Personality and Individual Differences 185 (2022) 111233

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Personality and Individual Differences

journal homepage: www.elsevier.com/locate/paid

Loneliness mediates the association between insecure attachment and

mental health among university students
Matilda K. Nottage a, Nicole Y.L. Oei a, b, c, Nine Wolters a, Anke Klein a,
Claudia M. Van der Heijde d, Peter Vonk d, Reinout W. Wiers a, b, e, *, 1, Jurrijn Koelen a, **, 1
a
Developmental Psychology, Department of Psychology, University of Amsterdam, Netherlands
b
Addiction Development and Psychopathology (ADAPT)-Lab, Department of Psychology, University of Amsterdam, Netherlands
c
Amsterdam Brain and Cognition (ABC), University of Amsterdam, Netherlands
d
Student Health Service, University of Amsterdam, Netherlands
e
Center for Urban Mental Health, University of Amsterdam, Netherlands

A R T I C L E I N F O A B S T R A C T

Keywords: Insecure attachment is a transdiagnostic personality factor which may confer risk for mental health issues. The
Attachment mechanisms underlying this association may be partly explained by loneliness. Loneliness, which is common in
Loneliness young adulthood, also concerns social relationships and is similarly associated with negative mental health
Depression
outcomes. This study investigates whether insecure attachment styles are associated with an increase in mental
Alcohol use
University students
health issues, specifically depressive symptoms and problematic alcohol use, and whether this link is mediated by
loneliness. Students at a Dutch university (n = 265) aged 17 to 43 completed an online survey assessing
attachment (ECR-SF), loneliness (DJGLS-11), social connectedness (LSNS-6), depression (PHQ-9) and alcohol use
(AUDIT-C). Results showed that in individuals with mixed attachment styles (scoring high on both the anxious
and avoidant dimensions), loneliness mediated the positive association between attachment style and depressive
symptoms. Exploratory moderated mediation, with social connectedness as a moderator, showed that loneliness
mediated the attachment-depression relationship in socially connected, anxiously attached young adults. Similar
results were found for alcohol use although the direction differed, with lonelier students drinking less. These
findings' implications are discussed considering future research and the potential of interventions targeting
loneliness from an attachment perspective.

1. Introduction depressive symptoms (Bifulco et al., 2002; Conradi et al., 2018). More­
over, a large meta-analysis of longitudinal studies by Fairbairn et al.
Attachment theory, initially formulated by John Bowlby (1969), de­ (2018) found that insecure attachment predicted later substance-related
scribes how an infant's sense of security is affected by their relationship problems. While these findings suggest that attachment style is associ­
with their caregiver. These early experiences may carry over into adult­ ated with depressive symptoms and problematic alcohol use, little is
hood, determining the perception of later relationships as secure or inse­ known about how or why they are linked.
cure (Fraley & Shaver, 2000; Roisman et al., 2007). This theory contrasts Loneliness, another concept relating to the perception of social re­
the secure style with two insecure styles, often referred to as anxious and lationships, may help explain this link. Insecurely attached individuals
avoidant attachment (Bowlby, 1969; Mikulincer & Shaver, 2017). A fourth report more loneliness than their securely attached counterparts (Ber­
mixed or fearful style is sometimes described, characterised by both nardon et al., 2011; DiTommaso et al., 2003), although further research
anxious and avoidant tendencies (Bartholomew, 1990). Growing evidence is required to determine the specific impact of insecure attachment
suggests that insecure attachment has detrimental effects on mental health subtypes. Unsurprisingly, loneliness correlates with depression (Heik­
(Mikulincer & Shaver, 2017), and that it is positively associated with kinen & Kauppinen, 2004; Jaremka et al., 2013; Victor & Yang, 2012).

