A network analysis of gender differences in unresolved attachment, post-traumatic stress following COVID-19, psychiatric comorbidity, and contamination fear in adolescents: Implications for psychotherapy

Objectives: This study used a network approach to examine gender differences in adolescents regarding unresolved attachment styles, COVID-19 PTSD symptoms, comorbid psychiatric symptoms, and contamination fear. The rationale for the study stems from the suggestion that parents‘ relationships with adolescents (i.e., attachment) can influence how adolescents cope with distress during COVID-19. Since attachment is linked to gender differences, these differences should also be considered. Furthermore, while much has been documented on secure or insecure attachment, little is known about whether the impact of unresolved attachment can influence psychological distress in adolescents. Methods: Adolescents (n = 1715; 803 females, 912 males) from five Hong Kong secondary schools completed measures assessing unresolved attachment, contamination-related fears, PTSD symptoms, and general psychological disorders. Results: No significant gender differences were observed in network density or global strength. However, network structure analysis revealed weaker connections among males compared to females. For males, all unresolved attachment aspects were linked to COVID-19 PTSD and comorbid psychiatric symptoms, while for females, only perceived failed protection correlated with depression. Both genders showed associations between PTSD, comorbid symptoms, and contamination fear. Conclusions: While trauma and psychological reactions were shared, gender differences emerged in how unresolved attachment influenced distress. Males exhibited broader attachment-related distress links, whereas females showed more specific associations. These findings enhance understanding of adolescent psychotherapy needs during crises.