Is there a connection between insecure attachment and suicidal ideation in adolescents?

Article in Review: Sheftall, A, Schoppe-Sullivan, S. & Bridge, J. (2014) Insecure attachment and suicidal behaviour in adolescents. Crisis, 35(6), 426-430

Summary: A brief summary of the research on attachment styles and suicidality in adolescents, including interpretations for how this might be used clinically with tips for clinicians 

Insecure attachments in adolescents and adulthood develop from poor relationships in childhood. Dysfunctional attachments can lead to emotional and behavioural difficulties including mental illness, each of which are known risk factors for suicidal behaviour. Research by Sheftall, Schoppe-Sullivan & Bridge (2014) investigated this association within a network of adolescents who have previously attempted suicide, and adolescents who have never attempted suicide. To determine if attachment avoidance/anxiety was independently linked to suicidal behaviour, the research explored other known risk factors including attachment style, family alliance, and depressive symptoms.

 Is attachment avoidance/anxiety independently linked to suicidal behaviour in young adults?

 The research highlighted how individuals who experience attachment avoidance commonly dismiss the value of relationships and often avoid connections with others. This causes them to withdraw from expressing emotions, resulting in a self-reliant lifestyle. Such tendencies could lead to interpersonal difficulties that are closely linked to suicidal behaviours. After controlling influences of mental illnesses, it was determined that attachment avoidance was not strongly connected to depression. For this reason, attachment avoidance is an independent risk factor, and therefore a significant predictor of suicidal behaviour. However, is this the same case for anxious attachment? Unlike attachment avoidance, anxious attachment is closely linked to depressive symptoms. Due to this factor, anxious attachment cannot be independently linked to suicidal behaviour in adolescents.

 Overall, it was not surprising that the research found that previous people who had attempted, experienced a higher level of attachment avoidance/anxiety than never-suicidal youth.

 How can this research be used?

While there is no capacity to draw causal links between attachment styles and suicidality, there are certainly risk factors clinicians can work with. With suicide being a prominent public health concern, the primary goal of clinicians is to reduce the rate of suicide. Developing support from family and friends is often a strategy used to prevent suicidal attempts. However, adolescents who have developed insecure attachments function in a way that dismisses social connections, therefore causing such preventative strategies to become insufficient. In recognition of this research, future safety plans should take into account the behavioural differences of people with insecure attachments. Such considerations will allow for safety plans to adapt to the needs of these individuals, resulting in successful strategies in the prevention of suicide.

 Tips for practitioners

In addition to the range of safety and intervention planning we develop with our client, consider the following tips for those with avoidant and otherwise insecure attachments

• Develop a range of safety planning strategies – don’t rely on them help seeking or reaching out to others when this likely feels foreign or uncomfortable
• Consolidate the value of their independence and resourcefulness by listing multiple strategies that they are able to implement in their safety plan
• Collaborate with the avoidant attachment client to identify their critical inner voices that support withdrawal in difficult situations – work towards developing a rational and more adaptive inner voice that can also see value in developing secure attachments
• Support the client to develop insight into how they relate to others and whether this is associated with the onset of suicidality. Foster opportunities to safely challenge perceptions of attachments and that withdrawal may be comfortable but not always helpful

 Future considerations

Due to the high success rate of Attachment-Based Family Therapy in decreasing “major depression, anxiety, and suicidal ideation”, further research into this strategy should be considered. A greater understanding into insecure attachments will determine if it can be independently used to predict suicidal attempts among adolescents.

References

Sheftall, A, Schoppe-Sullivan, S. & Bridge, J. (2014) Insecure attachment and suicidal behaviour in adolescents. Crisis, 35(6), 426-430

First published 13 February 2016

By Carmen Betterridge