No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Attachment Styles as Predictors of Suicidal Behavior in School Going Adolescents
Abstract
Purpose: Secondary school students face numerous challenges as they balance academic challenges, parental and peer pressures, emotional issues related to puberty changes and adolescence expectations. They also grapple about not knowing what the future holds in terms of career paths. As a result of these challenges, it is common for adolescents to have suicidal thoughts that may lead to suicide attempts.. Suicide is among the leading cause of death in young people and is prevalent worldwide. Suicidal behavior has been associated with attachment security in studies but few of these studies have been done in Kenyan adolescents. This study filled this gap by investigating whether attachment styles predicted suicidal behavior in students attending secondary schools in Nairobi, Kenya. Methodology: The study was correlational in design and was based on the attachment theory. Three hundred and sixty seven randomly selected students completed self-report measures consisting of the Attachment Styles Questionnaire and a Suicidal Behavior Scale. Findings: Results of multiple regression showed that that attachment styles significantly predicted suicidal behavior (F = 36.125, P < .000) and 30% of variance in suicidal behavior was attributed to the attachment styles (R2 = .300). Preoccupied (β = .487, P < .001) and dismissing (β = .122, P = .018) attachment styles predicted suicidal behaviors. Unique Contribution to Theory, Practice and Policy: The contribution to knowledge of this paper is that it provides a theoretical and practical contribution on the importance of attachment styles in predicting suicidal behaviours. The results of the study show that attachment security plays an important role in adolescents’ suicide behavior as insecurely attached students have a higher risk of suicide.Basically, the study contributed to a theoretical enhancement of the current level of knowledge on the existing literature on attachment styles and suicidal behaviours, achieved by testing empirically the adolescent behaviour. Therefore, suicide prevention programs should take into account adolescents’ attachment styles.
... Özellikle çocukluk döneminde psikolojik kötü muameleye maruz kalan ebeveynlerin bağlanma stilleri (kaygılı-kararsız, kaçınan), çocuklarının içselleştirilmiş ve dışsallaştırılmış davranış sorunları geliştirmesine yol açmaktadır (Genç, & Arslan, 2023). Ergenlerde ise güvensiz bağlanma stillerinin davranışsal bağımlılıklar (Salehi et al., 2023), intihar (Mwania et al., 2023, öfke ve saldırganlık (Maalouf et al., 2022 gibi istenmeyen davranış ve tutumlarla anlamlı pozitif ilişkileri olduğu saptanmıştır. Ayrıca üniversite öğrencilerinin güvensiz bağlanmaya sahip olması, psikolojik dayanıklılıklarını (Wang, 2024) ve öz saygılarını (Demircioğlu, & Köse, 2020) düşürmekte, akademik tükenmişlik düzeylerini de artırmaktadır (Marques et al., 2023). ...
This study aimed to adapt the Attachment Styles Scale Short Form to Turkish culture. In order to perform the validity and reliability analyses of the scale, 374 university students were reached by convenience sampling method. Attachment Styles Scale Short Form, Life Satisfaction Scale and Fear of Happiness Scale were used as data collection tools. According to the results of the reliability analyses of the Attachment Styles Scale Short Form, Cronbach's alpha values were .76 for secure attachment, .76 for anxious attachment and .83 for avoidant attachment. Furthermore, the good level of item discrimination index values ensured that the internal validity of the scale was strong. According to the results of CFA conducted to ensure the construct validity of the scale, the model fit values were at an acceptable level. Item factor loadings were found to be between .45 and .83 for secure attachment, .47 and .75 for anxious attachment and .67 and .79 for avoidant attachment. Besides, the results of convergent-divergent validity and measurement invariance analyses diversified and expanded the method of the study. According to the results of criterion validity, secure attachment has negative significant relationships with fear of happiness and positive significant relationships with life satisfaction. Anxious and avoidant attachment had negative significant relationships with life satisfaction and positive significant relationships with fear of happiness. Consequently, Attachment Styles Scale Short Form, which was adapted, can be said to be a valid and reliable measurement tool in the Turkish sample.
Background:
To understand why attachment difficulties predispose individuals to suicidal thinking (suicide ideation) and behaviour, a leading cause of death, we need to explore the role of pertinent psychological mechanisms. Attachment processes are closely linked to the development of mentalisation capabilities, or reflective functioning; the ability to understand and interpret self and other behaviour as an expression of mental states. Interventions designed to improve mentalisation have been associated with a reduction in suicidal behaviour, yet reflective functioning has not been directly investigated in relation to suicidal ideation and behaviour.
Aim:
We aim to further verify the link between adult attachment security and suicidal ideation and examine whether deficits in reflective functioning mediate this relationship.
Methods:
Sixty-seven participants who experienced suicidal ideation within the past 12 months completed self-report measures of adult attachment, current suicidal ideation, reflective functioning, depressive symptomology and hopelessness. Partial correlations, mediation analyses and group comparisons were conducted to explore relationships between these factors.
Results:
Findings did not support a mediational role for reflective functioning in the relationship between attachment security and suicidal ideation. A direct relationship was established between attachment avoidance and suicidal ideation, after controlling for age, gender and depressive symptoms. However, participants with a history of attempted suicide were higher in anxious attachment compared to participants with no such history.
Conclusions:
This study shows that the attachment dimensions of attachment anxiety and avoidance may play differential roles in increasing risk for suicidal attempts versus ideation. This has important implications for tailoring interventions. Those aimed at reducing suicide attempts should focus on reducing attachment anxiety by helping people develop skills in emotional regulation. Interventions aimed at reducing suicidal ideation should focus on reducing attachment avoidance by helping people develop closer relationships with significant others. However, longitudinal and experimental designs are required to verify causality.
