https://doi.org/10.4081/ripppo.2024.785
The relationship among attachment styles, interpersonal needs, and suicidal ideation in patients with psychiatric disorders
Submitted: April 30, 2024
Accepted: November 22, 2024
Published: December 30, 2024
Accepted: November 22, 2024
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
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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.
Adams K.S. Suicidal behaviour and attachment: A developmental model. In: Blumenthal S.J., Kupfer D.J., editors. Suicide over the Life Cycle: Risk Factors, Assessment and Treatment of Suicidal Patients. Guilford Press; New York, NY, USA: 1994. pp. 39–96.
Ainsworth, M. S., & Bowlby, J. (1991). An ethological approach to personality development. American Psychologist, 46(4), 333.
DOI: https://doi.org/10.1037//0003-066X.46.4.333
Ainsworth, M. D. S., Blehar, M. C., Waters, E., & Wall, S. (1978). Patterns of attachment: A psychological study of the strange situation. Hillsdale, NJ: Lawrence Erlbaum Associates.
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders, fifth edition: DSM-5. Arlington, VA: American Psychiatric Association.
DOI: https://doi.org/10.1176/appi.books.9780890425596
Baumeister, R. F., & Leary, M. R. (1995). The need to belong: desire for interpersonal attachments as a fundamental human motivation. Psychological Bulletin, 117(3), 497–529.
DOI: https://doi.org/10.1037//0033-2909.117.3.497
Berardelli, I., Sarubbi, S., Rogante, E., Erbuto, D., Giuliani, C., Lamis, D. A., Innamorati, M., & Pompili, M. (2022). Association between Childhood Maltreatment and Suicidal Ideation: A Path Analysis Study. Journal of Clinical Medicine, 11(8), 2179.
DOI: https://doi.org/10.3390/jcm11082179
Bowlby, J. (1969). Attachment and loss. Vol. 1. London: Random House.
Chu, C., Buchman-Schmitt, J. M., Stanley, I. H., Hom, M. A., Tucker, R. P., Hagan, C. R., Rogers, M. L., Podlogar, M. C.,
Chiurliza, B., Ringer, F. B., Michaels, M. S., Patros, C. H. G., & Joiner, T. E. (2017). The interpersonal theory of suicide: A
systematic review and meta-analysis of a decade of cross-national research. Psychological Bulletin, 143(12), 1313–1345.
Diamond, G., Kodish, T., Ewing, E. S. K., Hunt, Q. A., & Russon, J. M. (2022). Family processes: Risk, protective and treatment factors for youth at risk for suicide. Aggression and Violent Behavior, 64, 101586.
DOI: https://doi.org/10.1016/j.avb.2021.101586
Diener, M. J., & Monroe, J. M. (2011). The relationship between adult attachment style and therapeutic alliance in individual psychotherapy: a meta-analytic review. Psychotherapy (Chicago, Ill.), 48(3), 237–248.
DOI: https://doi.org/10.1037/a0022425
Dienst, F., Forkmann, T., Schreiber, D., & Höller, I. (2023). Attachment and need to belong as moderators of the relationship between thwarted belongingness and suicidal ideation. BMC psychology, 11(1), 50.
DOI: https://doi.org/10.1186/s40359-023-01080-y
Feeney J, Noller P, Hanrahan M. Assessing adult attachment. In: Sperling MB, Berman WH, editors. Attachment in Adults: Clinical and Developmental Perspectives. New York, NY: Guilford Press (1994). p. 128–55.
Fergusson, D. M., Woodward, L. J., & Horwood, L. J. (2000). Risk factors and life processes associated with the onset of
suicidal behaviour during adolescence and early adulthood. Psychological Medicine, 30(1), 23–39.
Fossati, A., Feeney, J. A., Donati, D., Donini, M., Novella, L., the Attachment Style Questionnaire in Italian clinical and nonclinical participants. Journal of Social and Personal Relationships, 20(1), 55-79.
DOI: https://doi.org/10.1177/02654075030201003
Freudenstein, O., Zohar, A., Apter, A., Shoval, G., Weizman, A., & Zalsman, G. (2011). Parental bonding in severely suicidal adolescent inpatients. European psychiatry: the journal of the Association of European Psychiatrists, 26(8), 504–507.
