[Thesis]. Manchester, UK: The University of Manchester; 2018.
Approximately 800, 000 people die by suicide every year. Moreover, for every fatal
outcome approximately 20 people attempt to take their own life. Therefore, increasing
our understanding of the vulnerability factors and acute states that trigger suicide
and related behaviours is vital in improving suicide prevention efforts and initiatives.
This thesis aims to contribute to the evidence base by examining attachment in relation
to suicide-related outcomes and, specifically, the role of psychological mechanisms
in this relationship.
Paper one is a systematic review of quantitative empirical research investigating
the role of psychosocial mechanisms in the attachment-suicide relationship. Fifteen
papers were identified, most of which carried out mediation analyses. Studies were
extremely heterogeneous and there was limited overlap with respect to the psychological
mechanisms under investigation. However, there is preliminary evidence that suggests
a range of predisposing, precipitating and crisis-state factors mediate the association
between attachment styles and suicidality. Studies were critically evaluated and findings
were discussed in the context of a developmental model of suicide. Areas for further
exploration are considered and clinical implications discussed.
Paper two is an original empirical study investigating the mediating role of reflective
functioning between adult attachment and suicidality. Sixty-seven participants completed
self-report questionnaires measuring adult attachment, suicidal ideation, reflective
functioning, depressive symptoms and hopelessness. Mediation analyses did not support
an indirect effect of either attachment dimension on suicidal ideation via mentalization
impairments. However, a direct relationship was established between avoidant attachment
and suicidal ideation. Findings are considered in light of the limitations and cross-sectional
methodology. Future research directions are recommended, and clinical implications
Paper three is a critical reflection that aims to provide insight and reflections
on the research process. Explanations and justifications of key decisions are offered,
and reflections are made in respect to the study design, methodology, recruitment,
data analysis and personal experiences of the researcher.