An investigation of whether emotion regulation mediates the relationship between attachment insecurity and suicidal ideation and behaviour

The Mediating Role of Emotional Dysregulation in the Relationship Between Anxious Attachment and Suicidal Behavior in Children Admitted to an Emergency Department

Child suicide rates and emergency department visits due to suicidal thoughts and behaviors (STB) are rising at an alarming rate globally. In the United States, suicide deaths among children aged 5-12 increased by 195% from 1990 to 2020, highlighting an urgent need for greater understanding of the underlying risk factors. Although poor parent-child relationships and child emotional dysregulation have been identified as correlates of STB, the precise mechanisms linking these factors remain insufficiently explored. This study aimed to examine the associations between insecure attachment styles (anxious and avoidant), emotional dysregulation and STB in children. Grounded in attachment theory, it was hypothesized that emotional dysregulation would mediate the relationship between insecure attachment and STB. A sample of 111 children aged 7-12, admitted to a pediatric emergency department (ED) for STB, completed self-report measures assessing attachment styles (ECR-RC), emotional dysregulation (DERS), and STB (C-SSRS). Cross-sectional mediation regression analyses revealed that emotional dysregulation significantly mediated the relationship between anxious attachment and suicidal behaviors. However, no mediation effect was found between avoidant attachment and suicidal thoughts. These findings suggest that children with anxious attachment styles are particularly vulnerable to experiencing emotional dysregulation associated with suicidal behaviors. The absence of a similar mediation effect for avoidant attachment and suicidal thoughts may point to distinct psychological pathways underlying different forms of STB. These results highlight the potential importance of targeting the parent-child relationship to enhance children's emotional regulation abilities, which may, in turn, reduce the risk of suicidal behaviors.

The relationship among attachment styles, interpersonal needs, and suicidal ideation in patients with psychiatric disorders

Suicide is a major public health concern; therefore, numerous factors have been investigated for their role in increasing suicide risk. Distal factors, such as attachment style, and proximal factors, like unmet interpersonal needs, interact with each other and may influence suicidal ideation. Understanding this interplay is crucial for developing effective interventions for suicide prevention. The present study aimed to investigate the association between attachment and interpersonal needs in suicidal ideation. For this study, we administered the Attachment Style Questionnaire and the Interpersonal Needs Questionnaire-15, and suicide risk was assessed using the Columbia-Suicide Severity Rating Scale. We collected data from 181 psychiatric inpatients at the Sant'Andrea Hospital in Rome. The results indicated that suicidal ideation was negatively and significantly associated with ASQ Confidence and positively associated with ASQ's Need for Approval and Discomfort with Closeness and INQ's perceived burdensomeness. The mediation model showed that perceived burdensomeness mediated the relationship between secure attachment style and suicidal ideation. The results have also shown significant associations among suicidal ideation, some attachment styles, and interpersonal needs. Secure attachment showed a potential protective role in suicidal ideation through lower levels of perceived burdensomeness, highlighting the importance of a careful evaluation of the patient's individual experiences and characteristics that can guide the adaptation of therapeutic goals and strategies. Interventions that promote functional interpersonal beliefs, as well as interventions oriented to limit the negative effects of disruptive models of attachment, may contribute to reconstructing trust towards others, reducing perceived burden, and preventing suicide risk.

Suicidality and self-compassion in patients with major depressive disorder: the mediating role of the avoidant attachment type

Despite recent studies establishing self-compassion and secure attachment to be vital protective factors against suicidality, the role of attachment as a psychological mechanism that may mediate the relationship between self-compassion and suicidality has not been investigated to date. This study aims to address this gap by investigating whether attachment styles, specifically avoidant attachment, mediate the link between self-compassion and suicidality in patients with major depressive disorder (MDD). 273 adult patients with MDD completed the Suicidal Behaviors Questionnaire-Revised (SBQ-R), the Beck Depression Inventory (BDI-II), the Experiences in Close Relationships Scale (ECRS), and the Self-Compassion Scale (SCS) along with sociodemographic and clinical questions. Statistical analyses included correlation analysis and Mann- Whitney U tests to examine the relationships and possible differences between the non-suicidal group and the suicidal group of patients in terms of attachment style, self-compassion, and self-destructive behaviors. A mediation analysis to assess the role of attachment avoidance in the relationship between selfcompassion and suicidality was also conducted. Both attachment anxiety and avoidance were positively associated with suicidality and depression and negatively with self-compassion. The patients with increased suicidality differed significantly in the levels of depression, self-compassion, and attachment compared to those who were non-suicidal. The protective mechanism of self-compassion against suicidality was mediated by attachment avoidance. Research findings highlight the need for considering attachment-related issues to understand suicidality and tailor interventions in the field of suicide prevention and treatment while they gauge treatment priorities in working with depressed patients with suicidal thoughts and behaviors.

