Fearful Attachment and Suicide Probability: The Mediating Role of Psychological Symptoms on Medical School Students

Year 2024, , 63 - 75, 29.03.2024

Abdullah Tunç , Meryem Berrin Bulut

https://doi.org/10.17066/tpdrd.1269512_5

Abstract

The mediating role of psychological symptoms in the relationship between fearful attachment and suicide probability was examined. The data were obtained from 192 medical school students. Adult Attachment Styles Scale, Suicide Probability Scale, and Symptom Check List 90R were used to collect the data. Correlation analysis was utilized to examine the relationships between variables, and the mediating role was determined using the bootstrapping method. Findings showed significant relationships between fearful attachment, psychological symptoms, and suicide probability. Moreover, the fearful attachment was associated with increased psychological symptoms and suicide probability. Psychological symptoms were associated with increased suicide probability. Furthermore, psychological symptoms mediated the relationship between fearful attachment and suicide probability. Psychological symptoms are critical in the relationship between fearful attachment and suicide probability. The current research adds to our knowledge of suicide probability by investigating fearful attachment and psychological symptoms. Besides, it underlies and contributes to the antecedents of suicide probability.

Keywords

attachment, suicide, depression, paranoid ideation, psychoticism

References

• Acar, A. (2009). Investigation of suicide incidents received by emergency services in respect of socio-demographic aspects (Publication no: 267598) [Master Thesis, Marmara University]. CoHE Thesis Center.
• Avcı, D., Sabancıoğulları, S., & Yılmaz, F. T. (2016). Investigation of the relationship between suicide probability in inpatients and their psychological symptoms and coping strategies. Neurosciences Journal, 21(4), 345-351. https://doi.org/10.17712/nsj.2016.4.20150727
• Aggelidou, K., & Georgaca, E. (2017). Effective strategies for coping with paranoid thoughts: A qualitative investigation. International Journal of Mental Health, 46(3), 188–205. https://doi.org/10.1080/00207411.2017.1304075
• American Psychiatric Association. (APA) (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association. https://doi.org/10.1176/appi.books.9780890425596
• Bartholomew, K., & Horowitz, L. M. (1991). Attachment styles among young adults: a test of a four-category model. Journal of Personality and Social Psychology, 61(2), 226.
• BBC. (2022). Enes Kara: Reactions following the suicide of a medical student in a religious community dormitory. Retrieved from https://www.bbc.com/turkce/haberler-turkiye-59952350
• Benazzi, F. (2006). Various forms of depression, Dialogues in Clinical Neuroscience, 8(2), 151-161. https://doi.org/10.31887/DCNS.2006.8.2/fbenazzi
• Bork, T., Turkoglu, A., Atesçelik, M., & Tokgözlü, O. (2021). Evaluation of risk factors for suicide attempts in Turkey’s east: A five-year study. Pakistan Journal of Medical Sciences, 37(2), 572-575. https://doi.org/10.12669/pjms.37.2.3092
• Boroujerdi, F. G., Kimiaee, S. A., Yazdi, S. A. A., & Safa, M. (2019). Attachment style and history of childhood abuse in suicide attempters. Psychiatry Research, 271, 1-7.
• Cull, J. G., & Gill, W. S. (1988). Suicide Probability Scale (SPS) Manual. Western Psychological Services.
• Çaynak, S., & Kutlu, Y. (2016). The psychological symptom, probability of suicide, and coping ways of a group of convict and detainee. Anadolu Psikiyatri Dergisi, 17(2), 93-98. http://dx.doi.org/10.5455/apd.198596
• CDC (2020). Suicide Data and Statistics for 2020. Retrieved from https://www.cdc.gov/suicide/suicide-data-statistics.html
• Crowell, J. A., Treboux, D., & Waters, E. (2002). Stability of attachment representations: the transition to marriage. Developmental Psychology, 38(4), 467-479. https://doi.org/10.1037//0012-1649.38.4.467
• Dağ, İ. (1991). Reliability and validity of the Symptom Check List (SCL-90-R) for university students. Türk Psikiyatri Dergisi, 2(1), 5-12.
• Dansby Olufowote, R. A., Fife, S. T., Schleiden, C., & Whiting, J. B. (2020). How can I become more secure?: A grounded theory of earning secure attachment. Journal of Marital and Family Therapy, 46(3), 489-506. https://doi.org/10.1111/jmft.12409
