Relationship between anhedonia, separation anxiety, attachment style and suicidality in a large cohort of individuals with mood and anxiety disorders

Abstract

Background

Anhedonia is psychopathological dimension conceptualized as loss of pleasure in several activities. Although typically viewed as a characteristic feature of depressive episodes, anhedonic experience is also seen in other mental disorders. We aimed to investigate the relationship between anhedonia, separation anxiety, and attachment style in a large cohort of outpatients with mood and anxiety disorders, also considering its ties to suicidality.

Methods

384 consecutively recruited outpatients with mood or anxiety disorders were recruited and assessed with the Structured Clinical Interview for Mood Spectrum–Self Report (MOODS-SR) for anhedonia and suicidality, the Adult Separation Anxiety–Checklist (ASA-27), the Assessment of Adult Attachment Style Questionnaire (ASQ), the Hamilton Rating Scale for Depression (HAMD) and for Anxiety (HAM-A). Anhedonia score was calculated using eight items of the MOODS-SR encompassing the definition of anhedonia.

Results

84 patients were diagnosed with adult separation anxiety disorder only (A-SAD), 32 patients had separation anxiety disorder only during childhood (C-SAD), 77 had both A-SAD and C-SAD, and 191 had no A-SAD/C-SAD. No differences were found in HAM-A and HAM-D scores between the diagnostic groups. Anhedonia score was significantly worse in the two groups with A-SAD. Regression analyses showed that HAM-D (p < .024), ASA-27 (p < .002) total scores and the ASQ domains of Confidence (p < .001) and Discomfort with Closeness (p < .002) were significant predictors of anhedonia. Anhedonia score (p < .001) and ASA-27 (p < .041) total score were significant predictors of suicidal thoughts and behaviors.

Conclusions

Adult separation anxiety is associated with anhedonia and suicide risk in outpatients with mood and anxiety disorders.