DOI: https://doi.org/10.1016/j.eurpsy.2011.01.006
Galynker, I., Yaseen, Z., & Briggs, J. (2014). Assessing risk for imminent suicide. Psychiatric Annals, 44(9), 431–436.
DOI: https://doi.org/10.3928/00485713-20140908-07
Granieri, A., Casale, S., Sauta, M. D., & Franzoi, I. G. (2022). Suicidal Ideation among University Students: A Moderated
Mediation Model Considering Attachment, Personality, and Sex. International Journal of Environmental Research and
Public Health, 19(10), 6167.
Green, J., Berry, K., Danquah, A., & Pratt, D. (2020). The role of psychological and social factors in the relationship between attachment and suicide: A systematic review. Clinical Psychology & Psychotherapy, 27(4), 463–488.
DOI: https://doi.org/10.1002/cpp.2445
Grunebaum, M. F., Galfalvy, H. C., Mortenson, L. Y., Burke, A. K., Oquendo, M. A., & Mann, J. J. (2010). Attachment and
social adjustment: relationships to suicide attempt and major depressive episode in a prospective study. Journal of Affective Disorders, 123(1-3), 123–130.
DOI: https://doi.org/10.1016/j.jad.2009.09.010
Hayes, A. F. (2018). Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach (Methodology in the Social Sciences) (2nd ed.). New York, NY: The Guilford Press.
Iliceto, P., D’Antuono, L., Fino, E., Carcione, A., Candilera, G., Silva, C., & Joiner, T. E. (2021). Psychometric properties of
the Italian version of the Interpersonal Needs Questionnaire-15 (INQ-15-I). Journal of Clinical Psychology, 77(1), 268–
DOI: https://doi.org/10.1002/jclp.23026
285.
Joiner T. Why people die by suicide. Cambridge, MA, US: Harvard University Press; 2005.
Kidd, S., & Shahar, G. (2008). Resilience in homeless youth: the key role of self-esteem. The American Journal of Orthopsychiatry, 78(2), 163–172.
DOI: https://doi.org/10.1037/0002-9432.78.2.163
Klonsky, E. D., & May, A. M. (2014). Differentiating suicide attempters from suicide ideators: a critical frontier for suicidology research. Suicide & Life-Threatening Behavior, 44(1), 1–5.
DOI: https://doi.org/10.1111/sltb.12068
Lessard, J. C., & Moretti, M. M. (1998). Suicidal ideation in an adolescent clinical sample: attachment patterns and clinical implications. Journal of Adolescence, 21(4), 383–395.
DOI: https://doi.org/10.1006/jado.1998.0169
Ma, J., Batterham, P. J., Calear, A. L., & Han, J. (2016). A systematic review of the predictions of the Interpersonal-Psychological Theory of Suicidal Behavior. Clinical Psychology Review, 46, 34–45.
DOI: https://doi.org/10.1016/j.cpr.2016.04.008
Macneil, S., Roderbourg, L., Orri, M., Geoffroy, M. C., Mcgrath, J. J., Renaud, J., & Gouin, J. P. (2023). Attachment Styles and Suicidal Thoughts and Behaviors: A Meta-Analysis. Journal of Social and Clinical Psychology, 42(4), 323-364.
DOI: https://doi.org/10.1521/jscp.2023.42.4.323
Messina, I., Calvo, V., & Grecucci, A. (2023). Attachment orientations and emotion regulation: new insights from the study of interpersonal emotion regulation strategies. Research in Psychotherapy: Psychopathology, Process and Outcome, 26(3), 703.