* Correspondence to: R. Wiers, Developmental Psychology, Department of Psychology, University of Amsterdam, Netherlands.
** Corresponding author.
E-mail addresses: [email protected] (R.W. Wiers), [email protected] (J. Koelen).
1
Jurrijn Koelen and Reinout Wiers share senior authorship.

https://doi.org/10.1016/j.paid.2021.111233
Received 12 May 2021; Received in revised form 16 July 2021; Accepted 23 August 2021
Available online 8 September 2021
0191-8869/© 2021 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
M.K. Nottage et al. Personality and Individual Differences 185 (2022) 111233

Longitudinal data suggest that loneliness is a unique risk factor for the addition, we will exploratively test whether social connectedness mod­
development of depressive symptoms and increased alcohol use (Åker­ erates the relationship between attachment style and loneliness.
lind & Hörnquist, 1992; Cacioppo et al., 2006; Qualter et al., 2010;
Stickley et al., 2014). Parallels between loneliness and insecure attach­ 2. Materials and methods
ment suggest a potential mechanism: insecurely attached individuals
may be at increased risk for depressive symptoms and problem drinking 2.1. Participants and procedures
because they feel lonelier.
Furthermore, a distinction should be made between loneliness, Undergraduate and graduate students at a Dutch university were
which results from a person's dissatisfaction with the quality and/or recruited starting September 2019. We used data collected before March
quantity of their relationships, and social connectedness (or isolation), 2020 to avoid interference from the COVID-19 pandemic and related
which refers to the objective condition of their social environment restrictions. Our sample (N = 278) consisted of 74% females (n = 195).
(Perlman & Peplau, 1998). Social connectedness can influence The mean age was 22.73 (SD = 3.81), ranging from 17 to 43. Students
perceived loneliness (De Jong-Gierveld & Van Tilburg, 2006); it might were local and international; 147 (56%) completed the survey in Dutch
therefore moderate the strength of the relationship between attachment and 118 (45%) in English.
and loneliness. Overall, a better understanding of the direct and indirect Data was collected as part of a larger study (Klein et al., 2021) with
mechanisms linking attachment style to mental health outcomes is specific inclusion criteria. Students (n = 22,597) aged 16+ were emailed
needed. Such insights may support the development of interventions to an initial survey; 7011 responded. Those who reported mild to severe
prevent or treat related issues, such as depression and problematic symptoms of depression (CES-D scores ≥16; Radloff, 1977) and/or
alcohol use, while considering attachment- and loneliness-specific anxiety (GAD-7 scores ≥5; Spitzer, Kroenke, Williams, & Löwe, 2006)
challenges. were invited to continue (n = 5717). Students who provided informed
consent underwent a telephonic interview (n = 341). Exclusion criteria
1.1. Insecure attachment and loneliness in students were: 1) current or recent manic episodes and/or psychotic symptoms
according to the MINI International Neuropsychiatric Interview (Shee­
Loneliness commonly affects university students, often leading to han et al., 1998), and 2) current psychological treatment for depression
mental ill-health (Diehl et al., 2018). Indeed, loneliness is most wide­ and/or anxiety. The remaining 312 participants were invited to com­
spread in adolescence and young adulthood (Hawkley & Cacioppo, plete the online survey used in this study, for which no rewards were
2010; Victor & Yang, 2012), with most university students falling within provided.
this demographic group. Furthermore, regardless of demographic
characteristics, university students are faced with a new social context 2.2. Materials
and pressure to form new relationships (Maunder, Cunliffe, Galvin,
Mjali, & Rogers, 2013). While this transitional time is generally 2.2.1. Attachment style
conducive to loneliness, its effect may be most pronounced in insecurely Attachment style was assessed using an abbreviated version of the
attached individuals (DiTommaso et al., 2003; Wiseman et al., 2006). Revised Experiences in Close Relationships self-report scale, the ECR-SF
Attachment may relate to conceptualisations of the self and of others, (Wei et al., 2007). Six items assess attachment anxiety and 6 assess
differently impacting self-esteem and social relationships, and by attachment avoidance, each rated from 1 (strongly disagree) to 7
extension loneliness (Bartholomew, 1990; Mikulincer & Shaver, 2017). (strongly agree). In a sample of American students, the ECR-SF yielded
According to this theory, securely attached individuals have positive Cronbach's alphas (α) of 0.78 for the anxiety subscale and 0.84 for the
views of themselves and others. In the context of university, a secure avoidance subscale (Wei et al., 2007).
student might miss the company of the friends or family left behind.
Nonetheless, they might trust that these existing relationships will last, 2.2.2. Loneliness
have positive attitudes about forming new relationships and the social Loneliness was assessed using the De Jong Gierveld Loneliness Scale
skills to do so (DiTommaso et al., 2003). An anxiously attached person (DJGLS-11; De Jong-Gierveld & Van Tilburg, 2006). This instrument
however, holding negative views of themself but positive views of asses an individual's evaluation of their social environment using 11
others, might feel very lonely. They might lack the social connections to items, each rated from 1 (no!) to 5 (yes!) and dichotomised (0–1). De
compensate for their low self-esteem. Individuals with negative views of Jong-Gierveld & Van Tilburg's suggested cut-offs are 0–2 (not lonely),
others (avoidant attachment) may refrain from seeking out new re­ 3–8 (moderately lonely), and 9–11 (severely to very severely lonely).
lationships, although it is unclear whether this would result in loneliness The scale authors report a typical reliability of α = 0.80 to 0.90.
in the same way as with anxious attachment. Finally, people with mixed
attachment, having negative views of themselves and others, might be at 2.2.3. Depressive symptoms
a loss where to seek support. These individuals often have a strong need Depressive symptoms were assessed using the Patient Health Ques­
for closeness (see ECR-SF; Wei et al., 2007) but could become disap­ tionnaire (PHQ-9; Kroenke et al., 2001), a 9-item self-report question­
pointed if others fail to meet these needs. This may lead to loneliness and naire focused on symptoms from the past two-week period, such as
withdrawal. In sum, attachment style determines how students perceive mood, sleep, and appetite. Items are rated from 0 (not at all) to 3 (nearly
themselves and others: these perceptions affect how lonely and how every day), with total scores 0–19. The PHQ-9 is suited for samples at
socially connected they are. In turn, levels of loneliness and social risk for depression, with high specificity (0.94) and a slightly low
connectedness may influence how likely a student is to experience sensitivity (0.77; Wittkampf et al., 2007).
mental health complaints.
2.2.4. Alcohol use
1.2. The current study Alcohol use was measured using the abbreviated Alcohol Use Dis­
order Identification Test, the AUDIT-C (Bush et al., 1998). This 3-item
This study aims to investigate whether loneliness mediates the instrument assesses quantity and frequency of drinking, and binge-
relationship between attachment style and mental health. We drinking sessions. Items are ranked 0–4, total scores range 0–12.
hypothesise that loneliness mediates the association between insecure Higher scores indicate more hazardous drinking. The AUDIT-C has been
attachment styles and mental health outcomes — specifically depressive validated in student populations (Verhoog et al., 2020).
symptomatology and problematic alcohol use, common issues among
university students (Ibrahim et al., 2013; Karam et al., 2007). In

