Introduction
Depression is the fourth major cause of disease burden in the world, which alone accounts for the largest share of non-fatal disease burden [1]. Various studies have been conducted on the etiology of this disorder. One of the factors that can predict depression is attachment style [2]. According to cognitive theories, problems, like depression are rooted in the spontaneous thoughts of a child. Therefore, these thoughts themselves are also rooted in the schemas obtained from the first mother-child relationships. Thus, the disturbance in these relationships and the instability of the beloved object or the mother can lead to the creation of schemas that will cause psychological disorders, such as depression in the individual in the future [3]. It seems unlikely that only one factor can explain the occurrence of depression, but depression results from the interaction of several different factors. According to Beck’s Theory, depression has four components: cognitive, emotional, motivational, and physical, where the cognitive component plays a more central role in the description of depression [4]. Among the cognitive components affecting depression, the effect of two variables, shame and self-criticism, on depression has been shown in various studies [10]. Considering the high prevalence of depression in students and the significant burden this disease imposes on the individual, health system, and society, it is necessary to conduct extensive studies to adopt appropriate methods for the prevention, treatment, and management of this disease. The present study was done to investigate the mediating role of shame and self-criticism in the relationship between attachment styles and the severity of depression symptoms.

Methods
The current research design was descriptive and structural equation modeling. The statistical population was all people with the age range of 18 to 47 years in Tehran in 2022. The sampling method in the present study was the available sampling method. The sample size was selected based on Klein’s rule. According to this rule, at least 20 samples are required for each parameter. According to the number of parameters of the current research (seven parameters), a minimum sample of 140 people was required, which was considered to be 212 people to prevent the possible loss of the sample. In order to collect data, the Beck depression questionnaire, Hazen and Shaver’s attachment styles questionnaire, Tangeni et al.’s Shame questionnaire, and Thompson and Zaroff’s Critical Levels questionnaire were used. The participants signed the informed consent form and had the right to leave the study at any time. This research observed ethical guidelines. In structural equation modeling, multivariate normality is one of the important assumptions that must be considered. In this study, the Kolmogorov-Smirnov test was used to test the assumption of normality. The fit indicators, including the goodness of fit index (GFI), root mean squared error of approximation (RMSEA), comparative fit index (CFI), and Bentler–Bonett normed fit index (NFI) were determined by LISREL software, version 8. Also, the Bootstrap method was used to investigate the indirect relationships of the routes. In this study, a significance level of less than 0.05 was considered. 

Results
In this study, there were 212 participants with an age range of 16-67 years with a standard deviation of 28.51±10.17, of whom 173 cases (81.6%) were women and 39 cases (18.4%) were men. Also, 155 cases (73.1%) were single and 57 cases (26.9%) were married. Forty-eight cases (22.6%) had a diploma and sub-diploma, 104 cases (49.1%) had a bachelor’s degree, 52 cases (24.5%) had a master’s degree, and 8 cases (3.8%) had a PhD.
Table 1 shows the fit indices of the relationship between attachment styles and the severity of depression symptoms mediated by shame.



Table 2 shows the fit indices of the relationship between attachment styles and the severity of depression symptoms mediated by self-criticism.



The results of data analysis showed a positive and meaningful relationship between anxious-avoidant attachment styles (r=0.62; p<0.01) and anxious-ambivalent (r=0.51; p<0.01) and the severity of depression symptoms, shame and the severity of depression (r=0.75; p<0.01), and self-criticism and the severity of depression (r=0.45; p<0.01). Also, the anxious-avoidant insecure attachment path and the anxious-ambivalent insecure attachment path showed a significant relationship with the severity of depression symptoms with the mediating role of shame, with standard coefficients of 0.30 and 0.33 at the p<0.05 level, respectively. In addition, the anxious-avoidant insecure attachment path and the anxious-ambivalent insecure attachment path showed a significant relationship with the severity of depression symptoms with the mediating role of self-criticism, with standard coefficients of 0.22 and 0.33 at the p<0.05 level, respectively.

Conclusion
According to the results of the present study, shame and self-criticism play a significant mediating role in the relationship between attachment styles and the severity of depression symptoms. According to the results of the current research and the direct and indirect effect of attachment style on depression symptoms, it is suggested to consider the role of attachment style in the design of programs and interventions related to the treatment of depression. Also, considering the role of shame and self-criticism in the severity of depression symptoms, therapists and counselors are suggested to consider the undeniable role of shame and self-criticism in the treatment of patients with depression and make efforts to change them. Due to the COVID-19 pandemic and the impossibility of random sampling, the sample was selected by the available sampling method and the questionnaires were distributed on virtual social networks. Also, the only tool to collect information in this research was a self-report questionnaire; thus, the subjects responded to the items according to their desire with the possibility of bias, which affects the research results. In line with these limitations, it is suggested that in future studies, in addition to questionnaires, other data collection methods, such as structured or semi-structured interviews should be used, data should be collected face-to-face and random sampling methods should be used as much as possible.

Ethical Considerations

Compliance with ethical guidelines
This study was approved by the Ethics Committee of Iran University of Medical Sciences (Code: IR.IUMS.REC.1400.1004). All ethical principles were considered in this study. All participants were informed about the study methods and their information was kept confidential.

Funding
This study was extracted from tthe MSc thesis of Hosein Mahdavi Rad approved by the Department of Clinical Psychology, School of Behavioral Sciences and Mental Health, Tehran Psychiatric Institute. It received financial support from Iran University of Medical Sciences.

Authors contributions
Conceptualization and investigation: Hosein Mahdavi Rad, Komeil Zahedi Tajrishi; Methodology: Abbas Ramezanifarani; Writing, review, and editing: Hosein Mahdavi Rad; Funding acquisition, and resources: Aliasghar Asgharnejad Farid

Conflicts of interest
The author declared no Conflict of Interest.

Acknowledgements
The authors would like to thank all participants for their cooperation.

 

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