The mediating role of attachment and mentalising in the relationship between childhood maltreatment, self-harm and suicidality. (June 2022)

• Record Type: Journal Article
• Authors: Stagaki, Maria; Nolte, Tobias; Feigenbaum, Janet; King-Casas, Brooks; Lohrenz, Terry; Fonagy, Peter; Montague, P. Read
• Is Part Of: Child abuse & neglect. Volume 128(2022)
• Publication Date: 2022-06
• Subjects: Non-suicidal self-injury (NSSI) -- Suicidality -- Childhood trauma -- Attachment -- Mentalising -- Structural equation model; Child abuse -- Periodicals; 362.76
• DOI: 10.1016/j.chiabu.2022.105576
• Languages: English
• ISSNs: 0145-2134

Abstract

Abstract: Background: Although the relationship between childhood maltreatment, self-harm and suicidality is well-established, less is known about the mediating mechanisms explaining it. Based on a developmental mentalisation-based theoretical framework, childhood adversity compromises mentalising ability and attachment security, which in turn increase vulnerability to later stressors in adulthood. Objective: This study aimed to investigate the role of attachment and mentalising as potential mechanisms in the relationship between childhood maltreatment, self-harm and suicidality. Participants and setting: We recruited 907 adults from clinical and community settings in Greater London. Methods: The study design was cross-sectional. Participants completed self-report questionnaires on retrospectively rated childhood trauma, and current attachment to the romantic partner, mentalising, self-harm, suicidal ideation and attempt. We used structural equation modelling to examine the data and conceptualized childhood maltreatment as a general factor in a confirmatory bifactor model. Results: The results showed that childhood maltreatment was both directly associated with self-harm and suicidality and indirectly via the pathways of attachment and mentalising. Conclusions: These findings indicate that insecure attachment and impaired mentalising partially explain the association between childhood maltreatment, self-harm and suicidality. Clinically, they provide support for the potential of mentalisation-based therapy or other psychosocial interventions that aim to mitigate the risk of self-harm and suicidality among individuals who have experienced childhood maltreatment via increasing understanding of self and other mental states. Highlights: Although the relationship between childhood maltreatment, self-harm and suicidality is well-established, less is known about the mediating mechanisms explaining it. We employed structural equation modelling in a large clinical and community sample of 907 adults, consisting largely of individuals with personality disorders and used a novel approach to conceptualise childhood maltreatment as a general factor in a confirmatory bifactor model while studying this relationship. We found that insecure attachment and compromised mentalising partially mediate this association and discuss these results within a mentalisation-based framework.