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M.K. Nottage et al. Personality and Individual Differences 185 (2022) 111233

Table 1 Median splits on the two dimensions of the ECR-SF (anxious and
Variable means, standard deviations, and reliability statistics. avoidant) determined whether an individual scored high or low. In­
Variable M SD Cronbach's α dividuals scoring low on both were referred to as secure, those scoring
high only on avoidance as avoidant, those scoring high only on anxiety as
English Dutch
anxious, and those scoring high on both as mixed. Because attachment
ECR-SF was operationalised as a multi-categorical antecedent with four cate­
Anxiety 3.48 1.38 0.83 0.83
Avoidance 3.42 1.28 0.85 0.84
gories, it was translated into three indicator variables in the statistical
DJGLS-11 5.44 3.51 0.81 0.89 model (Hayes, 2018). The secure category was used as reference to
PHQ-9 10.72 5.22 0.84 0.78 create the indicator variables X1 (anxious), X2 (avoidant) and X3 (mixed).
AUDIT-C 3.83 2.37 0.71 0.66 Two mediation analyses were conducted using Process (Hayes,
LSNS-6 16.13 4.78 0.78 0.78
2018). Dependent variables were depressive symptoms (Y1) and alcohol
Note. Cronbach's alphas of 0.70 to 0.90 indicate satisfactory reliability; lower use (Y2), both continuous. We tested whether loneliness (mediator)
values can be expected for very brief scales like the AUDIT-C (Tavakol & Den­ mediated the relation between attachment style (independent variable)
nick, 2011). and each dependent variable (process model 4, see Fig. 1). An explor­
atory moderated mediation analysis (model 7) tested whether social
connectedness moderated this indirect relation (Fig. 2). For both
models, the secure attachment category was used as an indicator vari­
able to be compared with each insecure attachment category. Indirect
effects were considered significant when the 95% bootstrap confidence
intervals based on 5000 bootstrap samples did not cross zero.

