The mediating role of adult attachment styles between early traumas and suicidal behaviour

Our Hungarian cross-sectional study highlights the crucial mediating role that adult attachment styles play in the relationship between early traumas and suicidal behaviour, shaping how individuals process and respond to traumatic experiences. Early traumas, such as abuse or neglect, often disrupt the development of secure attachment, leading to insecure styles in adulthood-such as anxious or avoidant attachment. These insecure attachment styles influence emotional regulation, interpersonal relationships, and coping mechanisms, thereby exacerbating feelings of isolation and despair. For instance, anxious attachment can intensify fear of abandonment and hypersensitivity to rejection, increasing emotional instability and suicidal ideation. Conversely, avoidant attachment may lead to emotional suppression and reluctance to seek support, amplifying feelings of hopelessness. Psychopathological symptoms resulting from early trauma-such as depression and PTSD-are often filtered through these attachment patterns, shaping how distress is experienced and managed. In our research, we analysed the role of adult attachment styles and early traumas in suicidal behaviour. We also examined the mediating effect of attachment style in the relationship between early traumas and suicidal behaviour. A total of 357 subjects between the ages of 18 and 85 (mean = 37.02, SD = 12.86) were included in the analysis; 33.6% were male and 66.4% female. The sample consisted of 146 individuals with a history of suicide, 154 clinical participants without a history of suicide, and 57 from a non-clinical population. The adult attachment scale (AAS) and the childhood trauma questionnaire (CTQ) were used as assessment tools. To model the relationships between variables, logistic regression, generalized linear models, and mediation analyses were conducted. All models were adjusted for basic demographic variables. Our results showed that the severity of emotional abuse (adjusted OR 1.064, p = 0.004), emotional neglect (adjusted OR 1.064, p = 0.007), and overall traumatization measured by the CTQ (adjusted OR 1.021, p = 0.006) significantly predicted a higher risk of suicidal behaviour. In contrast, higher levels of secure attachment style predicted a lower risk of suicide attempt (adjusted OR -0.091, p = 0.004). Additionally, secure attachment style significantly mediated part of the total effect of early traumatization severity on suicidal behaviour (indirect effect = 0.0032, p < 0.05; Pm = 16.5%). We also examined the relationship between early traumas and attachment style and found multiple significant associations. For avoidant attachment, significant associations were observed with the total traumatization score (B = 0.086, p < 0.001) and specific adversities, including emotional abuse, emotional neglect, and physical neglect (B = 0.244-0.319, all p < 0.001). Anxious-ambivalent attachment was associated with the total CTQ score (B = 0.088, p < 0.001), as well as emotional abuse (B = 0.298, p < 0.001), emotional neglect (B = 0.254, p < 0.001), physical abuse (B = 0.248, p < 0.001), and physical neglect (B = 0.261, p = 0.010). A lower level of secure attachment was linked to the overall traumatization score (B = -0.039, p = 0.004), as well as emotional abuse, emotional neglect, and sexual abuse (B = -0.101 to -0.163, all p < 0.05). By mediating the relationship between trauma and suicidal behaviour, adult attachment styles can either perpetuate maladaptive coping strategies or hinder recovery. Understanding this mediating role is crucial for developing interventions that address attachment insecurities while promoting resilience and emotional healing. Therapeutic approaches aimed at fostering secure attachment patterns can help mitigate the effects of early trauma and reduce the risk of suicidal behaviour. These findings underscore the importance of incorporating attachment-focused strategies into trauma-informed care.