The Mediating Role of Emotional Dysregulation in the Relationship Between Anxious Attachment and Suicidal Behavior in Children Admitted to an Emergency Department

Summary & key facts

This study looked at 111 children aged 7–12 who came to a pediatric emergency department for suicidal thoughts or behaviors. The researchers measured children's attachment style, emotional regulation, and suicidal thoughts/behaviors. They found that emotional dysregulation explained (statistically mediated) the link between anxious attachment and suicidal behaviors. No similar mediation was found for avoidant attachment and suicidal thoughts. The study is cross-sectional, so it shows associations but cannot prove cause and effect.

Key facts:

• Sample size: 111 children aged 7–12 who were admitted to a pediatric emergency department for suicidal thoughts or behaviors.
• U.S. context: suicide deaths among children aged 5–12 increased by 195% from 1990 to 2020 (figure given in the paper to underline the problem).
• Main result: emotional dysregulation significantly mediated the relationship between anxious attachment and suicidal behaviors in these children.
• No mediation effect was found between avoidant attachment and suicidal thoughts in this sample.
• Measures used included self-report scales for attachment (ECR-RC), emotional dysregulation (DERS), and suicidal thoughts/behaviors (C-SSRS).
• Because the data are cross-sectional (measured at one time), the study can show associations but cannot prove that attachment or dysregulation caused suicidal thoughts or behaviors.

Abstract

Child suicide rates and emergency department visits due to suicidal thoughts and behaviors (STB) are rising at an alarming rate globally. In the United States, suicide deaths among children aged 5-12 increased by 195% from 1990 to 2020, highlighting an urgent need for greater understanding of the underlying risk factors. Although poor parent-child relationships and child emotional dysregulation have been identified as correlates of STB, the precise mechanisms linking these factors remain insufficiently explored. This study aimed to examine the associations between insecure attachment styles (anxious and avoidant), emotional dysregulation and STB in children. Grounded in attachment theory, it was hypothesized that emotional dysregulation would mediate the relationship between insecure attachment and STB. A sample of 111 children aged 7-12, admitted to a pediatric emergency department (ED) for STB, completed self-report measures assessing attachment styles (ECR-RC), emotional dysregulation (DERS), and STB (C-SSRS). Cross-sectional mediation regression analyses revealed that emotional dysregulation significantly mediated the relationship between anxious attachment and suicidal behaviors. However, no mediation effect was found between avoidant attachment and suicidal thoughts. These findings suggest that children with anxious attachment styles are particularly vulnerable to experiencing emotional dysregulation associated with suicidal behaviors. The absence of a similar mediation effect for avoidant attachment and suicidal thoughts may point to distinct psychological pathways underlying different forms of STB. These results highlight the potential importance of targeting the parent-child relationship to enhance children's emotional regulation abilities, which may, in turn, reduce the risk of suicidal behaviors.

Topics

Child and Adolescent Psychosocial and Emotional Development Maternal Mental Health During Pregnancy and Postpartum Suicide and Self-Harm Studies

Categories

Clinical Psychology Psychology Social Sciences

Tags

Attachment theory Clinical psychology Developmental psychology Emotional dysregulation Injury prevention Insecure attachment Law Mediation Medical emergency Medicine Moderated mediation Poison control Political science Psychology Social psychology Suicidal ideation Suicide prevention

Conditions & symptoms

Anxiety Depression Anxiety or worry Feeling disconnected from others Sadness or low mood