3. Results
Fig. 1. Simple Mediation Model (Model 4, Hayes, 2018) Note. Conceptual
model showing loneliness (M) as a mediator of the association between
attachment style (X) and health outcomes (Y1: depressive symptoms and Y2: Ten duplicate cases were removed. Since cases with missing data
alcohol use). were scarce (n = 3) they were removed using listwise deletion (Schafer
& Graham, 2002). After these exclusions, n = 265 remained. One outlier,
2.2.5. Social connectedness with a z-score of 3.03 on the AUDIT-C, was found but not excluded.
Social connectedness was measured using the Abbreviated Lubben Collinearity tests yielded variance inflation factors lower than 2, indi­
Social Network Scale (LSNS-6; Lubben et al., 2006), a self-report ques­ cating that multicollinearity was not an issue (O'Brien, 2007). Median
tionnaire evaluating the quality and quantity of social relationships. scores for attachment anxiety (Mdn = 3.33) and avoidance (Mdn = 3.50)
Three items concern relationships with family members (e.g. “How resulted in the following categories: secure (n = 86), anxious (n = 51),
many relatives do you see or hear from at least once a month?”), and 3 avoidant (n = 41), and mixed (n = 87). Half of participants reported
concern relationships with non-family members (e.g. “How many moderate loneliness (49%, n = 131) and a quarter (23%, n = 62) re­
friends do you feel close to such that you could call on them for help?”). ported severe to very severe loneliness. Twenty two percent were so­
Answers range from 0 (none) to 5 (nine or more), and total scores 0–30. cially isolated (n = 58).
Scores ≤12 suggest social isolation. The LSNS-6 demonstrated good
internal consistency (α = 0.83) across European elderly populations 3.1. Mediated effect of attachment style on health outcomes
(Lubben et al., 2006).
The first mediation analysis showed a significant relative indirect
2.3. Data processing and analysis effect (Hayes, 2018): loneliness mediates the association between mixed
attachment and depressive symptoms. The test of the direct effect of X on
Data were analysed with IBM SPSS Statistics 26 (IBM, 2019). Y1 was significant (R2 change 0.029, D(3, 260), p = .029), with a sig­
Descriptive and frequency statistics were computed for all variables nificant relative direct effect of mixed attachment on depressive symp­
(Table 1). Z-scores >3 were considered outliers. Independent samples t- toms. No relative direct or indirect effects were found for anxious or
tests were carried out on mean scores of the PHQ-9, AUDIT-C, and avoidant attachment on depressive symptoms (Table 2).
DJGLS-11 by gender and language (Appendix, Tables 1 and 2). The second mediation analysis also yielded a significant indirect

Fig. 2. Moderated Mediation Model (Model 7, Hayes, 2018) Note. Statistical model showing loneliness (Mi) mediating the association between attachment style (X1-
3) and health outcomes (Y1: depressive symptoms and Y2: alcohol use), and social connectedness (W) moderating the association between attachment and loneliness.
The conditional indirect effect of X1-3 on Y through Mi is (a(1-3)i + a(5-7)iW)bi. Direct effects of X1-3 on Y are also depicted (c’1-3).

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M.K. Nottage et al. Personality and Individual Differences 185 (2022) 111233

Table 2
Results of the mediation and moderated mediation analyses of attachment on depressive symptoms as a function of loneliness. Effects in bold are statistically significant
(p<.05 or bootstrapped Confidence Intervals not crossing 0).
Coeff SE t p LLCIa ULCIa

Mediation effect

Relative indirect effects (X → M → Y)

Anx a1 × b 0.519 0.313 − 0.056 1.173
Avoid a2 × b 0.381 0.347 − 0.251 1.137
Mix a3 × b 1.354 0.365 0.679 2.138
Relative direct effects (X → Y)
Anx → Dep c′ 1 0.588 0.845 0.696 .487 − 1.075 2.252
Avo → Dep c′ 2 0.882 0.904 0.975 .331 − 0.900 2.662
Mix → Dep c′ 3 2.242 0.760 2.950 .004 0.745 3.739
Effect of mediator on DV (M → Y)
Lone → Dep b 0.504 0.088 5.743 <.005 0.331 0.677