Aim:
The present study strives to find an experimental response to these questions: "Is the relationship between neuroticism and suicidal thoughts a simple relationship? Or are there other psychopathological variables such as attachment styles that also affect it?"
Subjects and methods:
In this cross-sectional study, 376 medical students were selected from the three major cities of Iran using multi-stage sampling method from July 2018 to September 2018 and were evaluated using the demographic information questionnaire, Beck Scale for Suicidal Ideation (BSSI), the Revised NEO Personality Inventory (NEO-FFI), and the Adult Attachment Questionnaire (AAQ).
Results:
The overall prevalence of having suicidal thoughts among Iranian medical students was 17%. Moreover, the prevalence of suicide among the female, widowed, separated, and divorced students was higher than others. There was also a significant correlation between suicidal thoughts, gender, relational status, neuroticism, avoidant insecure attachment style, secure attachment style, and anxious/ambivalent insecure attachment style. Additionally, the attachment styles have a moderating role in the relationship between neuroticism and suicidal thoughts.
Conclusion:
Based on the current study, it is concluded that despite the presence of neuroticism in medical students, the attachment styles can reduce the risk of suicide as moderator variables. Hence, attachment styles can be considered a potential treatment goal in the prevention of suicide.
Background:
Suicide accounts for approximately 1.4% of deaths globally and is the 15th leading cause of death overall. There are no reliable data on the epidemiology of completed suicide in rural areas of many developing countries, yet suicide is an indicator of the sustainable development goals on health.
Methods:
Using data collected between 2008 and 2016 from the Kilifi Health and Demographic Surveillance System in rural Kenya, we retrospectively determined the incidence rate and risk factors for completed suicide.
Results:
During the period, 104 people died by suicide, contributing to 0.78% (95% CI = 0.74-1.10) of all deaths. The mean annual incidence rate of suicide was 4.61 (95% CI = 3.80-5.58) per 100,000 person years of observation (pyo). The annual incidence rate for men was higher than that of women (IRR = 3.05, 95% CI = 1.98-4.70, p < 0.001) and it increased with age (IRR = 2.73, 95% CI = 2.30-3.24, p < 0.001). People aged > 64 years had the highest mean incidence rate of 18.58 (95% CI = 11.99-28.80) per 100,000 pyo. Completed suicide was associated with age, being male, and living in a house whose wall is made of scrap material, which is a proxy marker of extreme poverty in this region (OR = 5.5, 95% CI = 4.0-7.0, p = 0.02). Most cases (76%) completed suicide by hanging themselves. Spatial heterogeneity of rates of suicides was observed across the enumeration zones of the KHDSS.
Conclusions:
Suicide is common in this area, but the incidence of completed suicide in rural Kenya may be an underestimate of the true burden. Like in other studies, suicide was associated with older age, being male and poverty, but other medical and neuropsychiatric risk factors should be investigated in future studies.
Background: Self-injurious behaviours (SIB) continue to afflict a significant segment of the clinical and general population, sometimes with fatal consequences. The development of SIB seems to share developmental pathways and mechanisms similar to attachment insecurity. To date, no reviews have explored their relationship.
Methods: A search of publication databases PubMed and PsychInfo from 1969 through April 2018 was conducted. 17 papers met inclusion criteria.
Results: Of the 17 articles identified, 13 reported a positive relationship and 1 reported a negative relationship between attachment insecurity and SIB.
Conclusion: Both attachment anxiety and avoidance seem to play a role in the risk for SIB, possibly through different mechanisms and likely with different impacts on the choice for either self-harm or suicide attempts.
The present study aims to identify psychological predictors of suicidal ideation in university students. We collected a sample of 366 participants, representing a population of 7102 students from a university in northern Portugal (95% CI). Both in the whole sample and in the intra-gender analysis, students with suicidal ideation revealed higher levels of depressive symptoms, loneliness, social anxiety and fears of abandonment, and lower levels of comfort with intimacy and trust in others. Loneliness and depression are significant predictors of suicidal ideation, with an odds ratio of 1.095 and 1.108, respectively. The results were consistent with those found in the literature, and call for more research and implementation of intervention protocols in university populations.
Background:
There is evidence in the literature that adverse early attachment experiences and subsequent attachment insecurities during adulthood would lead to pessimism, low self-esteem, hopelessness and, ultimately, to suicide risk.
Subjects and methods:
This paper aims to review finding on the link between attachment style and suicidality. We searched the literature using the database of the U.S. National Center for Biotechnology Information (NCBI)-MedLine/Pubmed system from January 1992 until December 2016. We started with 1992 because, as far as we know, there are no published studies exploring the relationship between suicide and insecure attachment before that year. We considered reports published on the relationship between attachment style and suicidality. We applied several combinations of the following search terms: attachment, adult attachment style and suicidality, suicide, suicidal ideation, suicidal behavior or suicidal thoughts, and suicide attempts. We selected only English language studies.
Results:
Research suggests that insecure attachment style, mostly anxious, and unresolved traumas are associated with an increased suicide risk. Few studies prospectively examined clinical course, comorbid psychiatric disorders, familial suicidality or other psychosocial factors.
Conclusions:
Further research is needed to highlight the nature of the link between attachment and suicidality. The presence of suicidal ideation and attempts might be a consequence of an underlying interaction between the emergence of psychiatrics symptoms, and the long-lasting presence of inadequate patterns of attachment. Within this context, Separation Anxiety Disorder, categorized in the DSM-5 as a condition not confined to childhood but as an anxiety disorder that may occur through the entire lifespan, might be the a key for the comprehension of this link. From a neurobiological point of view, the role of oxytocin remains unclear.
