Green Jessica, Berry Katherine, Danquah Adam, Pratt Daniel
Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester M13 9PL, UK.
Greater Manchester Mental Health NHS Foundation Trust, Manchester M25 3BL, UK.
Int J Environ Res Public Health. 2021 Mar 17;18(6):3090. doi: 10.3390/ijerph18063090.
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.
We aim to further verify the link between adult attachment security and suicidal ideation and examine whether deficits in reflective functioning mediate this relationship.
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.
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.
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.
自杀念头（自杀观念）和行为是主要的死亡原因之一。为了理解为何依恋困难会使个体易产生自杀念头和行为，我们需要探究相关心理机制的作用。依恋过程与心理化能力（即反思功能）的发展密切相关，心理化能力是指理解和诠释自我及他人行为作为心理状态表达的能力。旨在改善心理化的干预措施已与自杀行为的减少相关联，但反思功能与自杀念头和行为之间的关系尚未得到直接研究。
我们旨在进一步验证成人依恋安全性与自杀念头之间的联系，并检验反思功能缺陷是否介导了这种关系。
67名在过去12个月内有自杀念头的参与者完成了关于成人依恋、当前自杀念头、反思功能、抑郁症状和绝望感的自我报告测量。进行偏相关分析、中介分析和组间比较以探究这些因素之间的关系。
研究结果不支持反思功能在依恋安全性与自杀念头关系中起中介作用。在控制年龄、性别和抑郁症状后，依恋回避与自杀念头之间建立了直接关系。然而，有自杀未遂史的参与者与无此病史的参与者相比，焦虑依恋水平更高。
本研究表明，依恋焦虑和回避这两个依恋维度在增加自杀未遂与自杀念头风险方面可能发挥不同作用。这对干预措施的定制具有重要意义。旨在减少自杀未遂的干预措施应通过帮助人们发展情绪调节技能来专注于降低依恋焦虑。旨在减少自杀念头的干预措施应通过帮助人们与重要他人建立更亲密关系来专注于降低依恋回避。然而，需要纵向和实验设计来验证因果关系。
