Effects Of Adult Attachment And Physical Activity On The Relationship Between Childhood Maltreatment And Depressive Symptom Among Medical Students

ObjectiveTo analyze the relationship between childhood maltreatment and depressive symptoms of medical students,explore the mediating role of adult attachment between childhood maltreatment and depressive symptoms among medical students,and explored the moderating effect of physical activity in the mediating pathway.MethodsFrom November to December 2019（T0）,a cluster of 4211 freshmen from two medical colleges in different cities in Anhui Province was selected for baseline data collection.Two follow-up visits were conducted from May to June 2020（T1）and November to December 2020（T2）.3662 students who completed both baseline and two follow-up visits were included in this study.The baseline and follow-up data were collected through questionnaires.Childhood Trauma Questionnaire（CTQ）,Experiences in Close Relationships-Revised（ECR-R）,Physical Activity Rating Scale-3（PARS-3）,and Self-Rating Depression Scale（SDS）were used to evaluate childhood maltreatment,adult attachment,physical activity,and depressive symptoms of medical students.The data were imported into SPSS 23.0 for statistical analysis,and t-test and analysis of variance were used for descriptive analysis;Spearman correlation was used to analyze the relationship between childhood maltreatment,adult attachment,physical activity and depressive symptom scores;Adjusting for factors such as age,gender,family residence,only child status,parents’ education level,and self-rated family economic status,the mediating effect of adult attachment between childhood maltreatment and depressive symptoms of medical students（model 4）and the moderating effect of physical activity in the mediating effect（model 59）were tested by a bootstrap of PROCESS software.ResultsSpearman correlation analysis showed that childhood maltreatment,emotional abuse,physical abuse,sexual abuse,emotional neglect,physical neglect,attachment anxiety,and attachment avoidance were positively correlated with the scores of depressive symptoms（P<0.05）;There was a negative correlation between physical activity and depressive symptoms（P<0.05）.Childhood maltreatment,emotional abuse,physical abuse,sexual abuse,emotional neglect,and physical neglect were positively correlated with attachment anxiety（P<0.05）,and physical activity was negatively correlated with attachment anxiety（P<0.05）;Childhood maltreatment,emotional abuse,physical abuse,emotional neglect,and physical neglect were positively correlated with attachment avoidance（P<0.05）,and physical activity was negatively correlated with attachment avoidance（P<0.05）.After adjusting for factors such as age,gender,family residence,only child status,parents’ education level,and self-rated family economic status,the bootstrap test showed that adult attachment played a partial mediating role in the association between childhood maltreatment and depressive symptoms,with a total mediating effect ratio of14.0%,and the mediating effects of attachment anxiety and attachment avoidance were8.3% and 5.7% respectively.In addition to sexual abuse,attachment anxiety and attachment avoidance play a partial mediating role in the association between emotional abuse,physical abuse,emotional neglect,physical neglect with depressive symptoms.Attachment anxiety plays a partial mediating role in the association between sexual abuse and depressive symptoms.After adjusting for factors such as age,gender,family residence,only child or not,parents’ education level and self-rated family economic status,the moderated mediation model shows that physical activity only moderated the path of “attachment anxiety-depression symptoms” in the four mediation model（“childhood maltreatment-adult attachment-depressive symptoms”,“emotional abuse-adult attachment-depressive symptoms”,“sexual abuse-adult attachment-depressive symptoms” and “emotional neglect-adult attachment-depressive symptoms”）,Physical activity plays different moderating roles in different mediating pathways,and the moderating effects were 0.029,0.042,0.029 and 0.029 respectively.ConclusionsAttachment anxiety and attachment avoidance play a mediating role in the association between childhood maltreatment and depressive symptoms of medical students.Physical activity plays a moderating role in the mediation model.The moderated mediation model is established.When evaluating the occurrence and development of depressive symptoms,early environmental adaptation factors（childhood maltreatment）psychopathology development factors（adult attachment）and potential resilience factors（physical activity）need to be considered.