Emotional regulation and suicidal ideation-Mediating roles of perceived social support and avoidant coping

Introduction

Recent research has uncovered a wide prevalence variation of suicidal ideation in university students ranging from 9.7% to 58.3%. India has witnessed a 4.5% increase in suicide rates in the year 2021. The interplay between cognitive reappraisal of a stressful situation, suppression of emotional expression, and coping strategies for suicidal ideation of Indian University students is yet to be explored. We aim to determine whether suicidal ideation would differ across different types of family units, and to predict the extent to which perceived social support and avoidant coping could mediate the relation between emotion regulation processes and suicidal ideation.

Methods

Two hundred randomly selected University students (Mean age = 19.9, SD = 1.43) participated. Kruskal-Wallis, Pearson's product-moment correlation, and GLM mediation model were computed.

Results and discussion

Lifetime suicidal ideation significantly differed between those who stay alone and those who live in a nuclear family (p < 0.01), and also those who stay in a joint family (p < 0.05). Cognitive reappraisal predicted a reduction in suicidal ideation mediated by perceived social support (B = -0.06, p < 0.05) and avoidant coping (B = -0.07, p < 0.05). Whereas, expressive suppression predicted induced levels of suicidal ideation through perceived social support (B = 0.05, p < 0.05), and avoidant coping (B = 0.06, p < 0.05) as mediators.

Conclusion

Though our sample size restricts the generalization, our findings implied the importance of regular psychological consultation regarding the efficacy of the said coping processes in dealing with suicidal ideation.

The Role of Emotion Dysregulation in Understanding Suicide Risk: A Systematic Review of the Literature

Suicide prevention represents a global imperative, and efforts to identify potential risk factors are intensifying. Among these, emotional regulation abilities represent a transdiagnostic component that may have an impactful influence on suicidal ideation and behavior. Therefore, the present systematic review aimed to investigate the association between emotion dysregulation and suicidal ideation and/or behavior in adult participants. The review followed PRISMA guidelines, and the research was performed through four major electronic databases (PubMed/MEDLINE, Scopus, PsycInfo, and Web of Science) for relevant titles/abstracts published from January 2013 to September 2023. The review included original studies published in peer-reviewed journals and in English that assessed the relationship between emotional regulation, as measured by the Difficulties in Emotional Regulation Scale (DERS), and suicidal ideation and/or behavior. In total, 44 studies were considered eligible, and the results mostly revealed significant positive associations between emotion dysregulation and suicidal ideation, while the findings on suicide attempts were more inconsistent. Furthermore, the findings also confirmed the role of emotion dysregulation as a mediator between suicide and other variables. Given these results, it is important to continue investigating these constructs and conduct accurate assessments to implement effective person-centered interventions.

The Mediating Role of Precepts and Meditation on Attachment and Depressive Symptoms in Adolescents

Research shows that Buddhist precept adherence (i.e., abstaining from killing, stealing, sexual misconduct, lying, and intoxicant use) and meditation practice influence mental health outcomes. This study investigated how Buddhist precept adherence and meditation practice influenced the relationship between insecure attachment and depressive symptoms among Thai adolescents. A total of 453 Thai boarding-school students from 10th-12th grade were recruited from five boarding schools (two purposively selected Buddhist schools and three conveniently selected secular schools). They completed these tools: Experiences in Close Relationships Questionnaire-revised-18, Outcome-Inventory-21: Depression Subscale, Precept Practice Questionnaire, and Inner-Strength-Based Inventory: Meditation. A parallel mediation model analyzed the indirect effects of attachment anxiety and attachment avoidance on depression through precept adherence and meditation practice. The participants' demographics were 16.35 ± 0.96 years, 88% female, and 89.4% Buddhist. The mean scores for attachment anxiety were 2.7 ± 1.1; attachment avoidance, 2.78 ± 1.2; overall regular precept adherence, 20.1 ± 4.4; regular but not daily meditation, 2.94 ± 1.3; and low depressive symptoms, 3.75 ± 3.4. The standardized indirect effects for attachment anxiety (β = 0.042, 95% CI = 0.022, 0.070) and avoidance (β = 0.024, 95% CI = 0.009, 0.046) on depressive symptoms through meditation and precept adherence were significant. Meditation practice had a significantly higher indirect effect size than precept adherence.