Linking mentalizing capacity, shame, and depressive symptoms in the context of childhood maltreatment

Background: Experiences of childhood maltreatment have been shown to be a crucial predictor of depressive symptoms. Objective: This study investigated the association between a history of maltreatment and depressive symptoms in a mixed sample of adults, exploring whether feelings of shame and impairments in mentalizing mediate this association and potentially represent health-affecting factors associated with an increase in depressive symptoms. Further, the association between feelings of shame and depressive symptoms was expected to be moderated by impairments in mentalizing. Participants and setting: A mixed sample of 796 adults, including clinical and non-clinical participants, completed questionnaires assessing retrospectively rated experiences of childhood maltreatment, feelings of shame, mentalizing capacities, and current depressive symptoms in a cross-sectional design. Methods: The hypotheses were tested using structural equation modelling. Results: Associations were found between childhood maltreatment, feelings of shame, impairments in mentalizing, and depressive symptoms. Impairments in mentalizing and feelings of shame partially mediated the link between maltreatment and depressive symptoms. However, impairments in mentalizing did not moderate the link between shame and depressive symptoms. Conclusion: The current study provides evidence for the role of metacognitive processes that affect mental health problems in the domain of depression. Psychological treatments that promote mentalizing capacities might be helpful in reducing feelings of shame, and consequently in reducing depressive symptoms.