• Davila, J., Burge, D., & Hammen, C. (1997). Why does attachment style change? Journal of Personality and Social Psychology, 73(4), 826–838. https://doi.org/10.1037/0022-3514.73.4.826
• De Leo, D., Burgis, S., Bertolote, J. M., Kerkhof, A. J., & Bille-Brahe, U. (2006). Definitions of suicidal behavior: lessons learned from the WHo/EURO multicentre Study. Crisis, 27(1), 4–15. https://doi.org/10.1027/0227-5910.27.1.4
• Derogatis, L. R., & Clearly, P. A. (1977). Confirmation of the Dimensional Structure of the SCL90: A Study in Construct Validation. Journal of Clinical Psychology, 33(4), 981-989. https://doi.org/10.1002/1097-4679(197710)33:4%3C981::AID-JCLP2270330412%3E3.0.CO;2-0
• Durak-Batıgün, A., & Hisli-Şahin, N. (2018). Suicide Probability Scale: Revision, validity, and reliability. Journal of Clinical Psychology Research, 2(2), 52-64.
• Durkheim, E. (2005). Suicide: A Study in Sociology. Routledge.
• Eysenck, S. B. G., Eysenck, H. J., & Barrett, P. (1985). A revised version of the Psychoticism Scale. Personality and Individual Differences, 6(1), 21–29. https://doi.org/10.1016/0191-8869(85)90026-1
• Freeman, D., McManus, S., Brugha, T., Meltzer, H., Jenkins, R., & Bebbington, P. (2011). Concomitants of paranoia in the general population. Psychological Medicine, 41(5), 923-936. https://doi.org/10.1017/s0033291710001546
• Freud, S. (1955). The theory of the instincts. The Modern Library.
• Gravetter, F. J., Wallnau, L. B., Forzano, L. A. B., & Witnauer, J. E. (2020). Essentials of Statistics for the Behavioral Sciences. 9th ed. Cengage Learning. Cengage Learning.
• Griffin, D., & Bartholomew, K. (1994). The metaphysics of measurement: The case of adult attachment. In Bartholomew, K., Perlman, D. (Eds.), Attachment processes in adulthood: Advances in personal relationships (Vol. 5, pp. 17–52). Jessica Kingsley Publishers.
• Güleç, G. (2016). Psychiatric Disorders and Suicide. Türkiye Klinikleri-Psikiyatri Özel Konular, 9(3), 21-25.
• Gündüz, B. (2013). The Contributions of Attachment Styles, Irrational Beliefs and Psychological Symptoms to the Prediction of Cognitive Flexibility. Educational Sciences: Theory & Practice, 13(4), 2071-2085.
• Gürhan, N., Meri̇ç, M., Kaya, B., Turan, N. D., & Kabataş, E. (2018). Comparison of Suicide Probability and Problem-Solving Levels of Faculty of Medicine and Nursing Students According to Socio-demographic Variables, Gümüşhane University Journal of Health Sciences, 7(1), 149-155.
• Gürhan, N., Beşer, N. G., Polat, Ü., & Koç, M. (2019). Suicide risk and depression in individuals with chronic illness. Community Mental Health Journal, 55(5), 840-848. https://doi.org/10.1007/s10597-019-00388-7
• Güvendiren, H. (2020). The relationship between the attachment styles and intolerance of uncertainty and psychic symptoms in seafarers (Publication no: 623616) [Master Thesis, İstanbul Gelişim University]. CoHE Thesis Center.
• Gvion, Y., Horesh, N., Levi-Belz, Y., & Apter, A. (2015). A proposed model of the development of suicidal ideations. Comprehensive Psychiatry, 56, 93-102.
• Habertürk. (2022). Doctor commits suicide in Bursa. Retrieved from https://www.haberturk.com/son-dakika-bursa-da-intihar-eden-doktor-mustafa-yalcin-in-veda-mektubu-ortaya-cikti-haberleri-2977469
• Hayes, A. F., & Preacher, K. J. (2013). Conditional process modeling: Using structural equation modeling to examine contingent causal processes. In G. R. Hancock & R. O. Mueller (Eds.), Structural equation modeling: A second course (pp. 219–266). IAP Information Age Publishing.
• Haynes, R. L., & Marques, J. K. (1984). Patterns of suicide among hospitalized mentally disordered offenders. Suicide and Life‐Threatening Behavior, 14(2), 113-125. https://doi.org/10.1111/j.1943-278X.1984.tb00342.x
• Hu, J., Wang, J., Li, D., Huang, X., Xue, Y., Jia, L., Zhang, Z., Wan, Y., Song, X., Wang, R., Fang, J., Sun, Y., & Zhang, S. (2022). Mediating effect of sleep disorder between low mental health literacy and depressive symptoms among medical students: the roles of gender and grade. Frontiers in Psychiatry, 13, 818295.
• Hussain, B., Khalily, M. T., & Khalily, M. A. (2022). Suicidal tendencies and psychiatric symptoms as consequence of anabolic androgenic steroid usage among athletes in District Rawalpindi. Journal of the Pakistan Medical Association, 72(4), 616-619. https://doi.org/10.47391/JPMA.791