Moderated mediation effect

Interaction effects (X × W → M)
Anx a5 0.256 0.111 2.315 .021 0.038 0.474
Avoid a6 0.107 0.126 0.845 .400 − 0.142 0.355
Mix a7 0.177 0.096 1.834 .068 − 0.013 0.367
Relative conditional indirect effect (X × W → M → Y)
Anx W
Low − 0.341 0.427 − 1.266 0.396
Mid 0.434 0.278 − 0.097 1.009
High 0.950 0.354 0.323 1.714
Index of moderated mediation (X × W → M → Y)
Anx 0.129 0.054 0.037 0.252
Avo 0.054 0.060 − 0.060 0.182
Mix 0.089 0.046 0.004 0.185b

Note. Lettered paths (a1, etc.) refer to statistical paths depicted in Fig. 1. X = attachment, Anx = anxious attachment; Avo = avoidant attachment; Mix = mixed
attachment; W = social connectedness (Abbreviated Lubben Social Network Scale); M/Lone = loneliness (De Jong Gierveld Loneliness Scale); Y/Dep = depressive
symptoms (Patient Health Questionnaire); SE = standard error, LLCI = lower limit confidence interval, ULCI = upper limit confidence interval.
a
95% confidence intervals computed with bootstrapped percentiles.
b
Mixed attachment yielded a significant index of moderated mediation yet no interaction effect, failing to support an indirect effect (Hayes, 2018).

effect for the mixed attachment group. Mixed attachment was associated was direct and part of it could be attributed to loneliness. This suggests
with decreased alcohol use via loneliness. The test of the direct effect of X that students with mixed attachment styles experience more depressive
on Y2 was significant (R2 change 0.038, D(3, 260), p = .016), with a symptoms than securely attached students, and that this is partly
significant relative direct effect of avoidant attachment on alcohol use. explained by increased loneliness. This is consistent with previous
No relative direct or indirect effects were found for anxious attachment findings indicating that individuals with this attachment style react to
on alcohol use (Table 3). separation and loneliness with more distress than securely attached in­
dividuals, remain anxious even when in the presence of others, and are
likely to show the most severe signs of psychopathology (Mikulincer &
3.2. Exploratory moderated mediation analysis
Shaver, 2017).
Loneliness also mediated the association between mixed attachment
We found a moderated mediation effect of anxious attachment on
style and alcohol consumption, although the direction of that relation­
depression (Table 2). The association between attachment and depres­
ship ran contrary to our hypotheses. Students with mixed attachment
sive symptoms runs via loneliness, specifically in individuals with
styles consumed less alcohol than secure students when they felt lonely.
anxious attachment styles who are highly socially connected. No sig­
While evidence links loneliness with increased alcohol use (Åkerlind &
nificant indirect effect was found for mixed or avoidant attachment.
Hörnquist, 1992; Stickley et al., 2014), there are suggestions that this
Similarly, we found a moderated mediation effect of anxious
link may not hold in student populations (Cacioppo et al., 2002).
attachment on alcohol use. The association between anxious attachment
Drinking may be a predominantly social activity in young adults. Feeling
and alcohol use runs via loneliness, especially for anxiously attached
lonely may lead students with mixed attachment styles, who hold
individuals who are highly socially connected (Table 3). No significant
negative views of themselves and others (Bartholomew, 1990), to retreat
indirect effect was found for mixed or avoidant attachment.
from social situations where they would otherwise likely drink. Further
studies should compare this mediation model in students and general
4. Discussion
adult populations.
Exploratory analyses comparing insecure attachment categories to
The aim of this study was to determine whether loneliness mediates
the secure category revealed that the relationship between anxious
the association between insecure attachment styles and common mental
attachment and depressive symptoms was mediated by loneliness,
health issues (depression and alcohol use) in a university student pop­
dependent on the student being well-connected socially. It may be that
ulation. We exploratively tested whether levels of social connectedness
anxiously attached students, who hold negative views of themselves but
influenced the strength of the attachment-loneliness association, and
positive views of others (Bartholomew, 1990), maintain connections to
their combined effect on mental health. Overall, the results support
avoid loneliness. If they still feel lonely despite this, they may feel more
direct and indirect associations between attachment style and the
depressed.
investigated outcomes. The direction of the association differed for
Socially connected students with anxious attachment styles were less
alcohol use, with lonelier students drinking less.
likely to consume alcohol when feeling lonely. We could propose a
Results from the simple mediation support a link between mixed
similar theory as for mixed attachment: anxiously attached students
attachment and increased depressive symptoms. Part of this association