Insecure attachment and the personality dimensions of self-criticism and dependency have been proposed as risk factors for suicide in adolescents. The present study examines whether self-criticism and dependency mediate the relationship between insecure attachment styles and suicidality. A sample of 340 high-school students (73.2% females), ranging in age from 13 to 20 years (M = 16.47, SD = 1.52), completed the Depressive Experiences Questionnaire for Adolescents, the Depressive Experiences Questionnaire for Adolescents, the Attachment Style Questionnaire, and the Suicidal Behaviors Questionnaire-Revised. The results partially support the expected mediation effects. Self-criticism, but not dependency, mediates the link between insecure attachment (anxiety and avoidance) and suicide-related behaviors. Implications for suicide risk assessment and management are discussed.
This article explores the possibility that romantic love is an attachment process--a biosocial process by which affectional bonds are formed between adult lovers, just as affectional bonds are formed earlier in life between human infants and their parents. Key components of attachment theory, developed by Bowlby, Ainsworth, and others to explain the development of affectional bonds in infancy, were translated into terms appropriate to adult romantic love. The translation centered on the three major styles of attachment in infancy--secure, avoidant, and anxious/ambivalent--and on the notion that continuity of relationship style is due in part to mental models (Bowlby's "inner working models") of self and social life. These models, and hence a person's attachment style, are seen as determined in part by childhood relationships with parents. Two questionnaire studies indicated that relative prevalence of the three attachment styles is roughly the same in adulthood as in infancy, the three kinds of adults differ predictably in the way they experience romantic love, and attachment style is related in theoretically meaningful ways to mental models of self and social relationships and to relationship experiences with parents. Implications for theories of romantic love are discussed, as are measurement problems and other issues related to future tests of the attachment perspective.
Introduction:
The attachment theory aims to understand close relationships in adulthood based on the relationship of a child with the caregiver. Attachment styles are classified as secure, preoccupied, fearful and dismissing, which are the subtypes of insecure attachment style. Insecure attachment is suggested to be related to depression and suicide. In this study, the relationship of suicidal ideation and behavior to attachment style is investigated in patients diagnosed with major depression.
Methods:
Sixty-two patients diagnosed with major depressive disorder according to the DSM-IV-TR criteria were taken and divided into two groups, 31 patients with and 31 patients without a past suicide attempt. Sixty healthy volunteers matched with the patients for age, gender and education and comprised the control group. Sociodemographic and clinical data form, Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Hamilton Depression Rating Scale (HDRS), Experiences in Close Relationships Scale (ECR), Scale of Suicidal Ideation and Suicidal Behavior Scale were applied to the groups.
Results:
In the patients with depression, ECR anxiety and avoidance scores were found to be higher compared with those in the control group. There were no differences in the anxiety and avoidance scores between the patients with and without suicide attempt. The rate of participants who showed secure attachment style in the control group was higher than that of those with depression. In the patients with fearful attachment style, the suicide attempt rate was found to be higher than the other groups. A positively significant relationship was detected between ECR anxiety score and scores of HDRS suicide item, Scale of Suicidal Ideation and Suicidal Behavior Scale.
Conclusion:
Patients with depression were more anxious and more avoidant and showed more insecure attachment. In patients with depression with fearful attachment style, suicide attempts were more common.
Background:
Suicide among adolescents is an important public health problem. One risk factor for youth suicidal behavior that has been underexplored is insecure attachment.
Aims:
To investigate the association between attachment avoidance/anxiety and suicidal behavior in an adolescent sample.
Method:
This study examined attachment insecurity in 40 adolescents who had attempted suicide and 40 never-suicidal demographically matched youths. Adolescents completed self-report measures of attachment style, family alliance, and depressive symptoms.
Results:
Suicide attempters reported significantly higher attachment avoidance and anxiety. Attachment avoidance, but not anxiety, predicted suicide attempt status in a conditional logistic regression analysis that controlled for depressive symptoms and family alliance.
Conclusion:
Future research should determine the relative utility of attachment insecurity in prospectively predicting suicide attempts and investigate potential mediators and moderators of this association. Implications for clinicians working with suicidal youth with insecure attachment styles are discussed.
Background: Identifying risk factors for suicide-related thoughts and behaviors (SRTB) is essential among adolescents in whom SRTB remain a leading cause of death. Although many risk factors have already been identified, influential theories now suggest that the domain of interpersonal relationships may play a critical role in the emergence of SRTB. Because attachment has long been seen as the foundation of interpersonal functioning, we suggest that attachment insecurity warrants attention as a risk factor for SRTB. Aims: This study sought to explore relations between attachment organization and suicidal ideation, suicide attempts, and self-harm in an inpatient adolescent sample, controlling for demographic and psychopathological covariates. Method: We recruited 194 adolescents from an inpatient unit and assigned them to one of four attachment groups (secure, preoccupied, dismissing, or disorganized attachment). Interview and self-report measures were used to create four variables reflecting the presence or absence of suicidal ideation in the last year, single lifetime suicide attempt, multiple lifetime suicide attempts, and lifetime self-harm. Results: Chi-square and regression analyses did not reveal significant relations between attachment organization and SRTB, although findings did confirm previously established relations between psychopathology and SRTB, such that internalizing disorder was associated with increased self-harm, suicide ideation, and suicide attempt and externalizing disorder was associated with increased self-harm. Conclusion: The severity of this sample and methodological differences from previous studies may explain the nonsignificant findings. Nonsignificant findings may indicate that the relation between attachment organization and SRTB is moderated by other factors that should be explored in future research.
The aim of this study was to investigate the relationship between attachment styles and suicide ideation in samples of students in Turkmen Sahra, Iran. Adult Attachment Questionnaire (AAQ) and Beck Suicide Scale Ideation (BSSI) were used in this study. Findings suggest that there are positive statistically significant correlation between adolescents unsecure attachment style with suicide ideation and negative statistically significant correlation between secure attachment style and suicide ideation. Attachment styles are an important predictor of suicide ideation. Interventions designed to reduce suicide ideation may help reduce suicide ideation in adolescents.
