The mediating role of attachment and mentalising in the relationship between childhood maltreatment, self-harm and suicidality

Stagaki, Maria; Nolte, Tobias; Feigenbaum, Janet; King‐Casas, Brooks; Lohrenz, Terry; Fonagy, Peter; Montague, P. Read

doi:10.1016/j.chiabu.2022.105576

Cited by 33 publications

(18 citation statements)

References 134 publications

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“…These differences could be at least in part due to sample size (relatively small versus relatively large), characteristics (clinical versus community sample), and assessment (current versus lifetime suicidal ideation). However, our results are consistent with previous studies that showed that both insecure attachment and RF failures are positively associated with suicide risk (Stagaki et al, 2022). Although further studies are needed, our findings suggest that some individuals at risk of suicidal ideation had a history of TLE, high attachment anxiety, and difficulties in mentalization.…”

Section: Discussionsupporting

confidence: 91%

“…Consistent with this theoretical framework, previous studies found positive associations between insecure attachment and increased risk of suicide, as well as a negative association between secure attachment and suicidal ideation and behaviors (Miniati et al, 2017;Green et al, 2020;Zortea et al, 2021). Moreover, adult attachment was found to mediate the relationship between childhood traumatic experiences and suicidality (Ihme et al, 2022;Stagaki et al, 2022). However, less is known about the relationship between TLE, adult attachment and suicidal ideation.…”

Section: Mediating Role Of Adult Attachmentmentioning

confidence: 53%

“…Mentalization, operationalized as reflective functioning (RF), represents a novel and emerging research field in the contest of suicide risk (Green et al, 2021;Stagaki et al, 2022). RF refers to the ability to understand one's own behavior and the behavior of others in terms of mental states (e.g., feelings, desires, and attitudes).…”

Section: Multiple Mediating Role Of Adult Attachment and Reflective F...mentioning

confidence: 99%

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Insecure adult attachment and reflective functioning as mechanisms of the relationship between traumatic life events and suicidal ideation: A path analysis

Musetti

Pingani²,

Zagaria³

et al. 2022

Front. Psychol.

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The relationship between traumatic life events and increased suicide risk has been well reported in literature. However, the complex nature of suicidality phenomena still hinders our ability to comprehend the mediation mechanism underlying this association. In this study, we examined the mediating role of adult attachment and reflective functioning in the relationship between traumatic life events and suicidal ideation. Nine hundred and fifty Italian adults completed an online survey evaluating traumatic life events, adult attachment, reflective functioning and suicidal ideation. The path analysis showed that the positive relationship between traumatic life events and suicidal ideation was partially mediated by attachment anxiety and reflective functioning. From a clinical point of view, these results support the relevance of evaluating and improving patients’ ability to mentalize as a part of psychotherapeutic intervention aimed at reducing suicidality in people with a history of traumatic experiences and attachment anxiety.

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Section: Discussionsupporting

confidence: 91%

Section: Mediating Role Of Adult Attachmentmentioning

confidence: 53%

Section: Multiple Mediating Role Of Adult Attachment and Reflective F...mentioning

confidence: 99%

See 1 more Smart Citation

Insecure adult attachment and reflective functioning as mechanisms of the relationship between traumatic life events and suicidal ideation: A path analysis

Musetti

Pingani²,

Zagaria³

et al. 2022

Front. Psychol.

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“…Mentalization originates from attachment relationships with familiar caregivers [ 59 ], which are built on early emotional interactions between the infant and the adult. A failure of emotional mirroring in the dyad may be followed by difficulty in mentalizing correctly, which may lead to maladaptive behaviors, such as self-harm [ 27 , 60 ]. Evidence suggests that attachment style affects the development of mentalization in both familiar [ 61 ] and extrafamilial settings (e.g., at school) [ 62 , 63 ].…”

Section: Discussionmentioning

confidence: 99%

The Risk-Taking and Self-Harm Inventory for Adolescents: Validation of the Italian Version (RTSHIA-I)

