Exploring the Role of Psychological Factors in the Relationship between Attachment and Suicidal Thoughts and Behaviours

  • Jessica Green

Student thesis: Doctor of Clinical Psychology


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 outlined. 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.
Date of Award31 Dec 2018
Original languageEnglish
Awarding Institution
  • The University of Manchester
SupervisorKatherine Berry (Supervisor), Daniel Pratt (Supervisor) & Adam Danquah (Supervisor)


  • Mediation Analyses
  • Systematic Review
  • Suicide
  • Attachment

Cite this