Depression may be conceptualized multidimensionally, owing to marked individual differences in developmental vulnerability and phenomenology. Blatt (Blatt, Quinlan, Chevran, McDonald, Zuroff, 1982; Blatt, Quinlan, Pilkonis, & Shea, 1995) has validated two subtypes of depression. Anaclitic depression involves excessive interpersonal concerns, including feelings of loneliness, weakness, helplessness and abandonment fears. Introjective depression denotes achievement concerns, and is characterized by a tendency towards self-criticism and self-evaluation. Present research examined this distinction by identifying possible differential attachment patterns for the depression subtypes. It was hypothesized that, while secure attachment would negatively relate to depression, insecure attachment would predict anaclitic and introjective subtypes, with perfectionism mediating this relationship. A sample of 245 participants completed the Depressive Experiences Questionnaire, the Beck Depression Inventory, the Multidimensional Perfectionism Questionnaire, and two measures of attachment. Regressional techniques revealed that anaclitic depression was predicted by preoccupied attachment (seeking others' acceptance to bolster low self-worth), with socially prescribed perfectionism (striving to meet the high standards of others) partially mediating the relationship. Introjective depression was predicted by fearful-avoidant attachment (low self-worth and expectations of rejection), with self-oriented perfectionism (self-imposed unrealistic standards) acting as a partial mediator. Findings further validate these depressive subtypes by indicating their different attachment-perfectionism paths. Results are concordant with attachment theory and have implications for both theory and therapy.

The present research examines links between adult attachment styles, working alliance, and treatment response in men and women receiving 16 sessions of supportive-expressive dynamic psychotherapy for major depression. 58 clients were assessed using the Relationship Questionnaire and the Hamilton Rating Scale for Depression (HRSD) prior to commencement of psychotherapy. The Working Alliance Inventory was completed in session 3, and the HRSD was readministered after six and 16 sessions. Results indicated that a high proportion (39%) of the sample reported 'fearful-avoidant' attachment at intake. Fearful avoidance also longitudinally predicted significantly more negative outcomes (particularly over the initial six sessions), but was unrelated to working alliance. Working alliance was unrelated to treatment response. Findings highlight the negative impact of fearful attachment on treatment response, but indicate that this occurs independent of the working alliance. The avoidance of intimacy for fear of rejection appears to impede successful psychotherapy, and treatment should be tailored for these clients.

Efforts to improve help-seeking for dementia should address attitudes relating to stigma including negative labelling and a desire for the avoidance of people with dementia. Fears relating to discrimination indicate a need to build public confidence regarding the capacity of the health and workforce sectors to support people with dementia ethically and appropriately.

Introduction With the population ageing, it is imperative for training practices to provide GP registrars with sound experience in managing the health problems of older persons, especially chronic conditions. However, it is reported that a significant proportion of these patients will be resistant to consulting registrars, with concerns regarding disruption of continuity of care being a significant factor. The challenge for training practices is to identify approaches to engage registrars in the management of older patients whilst maintaining patient satisfaction. This paper presents a review of the literature on patient attitudes to general practice registrars to better understand the nature and magnitude of the challenge, and to identify important research gaps. Methods Major electronic medical literature databases were searched for relevant articles using search terms including general practice, registrar, doctor-patient relationship, patient attitudes and elderly, for the period from 1980 to March 2009. The studies were analysed by methodology, content and theme. Results A total of 15 studies were identified that directly addressed patients' attitudes to GP registrars. Whilst there appeared an overall high acceptance of registrars by patients, increasing patient age was associated with more negative attitudes towards registrars, reduced trust and decreased satisfaction with communication. Presentations for chronic or emotional problems were associated with reduced willingness to consult registrars. Patients generally appreciated an ongoing involvement with their usual GP. Discussion These findings have implications for training practices and research directions. Demonstrating continuity of care through shared chronic disease management between supervisors and registrars is a possible model that meets registrars training and continuity needs. There is a need for quality research on the type and magnitude of problems affecting GP registrar encounters with older patients and, based on results from these studies to, create and assess models of registrar training involving older patients, that meet patients' needs for continuity of care.

Background: Preoccupied and fearful attachment have both been associated with depressive symptoms, but it is unclear which attachment style is primarily associated with major depression. While preoccupied attachment denotes a focus on relationships as a source of self-validation, fearful attachment involves an avoidance of relationships for fear of rejection. Present research aims to investigate the relative influence of fearful and preoccupied attachments on self-reported depressive symptoms within both a student and a clinical sample and to examine these associations separately for male and female participants. Sampling and Methods: All participants completed the Relationship Questionnaire and the Beck Depression Inventory. Study 1 assessed attachment ratings and self-reported severity of depression for 71 patients diagnosed with major depression. Study 2 similarly assessed 245 university students, and study 3 compared attachment ratings of the two samples. Results: Both Pearson correlations and partial correlations were examined for both samples. Fearful attachment was associated with self-reported depression severity for females with depression, but attachment styles were unrelated to depression severity for males with depression (study 1). For female university students, both fearful and preoccupied attachment styles were significantly related to depression severity, but again there were no associations for male university students when partial correlations were utilised (study 2). Study 3 revealed significantly higher levels of fearful attachment for women with depression compared with female university students and no significant differences for males overall. Conclusions: For females, the avoidance of intimacy for fear of rejection was associated with a broad spectrum of depressive symptoms. Results highlight gender differences in depressive experiences, and have implications for research into the effects of fearful attachment on social support and the therapeutic alliance. Limitations to this study include the reliance on self-report measures of attachment and depression severity, the small number of male participants in the clinical sample, and the use of a cross-sectional rather than longitudinal design.