Gender differences in attachment anxiety and avoidance and their association with psychotherapy use – Examining students from a German university

Abstract

Background: Attachment anxiety and avoidance have been insufficiently studied in relation to psychotherapy use. Attachment theory, specifically attachment anxiety and avoidance, might explain gender differences in psychotherapy use, which is generally lower in those identifying as male. In addition, university students are a particularly vulnerable group for mental health problems, and understanding psychotherapy use, especially among mentally distressed male students, is pivotal.Methods: A total of 44,299 students from a German university were invited to participate in an online survey on the topic of "studying with mental stress", and 4,894 completed the survey (adjusted response rate of 11.04%). The students answered questions regarding psychotherapy use, and they completed the Patient Health Questionnaire (PHQ-D) identifying syndromes of depression, anxiety, alcohol use, somatoform and eating disorders. In addition, the Experiences in Close Relationships – Revised (ECR-RD12) questionnaire, was used to measure attachment anxiety and avoidance.Results: Significant gender differences for attachment anxiety and avoidance emerged showing higher attachment anxiety in female students and higher attachment avoidance in male students. In addition, male students used psychotherapy significantly less than female students, and they also intended less to use psychotherapy in the near future. Male students did not differ from female students with regard to mental distress. When exploring regressions to predict psychotherapy use, male students’ attachment anxiety and avoidance predicted use. For female students, only attachment anxiety emerged as a significant predictor. Attachment anxiety further emerged as a significant moderator of the association between suffering from a depressive or somatoform syndrome and current psychotherapy use. In essence, students not presenting a psychiatric syndrome and exhibiting higher attachment anxiety were more likely to use psychotherapy.Conclusion: Attachment anxiety and avoidance are positively associated with psychotherapy use; however, gender differences in attachment anxiety and avoidance may partially explain lower psychotherapy use in male university students. Lower attachment anxiety in male students emerges as a relevant factor explaining lower psychotherapy use in males, which is not balanced by higher attachment avoidance in males.