This study examined the protective role of self-esteem, social involvement, and secure attachment among homeless youths. These protective factors were examined as they ameliorate risks among 208 homeless youths surveyed in New York City and Toronto. Both mental and physical health indicators were employed in this study, including loneliness, feeling trapped, suicidal ideation, subjective health status, and substance use. Self-esteem emerged as a key protective factor, predicting levels of loneliness, feeling trapped, and suicide ideation, and buffering against the deleterious effect of fearful attachment on loneliness. Findings highlight the role of the self-concept in risk and resilience among homeless youth.
The current study examined relationships between attachment style, parental rearing behaviors, and symptoms of internalizing and externalizing in a large sample of nonreferred adolescents (N = 742). Adolescents completed (a) a single-item measure of attachment style, (b) the child version of the EMBU, a questionnaire measuring perceptions of parental rearing behaviors, and (c) the Youth Self-Report, an index of severity of internalizing and externalizing symptoms. Results showed that attachment style was related to internalizing as well as externalizing symptoms. More specifically, adolescents who classified themselves as avoidantly or ambivalently attached displayed higher levels of internalizing and externalizing symptoms than adolescents who classified themselves as securely attached. Furthermore, perceived parental rearing behaviors were also associated with internalizing and externalizing symptoms. That is, low levels of emotional warmth and high levels of rejection and overprotection were accompanied by high levels of psychopathological symptoms. Finally, both attachment and parental rearing behaviors accounted for a unique proportion of the variance in internalizing symptoms. Yet, when predicting externalizing symptoms, only parental rearing behaviors declared a significant proportion of the variance.
In recent years, attachment theory, which was originally formulated to describe and explain infant-parent emotional bonding, has been applied to the study of adolescent and adult romantic relationships and then to the study of psychological processes, such as interpersonal functioning, emotion regulation, coping with stress, and mental health. In this paper, we offer a brief overview of the attachment perspective on psychopathology. Following a brief account of attachment theory, we go on to explain how the study of individual differences in adult attachment intersects with the study of psychopathology. Specifically, we review research findings showing that attachment insecurity is a major contributor to mental disorders, and that the enhancement of attachment security can facilitate amelioration of psychopathology.
Prior studies examining the relationship between social adjustment and suicidal ideation or behaviour have not examined attachment. This study examines the effect of attachment on the association between current social adjustment and suicide attempt risk.
Attachment, social adjustment, and history of suicide attempt were assessed in patients participating in research on major depressive disorder (N = 524). Suicide attempters and non-attempters were compared with attachment style and social adjustment using hierarchical logistic regression models. The two factor scoring method of the Adult Attachment Scale (secure vs. avoidant) was utilized as each measures unique aspects of attachment.
Anxious attachment (OR = 1.33; 95% CI = 1.016-1.728; P = 0.038) but not overall social adjustment (P = 0.14) was associated with a history of a past suicide attempt when both attachment and social adjustment were assessed in the same model. Among subtypes of social adjustment, work adjustment was associated with past history of suicide attempt (OR = 1.25; 95%CI = 1.019-1.540; P = 0.033). As impairment in work adjustment increased by 1 unit, the likelihood of reporting a suicide attempt increased by approximately 25%. There was no interaction between anxious attachment and work adjustment (P = 0.81).
Anxious attachment and work adjustment warrant further study as potential treatment targets in depressed suicidal patients.
The purpose of this paper is to evaluate the theory and evidence for the links of parent-child attachment with internalizing problems in childhood and adolescence. We address three key questions: (a) how consistent is the evidence that attachment security or insecurity is linked to internalizing symptoms, anxiety, and depression? (b) How consistent is the evidence that specific forms of insecurity are more strongly related to internalizing symptoms, anxiety, and depression than are other forms of insecurity? (c) Are associations with internalizing symptoms, anxiety, and depression consistent for mother-child and father-child attachment? The current findings are consistent with the hypothesis that insecure attachment is associated with the development of internalizing problems. The links between specific insecure attachment patterns and internalizing problems are difficult to evaluate. Father-child and mother-child attachments have a comparable impact, although there are relatively few studies of father-child attachment. No moderators consistently affect these relations. We also propose two models of how attachment insecurity may combine with other factors to lead to anxiety or depression.
To verify the prevalence and associated factors of suicidal ideation among adolescents aged 11 to 15 years.
Cross-sectional population-based study. Adolescents completed a self-report that contained the Children's Depression Inventory. Suicidal ideation was measured according to item 9 of the Children's Depression Inventory. Multivariate logistic regression analysis was applied using a hierarchical model.
1145 adolescents were invited to participate, and 1039 were interviewed (refusal rate: 9.26%). The prevalence of suicidal ideation was 14.1%. Factors associated to suicidal ideation: female gender, current alcohol consumption, use of illicit drugs, symptoms indicating conduct disorders and high Children's Depression Inventory scores for depressive symptoms.
Prevention strategies should focus on female adolescents, especially those sexually active with probable mental health problems and substance use.
The tragedy of suicide in adolescents is experienced by all countries of the world with as many as 200,000 youth and young adults ending their life in the prime of their life because of self-murder each year. Such a tragedy should be unacceptable to clinicians of the world and this article examines factors leading to such death in our youth with recommendations on how to prevent such a worldwide carnage. A major issue in suicide prevention is to screen all children and adolescents for depression and other factors that may trigger suicide in adolescence.
