Introduction: Suicide is one of the leading causes of death during adolescence. Predicting suicidal risk in adolescents is challenging due to the interplay of numerous protective and risk factors, encompassing neurobiological, social, psychological, and developmental characteristics. Due to various developmental changes are adolescents an even more vulnerable group, as their problem-solving abilities are not fully developed. Secure attachment is one of the fundamental sources of support for adolescents. Attachment theory advocates that the sense of security developed by children in the family environment, with support, forms the basis for the development of subsequent interactions with people. Children thus develop internal working models of themselves and others based on early interactions and experiences with their parents. Insecure attachment represents a risk factor for the development of mental disorders, including suicidal behavior.
Purpose, Objectives: The purpose of the study was to examine the connection between adolescents' attachment to the parents and the risk of suicidal behavior from the perspective of acquired capability for suicide and if attachment is an important predictive variable for the duration of hospitalization in a special care unit.
Subjects, Method: The study included adolescents who were hospitalized in the special care unit, due to serious suicidal risk. Adolescents aged between 11 and 18 were included. Exclusion criteria for participation in the study were intellectual disability, the influence of acute psychotic events or illicit psychoactive substances, and refusal to participate in the research. Participants answered to a set of questionnaires: ECR-RS, ACSS, PSS, LITE-S.
Results: Adolescents' attachment avoidance to mother (b = 0.23, 95 % CI (0.05, 0.45)), father (b = 0.21, 95 % CI (0.05, 0.40)), and both parents together (b = 0.32, 95 % CI (0.11, 0.58)) are connected to suicidal behavior through the mediator PZS. Similarly, the attachment anxiety to the father is also linked to suicidal behavior through PZS, but negatively (b = –0.17, 95 % CI (–0.36, –0.02)). Insecure attachment to the father was statistically significantly associated with any suicide attempt by the adolescent in their lifetime (챓²(1) = 5.85, p = 0.02). The odds ratio for attempted suicide was almost three times higher for adolescents who were insecurely attached to their father compared to adolescents who were insecurely attached to their mother. Attachment to parents is not a predictive factor for the duration of hospitalization. Even with the introduction of individual variables as moderators of this association (personality disorder, depressive disorder, family violence, experience of abuse), the predictive value was not statistically significant. Other factors influence the duration of hospitalization.
Discussion: A higher level of attachment avoidance is a more sensitive predictor of more severe suicidal behavior rather than attachment anxiety. Individuals with different attachment dimensions differ in how they experience and establish relationships with others, cope with problems, and regulate emotions. Mother and father provide their child with different forms of emotional support and equip them with different coping strategies, which can also be reflected in suicidal behavior. The duration of treatment in an intensive psychiatric unit depends on a combination of various psychosocial factors that influence the final treatment outcome.
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