Valle

Cavalli

Miraglia

et al. 2023

Behavioral Sciences

Self Cite

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The aim of the present paper is to establish the factorial validity and reliability of the Risk-Taking and Self-Harm Inventory for Adolescents (RTSHIA), proposed by Vrouva and colleagues in 2010, in an Italian sample. The RTSHIA measures both Risk-Taking and Self-Harm behavior in adolescents. We administered the scale to a total of 1292 Italian adolescents from 9th to 12th grade; to verify the validity of the scale, we also assessed emotion regulation and psychopathological traits. The exploratory factor analysis (EFA) (N = 638) and the confirmatory factor analysis (CFA) (N = 660) confirmed the original two-factor structure of the RTSHIA (Risk-Taking and Self-Harm). The only differences in the Italian version of the RTSHIA (RTSHIA-I) were that one item was moved from the original Risk-Taking factor to the Italian Self-Harm factor, and another item that was not included in the original RTSHIA is now part of the Risk-Taking factor in the Italian version. The reliability of the RTSHIA-I is also confirmed, and both factors correlate with emotion regulation and externalizing/internalizing traits. Our results suggest that the RTSHIA-I is a useful tool for assessing Risk-Taking and Self-Harm behaviors in Italian adolescents, and the correlational patterns indicate that these behaviors may be related to difficulties in mentalization skills.

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“…However, after considering the potential multicollinearity among five subtypes of childhood maltreatment, our results indicate that emotional abuse might have the most harmful effect on suicide behaviours. The difference may be related to the cultural and social background between China and other countries (Stoltenborgh et al, 2011). Traditional Chinese culture, such as Confucian values, strongly inhibits the disclosure of sexual abuse experiences, especially for adolescents (Ji et al, 2013).…”

Section: Discussionmentioning

confidence: 99%

Specific effects of five subtypes of childhood maltreatment on suicide behaviours in Chinese adolescents: the moderating effect of sex and residence

Peng

Cheng

Rong

et al. 2023

Epidemiol Psychiatr Sci

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Aims Although childhood maltreatment has been widely supported to be a robust predictor of suicide behaviours, the effects of different childhood maltreatment subtypes remain controversial and inconclusive. Moreover, whether the effects differ by sex in urban and rural adolescents is still unknown. This study aimed to quantify the associations between five subtypes of childhood maltreatment and different suicide behaviour involvement. Methods A multistage cluster sampling method was adopted from April to December 2021 for adolescents aged 12 to 18 across five representative provinces of China. The Childhood Trauma Questionnaire-Short Form was used to measure childhood maltreatment subtypes. Suicide behaviour involvement was classified as none group, suicide ideator, suicide planner and suicide attempter. Confounding variables include demographic characteristics, smoking, drinking alcohol, depression and anxiety. Results Among a total of 18,980 adolescents, 2021 (10.6%) were suicide ideator, 1595 (8.4%) were suicide planner and 1014 (5.3%) were suicide attempter. Rural females had the highest proportion of suicide ideator (13.8%) and suicide planner (11.5%). Multinomial logistic regression analysis indicated that five childhood maltreatment subtypes were independently associated with suicide behaviours, except for associations between sexual abuse and suicide ideator as well as suicide planner (p > 0.05). Moreover, these associations differ by sex and residence. After adjusted for interactions of different subtypes, structural equation model indicated that the direct effects of childhood maltreatment subtypes on suicide behaviours from high to low were emotional abuse (β = 0.363, p < 0.001), physical abuse (β = 0.100, p < 0.001) and sexual abuse (β = 0.033, p = 0.003), while the effects of physical neglect and emotional neglect were not significant (p > 0.05). Conclusions Five subtypes of childhood maltreatment have specific and non-equivalence associations with suicide behaviours. Emotional abuse may have the strongest effect, and sexual abuse have an acute effect on suicide behaviours. Suicide prevention programs for Chinese adolescents could focus on those who experienced emotional, physical and sexual abuse. Furthermore, strategies should be tailored by sex and residence, and rural females deserve more attention.

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The mediating role of attachment and mentalising in the relationship between childhood maltreatment, self-harm and suicidality

Cited by 33 publications

References 134 publications

Insecure adult attachment and reflective functioning as mechanisms of the relationship between traumatic life events and suicidal ideation: A path analysis

Insecure adult attachment and reflective functioning as mechanisms of the relationship between traumatic life events and suicidal ideation: A path analysis

The Risk-Taking and Self-Harm Inventory for Adolescents: Validation of the Italian Version (RTSHIA-I)

Specific effects of five subtypes of childhood maltreatment on suicide behaviours in Chinese adolescents: the moderating effect of sex and residence

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