Associations between insecure attachment styles to parents and suicidal ideation in adolescents with depression

Abstract Objective: Suicidal ideation and depressive symptoms are often interrelated in clinical settings. Insecure attachment may be a risk factor for suicidal ideation in depressed adolescents. To our knowledge, this study is the first to examine the association between self-reported insecure attachment styles to both parents and suicidal ideation in a clinical sample of adolescents with depression. Methods: Fifty clinically depressed adolescents (13-17 years, 84% girls) completed self-reported measures of suicidal ideation, depressive symptoms, and attachment style to parents. Results: There was a statistically significant bivariate association between higher levels of attachment anxiety in relation to mothers and fathers and higher levels of suicidal ideation. When attachments to both parents were included in the same multivariate model, only attachment anxiety to the mother was significantly associated with the level of suicidal ideation. Self-reported depressive symptoms remained significantly associated with the level of suicidal ideation in all analyses. Younger adolescents with attachment anxiety reported higher levels of suicidal ideation than older adolescents. Conclusion: Conclusions about directionality and causality of associations between insecure attachment and suicidal ideation are limited due to the cross-sectional design. Our findings suggest that attachment anxiety in relation to the mother and father is associated with increased levels of suicidal ideation. Implication of these findings for treatment selection is discussed.

[1]  L. Mehlum,et al.  Effectiveness of attachment-based family therapy compared to treatment as usual for depressed adolescents in community mental health clinics , 2020, Child and Adolescent Psychiatry and Mental Health.

[2]  R. Gallop,et al.  A Randomized Controlled Trial: Attachment-Based Family and Nondirective Supportive Treatments for Youth Who Are Suicidal. , 2019, Journal of the American Academy of Child and Adolescent Psychiatry.

[3]  Evan M. Kleiman,et al.  Annual Research Review: Suicide among youth – epidemiology, (potential) etiology, and treatment , 2018, Journal of child psychology and psychiatry, and allied disciplines.

[4]  P. Shaver,et al.  Attachment orientations and emotion regulation. , 2018, Current opinion in psychology.

[5]  M. Bauer,et al.  Suicidal Ideation vs. Suicide Attempts: Clinical and Psychosocial Profile Differences Among Depressed Patients A Study on Personality Traits, Psychopathological Variables, and Sociodemographic Factors in 228 Patients , 2017, The Journal of nervous and mental disease.

[6]  A. Vander Stoep,et al.  Suicidal ideation in early to middle adolescence: sex-specific trajectories and predictors. , 2016, Journal of child psychology and psychiatry, and allied disciplines.

[7]  C. Sharp,et al.  Preliminary evidence that thoughts of thwarted belongingness mediate the relations between level of attachment insecurity and depression and suicide-related thoughts in inpatient adolescents , 2014 .

[8]  A. Elklit,et al.  A validation of the Experiences in Close Relationships-Relationship Structures scale (ECR-RS) in adolescents , 2014, Attachment & human development.

[9]  D. Dougherty,et al.  Adolescent attachment security, family functioning, and suicide attempts , 2013, Attachment & human development.

[10]  Matthew K Nock,et al.  Prevalence, correlates, and treatment of lifetime suicidal behavior among adolescents: results from the National Comorbidity Survey Replication Adolescent Supplement. , 2013, JAMA psychiatry.

[11]  S. Blatt,et al.  Recollections of Parental Rejection, Self-Criticism and Depression in Suicidality , 2013, Archives of suicide research : official journal of the International Academy for Suicide Research.

[12]  Jennifer A. Silvers,et al.  Age-related differences in emotional reactivity, regulation, and rejection sensitivity in adolescence. , 2012, Emotion.

[13]  Kelly C. Cukrowicz,et al.  Thwarted belongingness and perceived burdensomeness: construct validity and psychometric properties of the Interpersonal Needs Questionnaire. , 2012, Psychological assessment.

[14]  M. Mikulincer,et al.  An attachment perspective on psychopathology , 2012, World psychiatry : official journal of the World Psychiatric Association.

[15]  R. C. Fraley,et al.  The Experiences in Close Relationships-Relationship Structures questionnaire: a method for assessing attachment orientations across relationships. , 2011, Psychological assessment.

[16]  L. Mehlum,et al.  Suicidality among Norwegian youth: Review of research on risk factors and interventions , 2010, Nordic journal of psychiatry.

[17]  R. Gallop,et al.  Attachment-based family therapy for adolescents with suicidal ideation: a randomized controlled trial. , 2010, Journal of the American Academy of Child and Adolescent Psychiatry.

[18]  K. Kerns,et al.  Parent–child attachment and internalizing symptoms in childhood and adolescence: A review of empirical findings and future directions , 2010, Development and Psychopathology.

[19]  J. Bridge,et al.  Epidemiology of youth suicide and suicidal behavior , 2009, Current opinion in pediatrics.

[20]  N. Sampson,et al.  Mental Disorders, Comorbidity and Suicidal Behavior: Results from the National Comorbidity Survey Replication , 2009, Molecular Psychiatry.

[21]  Matthew K Nock,et al.  Suicide and suicidal behavior. , 2008, Epidemiologic reviews.

[22]  J. Olin,et al.  The GRID-HAMD: standardization of the Hamilton Depression Rating Scale , 2008, International clinical psychopharmacology.

[23]  C. Dowrick,et al.  The prevalence of suicidal ideation in the general population: results from the Outcome of Depression International Network (ODIN) study , 2008, Social Psychiatry and Psychiatric Epidemiology.

