Insecure Attachment Styles Associated With Suicidal Ideation in Adulthood

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In addition to attachment styles, suicidal ideation was associated with variables such as obesity and living alone.

Certain attachment styles increase the likelihood for suicidal ideation in adult patients, according to cross-sectional study data published in the Journal of Affective Disorders.

The Adult Attachment in Primary Care study comprised patients aged 50 to 85 with at least 3 chronic conditions (n=207). Adult attachment style, depressive symptoms, and suicidal ideation were measured by self-report questionnaire; patients completed the Experiences in Close Relationships–Revised (ECR-RD12) and the Patient Health Questionnaire-9. Logistic regression analyses were performed to capture associations between suicidal ideation and ECR-RD12-attachment anxiety, ECR-RD12-attachment avoidance, and ECR-RD12-insecure adult attachment.

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Suicidal ideation was reported by 13% of patients. ECR-RD12-anxiety was significantly associated with suicidal ideation (odds ratio [OR], 1.88; CI, 1.44-2.44), although ECR-RD12-avoidance was not. Patients with ECR-RD12-insecure attachment were more than 3 times more likely to experience suicidal ideation compared with those with secure attachment (OR, 3.33; CI, 1.10-10.04). Moreover, 85.2% of patients with suicidal ideation were insecurely attached, compared with just 63.3% of patients without suicidal ideation. Demographic factors associated with suicidal ideation included obesity (P =.0344) and living alone (P =.0415). Increased depression symptoms per the Patient Health Questionnaire-9 were also associated with an increased risk for suicidal ideation. The effects of obesity on suicidal ideation were more pronounced in women, whereas the effects of depression symptomatology were more significant for men.

These data underscore a clear association between insecure adult attachment and suicidal ideation among adults with chronic conditions. Future research is necessary to investigate possible interventions for patients with insecure attachment styles, particularly those with chronic illness.


Rückert-Eheberg I-M, Lukaschek K, Brenk-Franz K, Strauß B, Gensichen J. Association of adult attachment and suicidal ideation in primary care patients with multiple chronic conditions. J Affect Disord. 2018;246:121-125.