), including emotional neglect, physical neglect, emotional abuse, physical abuse and sexual abuse, is associated with an increased risk of adult depression, particularly emotional abuse and neglect. Personality impairment is a significant mediator in the relationship between CM and adult depression. Methods This naturalistic cross‐sectional study aimed to examine the mediating role of personality functioning in the association between CM types and depressive symptoms in a clinical sample of adults. We assessed the two dimensions of personality functioning proposed by Section III of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM‐5), specifically self‐functioning and interpersonal functioning. The participants were 335 adult patients starting individual psychotherapy who completed intake self‐report questionnaires to evaluate experiences of CM, personality functioning, depression, and comorbidity of depression and anxiety. Bootstrap mediation analyses were performed to examine the mediating role of personality functioning in the relation between each CM type and depressive symptoms, as well as the comorbidity of depression and anxiety. Results Personality functioning explained half (53%) of the total effect of CM on depressive symptoms and comorbidity. Regarding the different CM types, only the total effects of emotional abuse and neglect on depressive symptoms were significant, evidencing their direct and indirect effect on adult depression. Both personality functioning dimensions were significant mediators, yet self‐functioning had a larger mediating effect, underscoring its critical role. Conclusions Psychotherapeutic interventions addressing impairments in personality functioning may be crucial in the treatment of depressive symptoms in adult patients with CM.