[24]  David R. Williams,et al.  Cross-national prevalence and risk factors for suicidal ideation, plans and attempts , 2008, British Journal of Psychiatry.

[25]  F. Verhulst,et al.  Long-term associations of childhood suicide ideation. , 2007, Journal of the American Academy of Child and Adolescent Psychiatry.

[26]  P. Shaver,et al.  Attachment in Adulthood: Structure, Dynamics, and Change , 2007 .

[27]  Matthew K Nock,et al.  Prevalence of and risk factors for suicide attempts versus suicide gestures: analysis of the National Comorbidity Survey. , 2006, Journal of abnormal psychology.

[28]  G. Fitzmaurice,et al.  Adolescent suicidal ideation as predictive of psychopathology, suicidal behavior, and compromised functioning at age 30. , 2006, The American journal of psychiatry.

[29]  D. Brent,et al.  Adolescent suicide and suicidal behavior. , 2006, Journal of child psychology and psychiatry, and allied disciplines.

[30]  John C. Wright,et al.  Attachment and the Body in Suicidal Adolescents: A Pilot Study , 2005 .

[31]  D. Wasserman,et al.  Suicide attempts, plans, and ideation in culturally diverse sites: the WHO SUPRE-MISS community survey , 2005, Psychological Medicine.

[32]  A. Beautrais,et al.  Suicidal behaviour in adolescence and subsequent mental health outcomes in young adulthood , 2005, Psychological Medicine.

[33]  Karen Rodham,et al.  Factors associated with suicidal phenomena in adolescents: a systematic review of population-based studies. , 2004, Clinical psychology review.

[34]  B. Birmaher,et al.  Suicidality and its relationship to treatment outcome in depressed adolescents. , 2004, Suicide & life-threatening behavior.

[35]  M. Lamb,et al.  Fathers’ influences on children’s development: The evidence from two-parent families , 2003 .

[36]  P. Shaver,et al.  Attachment Theory and Affect Regulation: The Dynamics, Development, and Cognitive Consequences of Attachment-Related Strategies , 2003 .

[37]  Suzanne Wilson,et al.  Continuity, stability, and change in daily emotional experience across adolescence. , 2002, Child development.

[38]  M. Oquendo,et al.  Protective factors against suicidal acts in major depression: reasons for living. , 2000, The American journal of psychiatry.

[39]  Michael E. Lamb,et al.  The History of Research on Father Involvement , 2000 .

[40]  J. Overholser,et al.  Suicidal Ideation in Adolescent Psychiatric Inpatients as Associated With Depression and Attachment Relationships , 2000, Journal of clinical child psychology.

[41]  Kelly A. Brennan,et al.  An item response theory analysis of self-report measures of adult attachment. , 2000, Journal of personality and social psychology.

[42]  D. Fergusson,et al.  Risk factors and life processes associated with the onset of suicidal behaviour during adolescence and early adulthood , 2000, Psychological Medicine.

[43]  M. West,et al.  Relationship between Attachment-Felt Security and History of Suicidal Behaviours in Clinical Adolescents , 1999, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[44]  M. Moretti,et al.  Suicidal ideation in an adolescent clinical sample: attachment patterns and clinical implications. , 1998, Journal of adolescence.

[45]  K. Jackson,et al.  Incidence and predictors of suicidal behaviors in a longitudinal sample of young adolescents. , 1998, Journal of the American Academy of Child and Adolescent Psychiatry.

[46]  P. Shaver,et al.  Attachment styles, emotion regulation, and adjustment in adolescence. , 1998, Journal of personality and social psychology.

[47]  N. Ryan,et al.  Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL): initial reliability and validity data. , 1997, Journal of the American Academy of Child and Adolescent Psychiatry.

[48]  P W O'Carroll,et al.  Beyond the Tower of Babel: a nomenclature for suicidology. , 1996, Suicide & life-threatening behavior.

[49]  A. Sheldon-Keller,et al.  Attachment organization and history of suicidal behavior in clinical adolescents. , 1996, Journal of consulting and clinical psychology.

[50]  D. Fergusson,et al.  Suicide attempts and suicidal ideation in a birth cohort of 16-year-old New Zealanders. , 1995, Journal of the American Academy of Child and Adolescent Psychiatry.

[51]  Meredith Gunlicks-Stoessel,et al.  Interpersonal Psychotherapy for Depressed Adolescents , 2021, Dulcan’s Textbook of Child and Adolescent Psychiatry.

[52]  K. Bartholomew,et al.  Attachment styles among young adults: a test of a four-category model. , 1991, Journal of personality and social psychology.

[53]  S. Schoppe‐Sullivan,et al.  Insecure attachment and suicidal behavior in adolescents. , 2014, Crisis.

[54]  E. Czyz,et al.  Suicidal Ideation of Psychiatrically Hospitalized Adolescents has One-Year Predictive Validity for Suicide Attempts in Girls Only , 2013, Journal of Abnormal Child Psychology.

[55]  P. Shaver,et al.  Adult attachment strategies and the regulation of emotion , 2007 .

[56]  L. Hankoff.  Why People Die by Suicide , 2006 .

[57]  T. Achenbach.  Manual for ASEBA School-Age Forms & Profiles , 2001 .

[58]  W. Berman,et al.  Attachment in adults: Clinical and developmental perspectives. , 1994 .

[59]  K. Adam.  Suicidal behavior and attachment: A developmental model. , 1994 .

[60]  M. De Jong,et al.  Attachment, individuation, and risk of suicide in late adolescence. , 1992, Journal of youth and adolescence.