DOI: https://doi.org/10.4081/ripppo.2023.703
Mikulincer, M., & Shaver, P. R. (2008). Adult attachment and affect regulation. In J. Cassidy & P. R. Shaver (Eds.), Handbook of attachment: Theory, research and clinical applications (2nd ed., pp. 503–531). New York, NY: The Guildford Press
Nilsson, M. E., Suryawanshi, S., Gassmann-Mayer, C., Dubrava, S., McSorley, P., & Jiang, K. (2013). Columbia–suicide severity rating scale scoring and data analysis guide. CSSRS Scoring Version, 2, 1-13. Available from: https://cssrs.columbia.edu/wp-content/uploads/ScoringandDataAnalysisGuide-for-Clinical-Trials-1.pdf
Nye, E. C., Katzman, J., Bell, J. B., Kilpatrick, J., Brainard, M., & Haaland, K. Y. (2009). Attachment representation and suicidal ideation in Vietnam combat veterans with posttraumatic stress disorder. Archives of suicide research 13(2),
DOI: https://doi.org/10.1080/13811110902835213
195–199.
O’Connor R. C. (2011). The integrated motivational-volitional model of suicidal behavior. Crisis, 32(6), 295–298.
DOI: https://doi.org/10.1027/0227-5910/a000120
Palitsky, D., Mota, N., Afifi, T. O., Downs, A. C., & Sareen, J. (2013). The association between adult attachment style, mental disorders, and suicidality: findings from a population based study. The Journal of Nervous and Mental Disease,
DOI: https://doi.org/10.1097/NMD.0b013e31829829ab
201(7), 579–586.
Parolin, L., Milesi, A., Comelli, G., & Locati, F. (2023). The interplay of mentalization and epistemic trust: a protective
mechanism against emotional dysregulation in adolescent internalizing symptoms. Research in Psychotherapy: Psychopathology, Process and Outcome, 26(3), 707.
Pompili, M., Innamorati, M., Erbuto, D., Luciano, M., Sampogna, G., Abbate-Daga, G., Barlati, S., Carmassi, C., Castellini, G., De Fazio, P., Di Lorenzo, G., Di Nicola, M., Ferrari, S., Goracci, A., Gramaglia, C., Martinotti, G., Nanni, M. G., Pasquini, M., Pinna, F., Poloni, N., Fiorillo, A. (2022). High depression symptomatology and mental pain characterize suicidal
DOI: https://doi.org/10.1192/j.eurpsy.2022.2312
psychiatric patients. European psychiatry: the journal of the Association of European Psychiatrists, 65(1), e54.
Pompili M. (2024). On mental pain and suicide risk in modern psychiatry. Annals of General Psychiatry, 23(1), 6.
DOI: https://doi.org/10.1186/s12991-024-00490-5
Posner, K., Brown, G. K., Stanley, B., Brent, D. A., Yershova, K.V., Oquendo, M. A., Currier, G. W., Melvin, G. A., Greenhill,
L., Shen, S., & Mann, J. J. (2011). The Columbia-Suicide Severity Rating Scale: initial validity and internal consistency
findings from three multisite studies with adolescents and adults. The American Journal of Psychiatry, 168(12), 1266–
1277.
Riggs, S. A., & Jacobvitz, D. (2002). Expectant parents’ representations of early attachment relationships: associations with mental health and family history. Journal of Consulting and Clinical Psychology, 70(1), 195–204.
DOI: https://doi.org/10.1037//0022-006X.70.1.195
Rodgers, R. F., van Leeuwen, N., Chabrol, H., & Leichsenring, F. (2011). An exploration of the role of defensive psychopathology in adolescent suicidal ideation and behavior. Bulletin of the Menninger Clinic, 75(3), 236–253.
DOI: https://doi.org/10.1521/bumc.2011.75.3.236
Sahle, B. W., Reavley, N. J., Li, W., Morgan, A. J., Yap, M. B. H., Reupert, A., & Jorm, A. F. (2022). The association between
adverse childhood experiences and common mental disorders and suicidality: an umbrella review of systematic reviews and meta-analyses. European Child & Adolescent Psychiatry, 31(10), 1489–1499.
DOI: https://doi.org/10.1007/s00787-021-01745-2
Slade, A., & Holmes, J. (2019). Attachment and psychotherapy. Current Opinion in Psychology, 25, 152–156.