This article addresses the question of how the transition from late childhood to early adolescence influences the organization of attachment. The applicability of a measure for attachment representations in early adolescence, the Attachment Interview for Childhood and Adolescence (AICA), was explored. The AICA is based on the Adult Attachment Interview, which was adapted in minor ways to the early adolescent age-group. It was hypothesized that attachment shows considerable stability from late childhood to early adolescence, although some changes might become manifest especially because distancing mechanisms toward the parents may be activated in this period. Also, stability may be different for the various secure and insecure attachment classifications. Lastly, because gender differences become larger during the transition from childhood to adolescence, attachment differences between boys and girls were explored. The same 31 Italian participants (14 girls, 17 boys) completed the AICA at 10 years and at 14 years of age. The AICA attachment classification distributions did not differ from Adult Attachment Interview (AAI) distributions in comparable but older adolescent or young adult samples. The stability of attachment security was considerable: 74% (k = .48). The stability of the dismissing and secure categories was somewhat higher than the stability of the (small) preoccupied and unresolved categories. The participants tended to show more dismissing strategies across the four years, and to report more rejection from their parents. It was suggested that the activation of dismissing defense mechanisms might be necessary to keep parental figures at some distance in order to achieve a more definite personal identity. Finally, no significant gender differences in attachment emerged during the transition from late childhood to early adolescence.
There is much to digest in a 30 year longitudinal study of the developing person (Sroufe, Egeland, Carlson, & Collins, 2005a). The following paper summarizes some key points regarding the place of infant attachment in the developmental course. It is argued that understanding the role of attachment entails grasping the organizational nature of the attachment construct and embracing a non-linear transactional model. Using such concepts, attachment history was shown in the Minnesota study to be clearly related to the growth of self-reliance, the capacity for emotional regulation, and the emergence and course of social competence, among other things. Moreover, specific patterns of attachment had implications for both normal development and pathology. Even more important than such linkages, however, study of the place of early attachment in later adaptation reveals much about developmental processes underlying both continuity and change. Findings are over-viewed concerning the complex links between attachment and ultimate outcomes and the preservation of early patterns even during times of change. In all, these findings have implications both for future research and for clinical application.
We aimed to (1) determine the extent of the relationship between attachment and suicidal thoughts and behaviors (STB), (2) investigate whether any gender differences exist, and (3) conduct a theoretical synthesis of the included studies. A systematic search of the databases Web of Science; EBSCO Host Medical and Psychology-related resources, which includes CINAHL, Health Source: Nursing/Academic Edition, Psychology and Behavioral Sciences Collection, and PsycINFO; and EMBASE was conducted, with 52 studies meeting the inclusion criteria. While secure attachment acts as protective factor, insecure attachment orientations appear to be vulnerability factors compromising an individual’s capacity to cope with relationship issues, increasing suicide risk. There is insufficient evidence about gender differences. The theoretical synthesis suggests that attachment, interacting with other psychological traits in response to negative life events, acts as a vulnerability or protective factor for STB. Implications for treatment are also discussed.
Insecure attachment styles have consistently been identified as risk factors for adolescent psychopathology and, more specifically, suicidal ideation. However, much less is known about the mechanisms that account for the relationship between attachment styles and severity of suicidal ideation within clinical samples. In the current study, adolescents' expectancies for caregiver availability and responsiveness were coded from transcripts of the Suicide Narrative Interview in a clinical sample of 129 depressed and suicidal adolescents. Results indicated that negative expectancies for caregiver availability in the Suicide Narrative Interview were associated both with attachment insecurity and with the intensity of adolescents' suicidal ideation. The implications of adolescents' expectancies for caregiver availability as targets for clinical intervention are discussed.
Background:
Suicidal ideation, defined as thoughts, ideas and the desire to commit suicide, is becoming a major public health problem among adolescents. Indeed, suicidal ideation is known as a key predictor of future suicide risk.
Objective:
This study aims to determine the prevalence and risk factors associated with suicidal ideation among adolescents in Malaysia.
Methods:
This study used data from the 2013 Malaysian adolescent health risk behavior (MyAHRB) study, a cross-sectional school survey conducted in Peninsular Malaysia among school-going adolescents aged 16-17 years (n=2789). Logistic regression analysis was used to determine the risk factors associated with suicidal ideation among Malaysian adolescents.
Results:
The overall prevalence of suicidal ideation among the adolescents was 6.2%. The prevalence was significantly higher among females than males (7.6% vs. 4.7%; p=0.002). Multivariate regression analysis revealed that adolescents who were females [odds ratio (OR)=2.02; 95% confidence interval (CI): 1.40-2.92] or of Indian ethnicity (OR=2.32; 95% CI: 1.35-3.98) were more likely to report suicidal ideation. Loneliness (OR=2.54; 95% CI: 1.57-4.11), anxiety or worry (OR=2.70; 95% CI: 1.70-4.31), no close friends (OR=2.71; 95% CI: 1.43-5.14), and lack of supportive peers (OR=1.69; 95% CI: 1.15-2.47) were identified as risk factors for adolescents' suicidal ideation. Adolescents who ever had sexual intercourse (OR=2.70; 95% CI: 1.48-4.92) and had been in a physical fight (OR=2.45; 95% CI: 1.62-3.70) were also reported to have higher risks of suicidal ideation.
Conclusion:
This study provides evidence on risk factors associated with suicidal ideation among Malaysian adolescents. Targeted mental health and health risk behavioral interventions for high-risk adolescents are recommended.