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M.K. Nottage et al. Personality and Individual Differences 185 (2022) 111233

Table 3
Results of the mediation and moderated mediation analyses of attachment on alcohol use as a function of loneliness. Effects in bold are statistically significant (p<.05
or bootstrapped Confidence Intervals not crossing 0).
Coeff SE t p LLCIa ULCIa

Mediation effect

Relative indirect effects (X → M → Y)

Anx a1 × b − 0.120 0.091 − 0.333 0.013
Avoid a2 × b − 0.088 0.087 − 0.284 0.059
Mix a3 × b ¡0.313 0.142 ¡0.635 ¡0.067
Relative direct effects (X → Y)
Anx → Alco c′ 1 − 0.088 0.411 − 0.214 .831 − 0.898 0.722
Avo → Alco c′ 2 1.278 0.440 2.903 .004 0.411 2.145
Mix → Alco c′ 3 0.455 0.370 1.230 .220 − 0.273 1.184
Effect of mediator on DV (M → Y)
Lone → Alco b ¡0.117 0.043 ¡2.728 .007 ¡0.201 ¡0.032

Moderated mediation effect

Interaction effects (X × W → M)
Anx a5 0.256 0.111 2.315 .021 0.038 0.474
Avoid a6 0.107 0.126 0.845 .400 − 0.142 0.355
Mix a7 0.177 0.096 1.834 .068 − 0.013 0.367
Relative conditional indirect effect (X × W → M → Y)
Anx W
Low 0.079 0.105 − 0.107 0.323
Mid − 0.100 0.077 − 0.282 0.018
High ¡0.220 0.115 ¡0.482 ¡0.036
Index of moderated mediation (X × W → M → Y)
Anx ¡0.030 0.016 ¡0.068 ¡0.004
Avo − 0.012 0.015 − 0.045 0.015
Mix − 0.021 0.013 − 0.050 − 0.000b

Note. Lettered paths (a1, etc.) refer to statistical paths depicted in Fig. 1. X = attachment, Anx = anxious attachment; Avo = avoidant attachment; Mix = mixed
attachment; W = social connectedness (Abbreviated Lubben Social Network Scale); M/Lone = loneliness (De Jong Gierveld Loneliness Scale); Y/Alco = alcohol use
(Abbreviated Alcohol Use Disorder Identification Test); SE = standard error, LLCI = lower limit confidence interval, ULCI = upper limit confidence interval.
a
95% confidence intervals computed with bootstrapped percentiles.
b
Mixed attachment yielded a significant index of moderated mediation yet no interaction effect, failing to support an indirect effect (Hayes, 2018).

