Division of Psychiatry, University College London, London, United Kingdom.
Wellcome Trust Centre for Neuroimaging, University College London, London, United Kingdom; Anna Freud National Centre for Children and Families, London, United Kingdom.
Child Abuse Negl. 2022 Jun;128:105576. doi: 10.1016/j.chiabu.2022.105576. Epub 2022 Mar 18.
Although the relationship between childhood maltreatment, self-harm and suicidality is well-established, less is known about the mediating mechanisms explaining it. Based on a developmental mentalisation-based theoretical framework, childhood adversity compromises mentalising ability and attachment security, which in turn increase vulnerability to later stressors in adulthood.
This study aimed to investigate the role of attachment and mentalising as potential mechanisms in the relationship between childhood maltreatment, self-harm and suicidality.
We recruited 907 adults from clinical and community settings in Greater London.
The study design was cross-sectional. Participants completed self-report questionnaires on retrospectively rated childhood trauma, and current attachment to the romantic partner, mentalising, self-harm, suicidal ideation and attempt. We used structural equation modelling to examine the data and conceptualized childhood maltreatment as a general factor in a confirmatory bifactor model.
The results showed that childhood maltreatment was both directly associated with self-harm and suicidality and indirectly via the pathways of attachment and mentalising.
These findings indicate that insecure attachment and impaired mentalising partially explain the association between childhood maltreatment, self-harm and suicidality. Clinically, they provide support for the potential of mentalisation-based therapy or other psychosocial interventions that aim to mitigate the risk of self-harm and suicidality among individuals who have experienced childhood maltreatment via increasing understanding of self and other mental states.
尽管儿童期虐待、自残和自杀意念之间的关系已得到充分证实，但对于解释这种关系的中介机制知之甚少。基于发展心理化的理论框架，儿童期逆境会损害心理化能力和依恋安全性，进而增加成年后对后期压力源的脆弱性。
本研究旨在探讨依恋和心理化作为儿童期虐待、自残和自杀意念之间关系的潜在机制的作用。
我们从伦敦大都市区的临床和社区环境中招募了 907 名成年人。
研究设计为横断面研究。参与者完成了关于 retrospectively rated 儿童创伤、当前与浪漫伴侣的依恋、心理化、自残、自杀意念和自杀企图的自我报告问卷。我们使用结构方程模型来检验数据，并将儿童期虐待概念化为验证性双因素模型中的一个一般因素。
结果表明，儿童期虐待与自残和自杀意念既直接相关，也通过依恋和心理化的途径间接相关。
这些发现表明，不安全的依恋和受损的心理化部分解释了儿童期虐待、自残和自杀意念之间的关联。从临床角度来看，它们为心理化治疗或其他心理社会干预的潜在应用提供了支持，这些干预旨在通过增加对自我和他人心理状态的理解，减轻经历过儿童期虐待的个体自残和自杀意念的风险。