Self-harm thoughts and behaviour have been found to be associated with a wide variety of distal and proximal factors; however, few studies have examined how these factors work together to increase the risk of self-harm. A key distal factor is a history of child and family adversity, which attachment theory views as a precursor of attachment insecurities that may increase the risk of later self-harm. A key proximal factor is the desire to escape from overwhelming distress, and Williams (2001) cry of pain model describes a process that could help better understand the reasons behind seeking escape via self-harm. This research investigated whether insecurely attached individuals tend to feel trapped and whether entrapment leads to self-harm thoughts (suicide ideation [Chapter 2] and thoughts about non-suicidal self-injury [Chapter 3]). This research also investigated whether feelings of entrapment among insecurely attached individuals varied as a function of problem-solving (as assessed with the Means-Ends Problem-Solving [MEPS] procedure [Chapter 4] and a diary study [Chapter 5]). The effect of stressful events on subsequent feelings of defeat and entrapment, and the role of attachment, was also examined using an experimental design (Chapter 6).
Self-harm thoughts were common among insecurely attached individuals and among those who felt trapped. Entrapment was reported by insecurely attached individuals, but this feeling did not explain their self-harm thoughts nor did it vary as a function of problem-solving. In response to a laboratory stressor, attachment insecurities seem to exacerbate negative emotions. The findings suggest that assessment of attachment styles could help to identify individuals at risk of self-harm. Moreover, interventions aimed at reducing feelings of entrapment could decrease the risk of self-harm. Still, studies are needed to clarify the direction of the relationships between attachment, entrapment and self-harm, and the psychological mechanisms that might underlie these relationships.
Recent research has suggested that adult attachment style, an orientation to relationships thought to be determined by child-hood relationships with parents and subsequent experiences with important attachment figures, affects the experience of romantic love. Several hypotheses were generated regarding attachment-style differences in affect-regulation strategies (nonintimate sexual behavior, alcohol use, and eating disorders) and attachment experiences and dynamics in couples (e.g., relationship satisfaction, partner-matching on attachment style). These hypotheses were tested using seven theoretically derived attachment scales, which reveal the specific attributes of a person's attachment style. Results indicate substantial associations between attachment dimensions and relationship satisfaction, nonintimate sexuality, eating disorders, and motives for drinking, and replicate previous research showing nonrandom but weak pairing of attachment styles in dating couples.
Ethological attachment theory is a landmark of 20th century social and behavioral sciences theory and research. This new paradigm for understanding primary relationships across the lifespan evolved from John Bowlby's critique of psychoanalytic drive theory and his own clinical observations, supplemented by his knowledge of fields as diverse as primate ethology, control systems theory, and cognitive psychology. By the time he had written the first volume of his classic Attachment and Loss trilogy, Mary D. Salter Ainsworth's naturalistic observations in Uganda and Baltimore, and her theoretical and descriptive insights about maternal care and the secure base phenomenon had become integral to attachment theory. Patterns of Attachment reports the methods and key results of Ainsworth's landmark Baltimore Longitudinal Study. Following upon her naturalistic home observations in Uganda, the Baltimore project yielded a wealth of enduring, benchmark results on the nature of the child's tie to its primary caregiver and the importance of early experience. It also addressed a wide range of conceptual and methodological issues common to many developmental and longitudinal projects, especially issues of age appropriate assessment, quantifying behavior, and comprehending individual differences. In addition, Ainsworth and her students broke new ground, clarifying and defining new concepts, demonstrating the value of the ethological methods and insights about behavior. Today, as we enter the fourth generation of attachment study, we have a rich and growing catalogue of behavioral and narrative approaches to measuring attachment from infancy to adulthood. Each of them has roots in the Strange Situation and the secure base concept presented in Patterns of Attachment. It inclusion in the Psychology Press Classic Editions series reflects Patterns of Attachment's continuing significance and insures its availability to new generations of students, researchers, and clinicians.
Theories of suicidal behavior suggest that the desire to die can arise from disruption of interpersonal relationships. Suicide research has typically studied this from the individual's perspective of the quality/frequency of their social interactions; however, the field of attachment may offer another perspective on understanding an individual's social patterns and suicide risk. This study examined attachment along with broader family functioning (family adaptability and cohesion) among 236 adolescent psychiatric inpatients with (n = 111) and without (n = 125) histories of suicide attempts. On average, adolescents were 14 years of age and Hispanic (69%). Compared to those without suicide attempts, adolescent attempters had lower self-reported maternal and paternal attachment and lower familial adaptability and cohesion. When comparing all three types of attachment simultaneously in the logistic regression model predicting suicide attempt status, paternal attachment was the only significant predictor. Suicide attempt group was also significantly predicted by self-rated Cohesion and Adaptability; neither of the parent ratings of family functioning were significant predictors. These findings are consistent with the predictions of the Interpersonal Theory of Suicide about social functioning and support the efforts to develop attachment-based interventions as a novel route towards suicide prevention.
Context:
Although suicide is the third leading cause of death among US adolescents, little is known about the prevalence, correlates, or treatment of its immediate precursors, adolescent suicidal behaviors (ie, suicide ideation, plans, and attempts).
Objectives:
To estimate the lifetime prevalence of suicidal behaviors among US adolescents and the associations of retrospectively reported, temporally primary DSM-IV disorders with the subsequent onset of suicidal behaviors.
Design:
Dual-frame national sample of adolescents from the National Comorbidity Survey Replication Adolescent Supplement.
Setting:
Face-to-face household interviews with adolescents and questionnaires for parents.
Participants:
A total of 6483 adolescents 13 to 18 years of age and their parents.
Main outcome measures:
Lifetime suicide ideation, plans, and attempts.
Results:
The estimated lifetime prevalences of suicide ideation, plans, and attempts among the respondents are 12.1%, 4.0%, and 4.1%, respectively. The vast majority of adolescents with these behaviors meet lifetime criteria for at least one DSM-IV mental disorder assessed in the survey. Most temporally primary (based on retrospective age-of-onset reports) fear/anger, distress, disruptive behavior, and substance disorders significantly predict elevated odds of subsequent suicidal behaviors in bivariate models. The most consistently significant associations of these disorders are with suicide ideation, although a number of disorders are also predictors of plans and both planned and unplanned attempts among ideators. Most suicidal adolescents (>80%) receive some form of mental health treatment. In most cases (>55%), treatment starts prior to onset of suicidal behaviors but fails to prevent these behaviors from occurring.