might retreat from social situations when they feel lonely. The effect of 11% (n = 29) met criteria for harmful alcohol use (scores ≥7 for women
this behaviour on alcohol consumption might be most noticeable in and ≥8 for men), a lower rate than the general prevalence in Dutch
well-connected individuals, who would have had more opportunities for student populations (Verhoog et al., 2020). Replication using a random
social drinking. This is intuitively more unlikely, since anxiously general population sample would be necessary to obtain generalisable
attached individuals are not likely to refrain from contact with others results. Furthermore, we detected associations between gender, lan­
(Bartholomew, 1990; Mikulincer & Shaver, 2017). The dynamics of guage, and alcohol use. With adequate power, separate analyses by
loneliness may impact these individuals in a unique way, but further subgroups (gender, language, and local/international) may yield further
study is required to determine specifically how. insights. Finally, there are limitations to the instruments and constructs
Lastly, our analyses revealed a direct link between avoidant attach­ used in this study. For example, the LSNS-6 has only been validated for
ment and increased alcohol use. The literature does suggest that insecure elderly populations. Self-report measures are susceptible to social
individuals are at increased risk for harmful substance use (De Rick & desirability and recall biases (Arnold & Feldman, 2017). Lastly, we used
Vanheule, 2007; Kassel et al., 2007), however it is unclear why this held attachment categories to run moderated mediation analyses using Pro­
for the avoidant subtype only. There is sparse evidence that avoidantly cess. Attachment categories have limitations and a dimensional
attached individuals might be at higher risk for alcohol use disorders approach to attachment is generally preferable (Mikulincer & Shaver,
than other insecure subtypes (Vungkhanching et al., 2004); further 2017).
investigation is needed to confirm this association and determine its
mechanisms. Clinically, this may be relevant to identify the potential of 5. Conclusions
avoidantly attached individuals for non-social, ‘silent’ drinking.
Results support the hypothesised mediation models of the relation­
ship between attachment and mental health, as well as offering some
4.1. Study limitations
initial insights into the role of social connectedness. While these findings
are preliminary, they highlight a possible approach to understanding
These findings should be interpreted in light of limitations. First, the
and addressing loneliness, particularly in students. In adjusting to col­
cross-sectional design limits causal inferences. We cannot rule out the
lege and university life, anxiously attached individuals are faced with
possibility that the associations run in different directions from the ones
challenges which may be unique to their personality dynamics. Indeed,
we modelled: loneliness may deteriorate attachment, and depressive
our findings resonate with other studies, indicating that students with
symptoms may increase loneliness. While unlikely (since attachment is
specific attachment styles may benefit from specific interventions aimed
considered a stable trait-like characteristic) this should be ruled out in
at reducing loneliness and depression (Wei et al., 2005). Taken together,
further studies, accounting for possible confounders and using longitu­
these combined findings highlight the potential of interventions which
dinal data (Rohrer, 2018). Secondly, selection bias is likely in this self-
target loneliness from an attachment perspective.
selected and pre-screened sample. Rates of depressive complaints were
above average, with 89% (n = 235) of participants reporting mild to
severe symptoms (scores 5–19; Kroenke et al., 2001). On the other hand,

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M.K. Nottage et al. Personality and Individual Differences 185 (2022) 111233

CRediT authorship contribution statement curation, Writing – review & editing, Supervision.

Matilda K. Nottage: Writing – original draft, Data curation, Formal Acknowledgements

analysis, Visualization. Nicole Y.L. Oei: Conceptualization, Methodol­
ogy, Formal analysis, Visualization, Writing- review and editing, Su­ We thank Ruben Atteveld, Jorien van Blom, Eline Bol, Lisa de Kon­
pervision. Nine Wolters: Writing – review & editing. Anke Klein: ing, and Samantha Roetink for their contributions.
Writing – review & editing. Claudia M. Van der Heijde: Writing – re­
view & editing. Peter Vonk: Writing – review & editing, Funding Funding
acquisition. Reinout W. Wiers: Writing – review & editing, Funding
acquisition. Jurrijn Koelen: Conceptualization, Methodology, Data This work was supported by the University of Amsterdam.

Appendix A
Table 1
Independent samples t-tests: Language.

Variable Dutch n = 147 English n = 118 t df p

M SD M SD

Social connectedness 16.50 4.89 15.66 4.62 1.43 256 .155

Loneliness 4.71 3.66 6.36 3.11 − 3.97 262 <.005
Attachment avoidance 3.37 1.18 3.49 1.39 − 0.81 231 .422
Attachment anxiety 3.26 1.29 3.75 1.44 − 2.87 237 <.005
Alcohol 4.06 2.46 3.54 2.24 1.80 259 .074
Depression 10.37 4.82 11.15 5.68 − 1.20 230 .233

Table 2
Independent samples t-tests: Gender.

Variable Male n = 66 Female n = 195 t df p

M SD M SD

Social connectedness 16.05 4.76 16.12 4.82 − 0.11 113 .909

Loneliness 5.62 3.51 5.37 3.55 0.49 113 .623
Attachment avoidance 3.57 1.20 3.37 1.31 1.11 121 .269
Attachment anxiety 3.41 1.32 3.50 1.41 − 0.50 119 .620
Alcohol 4.39 2.46 3.67 2.32 2.09 107 .039
Depression 10.65 5.00 10.60 5.24 0.07 117 .943

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