Adolescent attachment security, family functioning, and suicide attempts

Abstract

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 3 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.

Preliminary Examination of the Interpersonal Psychological Theory of Suicide in an Adolescent Clinical Sample

“…However, few studies have utilized clinical samples (Joiner et al 2009) or specifically adolescent clinical samples (exceptions are Czyz et al 2014;Klonsky et al 2013;Liu et al 2014;Nock et al 2006;Prinstein et al 2008;Sheftall et al 2013). Relative to studies on acquired capability for suicide, there are fewer studies focusing on thwarted belongingness and perceived burdensomeness with adolescent clinical samples in the IPTS literature.…”

“…Longitudinally, NSSI and history of suicide attempt (both indicators of acquired capability for suicide) demonstrated associations with post-discharge suicide attempt in an adolescent psychiatric inpatient sample . Indicators of thwarted belongingness such as paternal attachment, family cohesion, and family adaptability distinguished between those with and without lifetime history of suicide attempt in a sample of adolescents with a history of inpatient psychiatric care (Sheftall et al 2013).…”

Adult Attachment Style and Suicidality

“…More recently, Sheftall et al (2013) examined the attachment patterns along with broader family functioning (family adaptability and cohesion) in a sample of 236 adolescent psychiatric inpatients with (n=111) and without (n=125) history of suicide attempts. Compared to those without suicide attempts, adolescent attempters had lower levels of self-reported maternal and paternal attachment, and lower familial adaptability and cohesion.…”

Family Functioning and Parental Invalidation of Depressed Adolescents with Borderline Personality Disorder Traits

“…On the other hand, research suggests that less flexible and cohesive families may not be able to adequately meet the adolescent's demands and needs for change within the family system, which may contribute to problematic behaviour [22]. For example, it has been found that adolescent perceptions of cohesion and flexibility in the family are significant predictors of suicide attempts [23]. Childhood depression has also been associated with disengaged family systems, marked by inadequate closeness and support [24].…”