Conclusions:
Suicidal behaviors are common among US adolescents, with rates that approach those of adults. The vast majority of youth with suicidal behaviors have preexisting mental disorders. The disorders most powerfully predicting ideation, though, are different from those most powerfully predicting conditional transitions from ideation to plans and attempts. These differences suggest that distinct prediction and prevention strategies are needed for ideation, plans among ideators, planned attempts, and unplanned attempts.
Attachment anxiety is expected to be positively associated with dependence and self-criticism. However, attachment avoidance is expected to be negatively associated with dependence but positively associated with self-criticism. Both dependence and self-criticism are expected to be related to depressive symptoms. Data were analyzed from 424 undergraduate participants at a large Midwestern university, using structural equation modeling. Results indicated that the relation between attachment anxiety and depressive symptoms was fully mediated by dependence and self-criticism, whereas the relation between attachment avoidance and depressive symptoms was partially mediated by dependence and self-criticism. Moreover, through a multiple-group comparison analysis, the results indicated that men with high levels of attachment avoidance are more likely than women to be self-critical.
A central tenet of attachment theory is that a person's attachment pattern in adulthood is a reflection of his or her attachment history—-beginning with the person's earliest attachment relationships. However, the precise way in which early representations might shape adult attachment patterns is ambiguous, and different perspectives on this issue have evolved in the literature. According to the prototype perspective, representations of early experiences are retained over time and continue to play an influential role in attachment behavior throughout the life course. In contrast, the revisionist perspective holds that early representations are subject to modification on the basis of new experiences and therefore may or may not reflect patterns of attachment later in life. In this article, I explore and test mathematical models of each of these theoretical processes on the basis of longitudinal data obtained from meta-analysis. Results indicate that attachment security is moderately stable across the first 19 years of life and that patterns of stability are best accounted for by prototype dynamics.
To study two aspects of interpersonal function - attachment security and social adjustment - in relation to suicide attempt and major depressive episode (MDE) during naturalistic follow-up of up to one year after presentation with MDE.
136 adults who presented with a DSM-IV MDE completed the Adult Attachment Scale and the Social Adjustment Scale-Self Report at study entry. Based on follow-up interviews at three months and one year, we used survival analysis to investigate the relationship of scores on these measures with time to a suicide attempt and time to recurrent MDE.
Less secure/more avoidant attachment predicted increased risk of suicide attempt during the 1-year follow-up (Wald chi(2)=9.14, df=1, p=0.003, HR=1.16, 95% CI=1.05 to 1.27). Poorer social adjustment predicted increased risk of recurrent MDE (Wald chi(2)=6.95, df=1, p=0.008, HR=2.36, 95% CI=1.25 to 4.46), and that in turn increased the risk of a suicide attempt (z=4.19, df=1, p<0.001, HR=17.3, 95% CI=4.6 to 65.5).
Avoidant attachment in the setting of major depressive disorder is a potential therapeutic target to prevent suicidal behavior. Enhancing social adjustment may reduce relapse in major depressive disorder and thereby reduce risk of a suicide attempt. Study limitations include small sample size and use of a self-report attachment scale.
The relationships among adult attachment styles, interpersonal problems, and categories of suicide-related behaviors (i.e., self-harm, suicide attempts, and their co-occurrence) were examined in a predominantly psychiatric sample (N = 406). Both anxious and avoidant attachment styles were associated with interpersonal problems. In turn, specific interpersonal problems differentially mediated the relations between attachment style and type of suicide-related behaviors. These findings suggest the importance of distinguishing between these groups of behaviors in terms of etiological pathways, maintenance processes, and treatment interventions.
Two studies examined attachment style differences in social perception. In Study 1, participants wrote open-ended explanations for hypothetical relationship events and described how they would feel and behave in response to each event. Compared with secure participants, preoccupied participants explained events in more negative ways; they also reported more emotional distress and behaviors that were likely to lead to conflict. Avoidant participants also provided negative explanations, but did not report emotional distress. Path analysis indicated that attachment style differences in behavior were mediated by explanation patterns and emotional distress. Study 2 was designed to replicate Study 1 and test the relative importance of attachment style and relationship quality to predicting each outcome. Results indicated that both variables were significant predictors of explanations, but only attachment style predicted emotional responses. These findings are consistent with the idea that adults with different working models of attachment are predisposed to think, feel, and behave differently in their relationships.
To investigate the risk and protective factors for previous and future suicide attempts among adolescents.
A representative sample of high school students (N = 9,679) in grades 7 through 12 (aged 12-20 years) were followed from 1992 to 1994. Response rate was 97% at initial testing and 80% at follow-up. Measures of psychiatric symptoms (depressed mood, eating problems, conduct problems), substance use, self-worth, pubertal timing, social network, and social integration were included.
A total of 8.2% had ever attempted suicide and 2.7% reported an attempt during the 2-year study period. Logistic regression analysis showed that future attempts were predicted by previous attempt, female gender, young age, perceived early pubertal development (stronger among girls), suicidal ideation, alcohol intoxication, not living with both parents, and poor self-worth.
The importance that the clinician ask about previous suicidal behaviors is underscored. Early pubertal timing (particularly among girls), loss of self-worth, and alcohol intoxication may serve as risk factors for future suicide attempts.