DOI: https://doi.org/10.1016/j.copsyc.2018.06.008
Stepp, S. D., Morse, J. Q., Yaggi, K. E., Reynolds, S. K., Reed, L. I., & Pilkonis, P. A. (2008). The role of attachment styles and interpersonal problems in suicide-related behaviors. Suicide & Life-Threatening Behavior, 38(5), 592–607.
DOI: https://doi.org/10.1521/suli.2008.38.5.592
Talia, A., Daniel, S. I., Miller-Bottome, M., Brambilla, D., Miccoli, D., Safran, J. D., & Lingiardi, V. (2014). AAI predicts
patients’ in-session interpersonal behavior and discourse: a «move to the level of the relation» for attachment-informed psychotherapy research. Attachment & Human Development, 16(2), 192–209.
DOI: https://doi.org/10.1080/14616734.2013.859161
Taylor, P. J., Rietzschel, J., Danquah, A., & Berry, K. (2015). The role of attachment style, attachment to therapist, and working alliance in response to psychological therapy. Psychology and Psychotherapy, 88(3), 240–253.
DOI: https://doi.org/10.1111/papt.12045
Turanovic, J. J., & Pratt, T. C. (2015). Longitudinal effects of violent victimization during adolescence on adverse outcomes in adulthood: a focus on prosocial attachments. The Journal of Pediatrics, 166(4), 1062–9.e1.
DOI: https://doi.org/10.1016/j.jpeds.2014.12.059
Turton, H., Berry, K., Danquah, A., Green, J., & Pratt, D. (2022). An investigation of whether emotion regulation mediates the relationship between attachment insecurity and suicidal ideation and behaviour. Clinical Psychology & Psychotherapy, 29(5), 1587–1598.
DOI: https://doi.org/10.1002/cpp.2735
Van Orden, K. A., Witte, T. K., Cukrowicz, K. C., Braithwaite, S. R., Selby, E. A., & Joiner, T. E., Jr (2010). The interpersonal
theory of suicide. Psychological Review, 117(2), 575–600.
Van Orden, K. A., Cukrowicz, K. C., Witte, T. K., & Joiner, T. E. (2012). Thwarted belongingness and perceived burdensomeness: construct validity and psychometric properties of the Interpersonal Needs Questionnaire. Psychological assessment, 24(1), 197–215.
DOI: https://doi.org/10.1037/a0025358
Venta, A., Mellick, W., Schatte, D., & Sharp, C. (2014). Preliminary evidence that thoughts of thwarted belongingness mediate the relations between level of attachment insecurity and depression and suicide-related thoughts in inpatient adolescents. Journal of Social and Clinical Psychology, 33(5), 428-447.
DOI: https://doi.org/10.1521/jscp.2014.33.5.428
Westerling III, T. W., Drinkwater, R., Laws, H., Stevens, H., Ortega, S., Goodman, D., & Drill, R. L. (2019). Patient attachment and therapist countertransference in psychodynamic psychotherapy. Psychoanalytic Psychology, 36(1), 73.
DOI: https://doi.org/10.1037/pap0000215
Winnicott, D. W. (1965). The maturational processes and the facilitating environment: Studies in the theory of emotional development. International Universities Press.
World Health Organization. Suicide. Available from: https://www.who.int/news-room/fact-sheets/detail/suicide [Accessed July 23, 2024].
Zeyrek, E. Y., Gençöz, F., Bergman, Y., & Lester, D. (2009). Suicidality, problem-solving skills, attachment style, and hopelessness in Turkish students. Death Studies, 33(9), 815–827.
DOI: https://doi.org/10.1080/07481180903142407
Zortea, T. C., Gray, C. M., & O’Connor, R. C. (2021). The Relationship Between Adult Attachment and Suicidal Thoughts
and Behaviors: A Systematic Review. Archives of Suicide Research, 25(1), 38–73.
How to Cite
Sarubbi, S., Rogante, E., Erbuto, D., Migliorati, M., Berardelli, I., Innamorati, M., & Pompili, M. (2024). The relationship among attachment styles, interpersonal needs, and suicidal ideation in patients with psychiatric disorders. Research in Psychotherapy: Psychopathology, Process and Outcome, 27(3). https://doi.org/10.4081/ripppo.2024.785
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