Global suicide rates among adolescents in the 15-19 age group, according to the latest World Health Organization (WHO) Mortality Database, were examined. Data for this age group were available from 90 countries (in some cases areas) out of the 130 WHO member states. The mean suicide rate for this age group, based on data available for the latest year, was 7.4/100,000. Suicide rates were higher in males (10.5) than in females (4.1). This applies in almost all countries. The exceptions are China, Cuba, Ecuador, El Salvador and Sri Lanka, where the female suicide rate was higher than the male. In the 90 countries (areas) studied, suicide was the fourth leading cause of death among young males and the third for young females. Of the 132,423 deaths of young people in the 90 countries, suicide accounted for 9.1%. The trend of suicide rates from 26 countries (areas) with data available during the period 1965-1999 was also studied. A rising trend of suicide in young males was observed. This was particularly marked in the years before 1980 and in countries outside Europe. The WHO database is the largest of its kind and, indeed, the only information source that can currently be used for analysis of global mortality due to suicide. Methodological limitations are discussed.
The Structured Clinical Interview for DSM-III-R (SCID-I) and the Adult Attachment Interview (AAI) were administered to 60 women participating in a study (n=226) of mother-child interaction. These women were not referred to the study for psychiatric care. The 60 women interviewed with the AAI were selected from the first 190 women who completed the SCID-I, so that 30 received a diagnosis and 30 did not. Analyses indicated that psychopathology diagnoses were associated significantly with mental representations of attachment classified in the AAI. The non-autonomous groups had increased likelihood of SCID diagnosis, compared to the autonomous group. While 32% of women with autonomous AAI transcripts received SCID diagnoses, 63% of women with Dismissing, 100% of woman with Preoccupied, and 65% of women with Unresolved transcripts received diagnoses. Secondary analyses indicated that Dismissing classifications were associated with Axis I diagnoses and Preoccupied classifications with affective disorders. Of note was that among women with Unresolved classifications, underlying secure attachment was associated with low risk of psychopathology, while underlying anxious attachment was associated with elevated risk of diagnosis. These findings support the premise from attachment theory that early relationships affect patterns of interpersonal expectations and behavior and affect regulation.
The relation of attachment security to multiple domains of psychosocial functioning was examined in a community sample of 167 early adolescents. Security of attachment organization, assessed using the Adult Attachment Interview, was linked to success in establishing autonomy while maintaining a sense of relatedness both with fathers and with peers, even after accounting for predictions from qualities of the mother-teen relationship. Growth curve analyses revealed links of insecurity to increasing patterns of externalizing behavior and higher and stable patterns of depressive symptoms across adolescence. Implications for a developing theory of the connections of the attachment system to multiple domains of functioning in adolescence are discussed.
The tragedy of suicide in children and adolescents is considered a national and global phenomenon. There are approximately 900,000 suicides in the world each year, including as many as 200,000 adolescents and young adults. Suicide rates vary from country to country depending on local factors, including reporting methods. Causes of suicide include depression; abuse; loss of friends (including boyfriend or girlfriend); academic failure; social isolation; and substance abuse. The link between use of antidepressants and suicidal ideation is discussed, and concepts of management are also considered.
Attachment styles among young adults: A test of a four-category model
- K Bartholomew
- L M Horowitz
Bartholomew, K., & Horowitz, L. M. (1991). Attachment styles among young adults: A test
of a four-category model. Journal of Personality and Social Psychology, 61(2), 226-244. https://doi.org/10.1037//0022-3514.61.2.226
Self/other perception mediates between personality and suicidal ideation in young adults
- E Fino
- P Iliceto
- U Sabatello
- F Petrucci
- G Candilera
Fino, E., Iliceto, P., Sabatello, U., Petrucci, F., & Candilera, G. (2014). Self/other perception
mediates between personality and suicidal ideation in young adults. The European
Journal of Psychiatry, 28(2), 104-113.
https://doi.org/10.4321/s021361632014000200004
Hopelessness , impulsivity and attachment as possible predictors of nonsuicidal self-injury and suicide ideations in Croatian college students
- I Kirša
- J Juretić
- I Živčić-Bećirević
Kirša, I., Juretić, J., & Živčić-bećirević, I. (2016). Hopelessness, impulsivity and attachment
as possible predictors of nonsuicidal self-injury and suicide ideations in Croatian
college students. Addiction and Drug Sensitization, 1(1), 41-47.
Prevalence of suicidal behavior among adolescents with depressive disorders and posttraumatic stress in informal settlements of Nairobi
- P Mugambi
- A Munene
- M Mogute
Mugambi, P., Munene, A., & Mogute, M. (2020). Prevalence of suicidal behavior among
adolescents with depressive disorders and posttraumatic stress in informal settlements
of Nairobi, Kenya. African Journal of Clinical Psychology, 03(01), 1-25
The Relationship between K.C.S.E Examination Scores and Symptoms of Anxiety, Depression and Suicide Ideation among Adolescents in
- J M Ngondi
Ngondi, J. M. (2016). The Relationship between K.C.S.E Examination Scores and Symptoms
of Anxiety, Depression and Suicide Ideation among Adolescents in Nairobi, Kenya.
[Unpublished Masters Thesis, United States International University].
Prevalence and correlates of suicidal ideation among students in sub-Saharan Africa
- J B Palmier
Palmier, J. B. (2011). Prevalence and correlates of suicidal ideation among students in sub-Saharan Africa. Unpublished Masters Thesis, Georgia State University
Ontwikkeling en evaluatie van de Hechtingstijllijst
- J P L M Van Oudenhoven
- J Hofstra
- W Bakker
Van Oudenhoven, J. P. L. M., Hofstra, J., & Bakker, W. (2003). Ontwikkeling en evaluatie
van de Hechtingstijllijst [Development and evaluation of the
Attachment Styles
Suicide [Fact sheet no
World Health Organization. (2014). Suicide [Fact sheet no. 398]. Available from
http://www.who.int/mediacentre/factsheets/fs398/en/01912