• İlhan, R. S., & Akaslan, D. S. (2019). Sociodemographic Characteristics of Suicide Cases on Internet News. Kriz Dergisi, 27(2), 71-78.
• Kapikiran, S., & Acun-Kapikiran, N. (2016). Optimism and Psychological Resilience in Relation to Depressive Symptoms in University Students: Examining the Mediating Role of Self-Esteem. Educational Sciences: Theory and Practice, 16(6), 2087-2110.
• Kidd, S., & Shahar, G. (2008). Resilience in homeless youth: The key role of self‐esteem. American Journal of Orthopsychiatry, 78(2), 163-172. https://doi.org/10.1037/0002-9432.78.2.163
• Kılıç, M. (1987). Değişik Psikolojik Arazlara Sahip Olan ve Olmayan Öğrencilerin Sorunları (Publication no: 4518) [Doctoral Thesis, Hacettepe University] CoHE Thesis Center.
• Klein, M. (1997). Envy And Gratitude And Other Works 1946-1963. Vintage Classics.
• Koparal, B., & Hocaoğlu, Ç. (2019). Schizophrenia and Suicide; A Review. Balıkesir Medical Journal, 3(3), 135-146. https://doi.org/10.33716/bmedj.622389
• Levi-Belz, Y., & Beautrais, A. (2016). Serious suicide attempts: Toward an integration of terms and definitions. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 37(4), 299–309.  https://doi.org/10.1027/0227-5910/a000386
• Levi‐Belz, Y., Gavish‐Marom, T., Barzilay, S., Apter, A., Carli, V., Hoven, C., Sarchiapone, M., & Wasserman, D. (2019). Psychosocial factors correlated with undisclosed suicide attempts to significant others: findings from the adolescence SEYLE study. Suicide and Life‐Threatening Behavior, 49(3), 759-773.
• Levi-Belz, Y., Gvion, Y., & Apter, A. (2019). The psychology of suicide: From research understandings to intervention and treatment. Frontiers in Psychiatry, 10, 214-218.
• Levi‐Belz, Y., Gvion, Y., Horesh, N., & Apter, A. (2013). Attachment patterns in medically serious suicide attempts: The mediating role of self‐disclosure and loneliness. Suicide and Life‐Threatening Behavior, 43(5), 511-522.
• Li, S., Galynker, I. I., Briggs, J., Duffy, M., Frechette-Hagan, A., Kim, H. J., Cohen, L. J., & Yaseen, Z. S. (2017). Attachment style and suicide behaviors in high risk psychiatric inpatients following hospital discharge: The mediating role of entrapment. Psychiatry Research, 257, 309-314. https://doi.org/10.1016/j.psychres.2017.07.072.
• Lolas, F., Gomez, A., & Suarez, L. (1991). EPQ-R and suicide attempt: The relevance of psychoticism. Personality and Individual Differences, 12(9), 899-902. https://doi.org/10.1016/0191-8869(91)90178-E
• Mikulincer, M., & Shaver, P. R. (2012). An attachment perspective on psychopathology. World Psychiatry: Official Journal of the World Psychiatric Association (WPA), 11(1), 11–15. https://doi.org/10.1016/j.wpsyc.2012.01.003
• Milliyet. (2022). Medical student found dead at home. Retrieved from https://www.milliyet.com.tr/gundem/evinde-olu-bulunan-tip-ogrencisinin-cenazesi-gozyaslari-icinde-alindi-6752919
• Murphy, B., & Bates, G. W. (1997). Adult attachment style and vulnerability to depression. Personality and Individual Differences, 22(6), 835-844. https://doi.org/10.1016/S0191-8869(96)00277-2
• Nagra, G. S., Lin, A., & Upthegrove, R. (2016). What bridges the gap between self-harm and suicidality? The role of forgiveness, resilience, and attachment. Psychiatry Research, 241, 78-82. https://doi.org/10.1016/j.psychres.2016.04.103
• NTV. (2022a). Letter of Dr. Mustafa Yalçın, who committed suicide in Bursa, emerges. Retrieved from https://www.ntv.com.tr/turkiye/bursada-intihar-eden-doktor-mustafa-yalcinin-mektubu-ortaya-cikti,5H7wDgEs0E29oeKSN9wihg
• NTV. (2022b). Medical student Enes Kara commits suicide in Elazığ. Retrieved from https://www.ntv.com.tr/turkiye/elazigda-tip-ogrencisi-enes-kara-intihar-etti,jtY5ZCN4MkaLms1_1YjwIQ
• O'Neill, C., Pratt, D., Kilshaw, M., Ward, K., Kelly, J., & Haddock, G. (2021). The relationship between self‐criticism and suicide probability. Clinical Psychology & Psychotherapy, 28(6), 1445-1456. https://doi.org/10.1002/cpp.2593
• Organization for Economic Co-operation and Development (OECD). (2016). Education at A Glance 2016: OECD indicators. OECD Publishing.
• Önen, S., İnel, A., Biçer Kanat, B., Taymur, İ., & Eraybay, S. (2017). Comparison of Childhood Traumatic Experience and Attachment Styles among Patients Who Attempt Suicide with Drugs and the Healthy Control Group. Bilişsel Davranışçı Psikoterapi ve Araştırmalar Dergisi, 6(2), 51-58. http://dx.doi.org/10.5455/JCBPR.244662
• Özer, Ü., Yıldırım, E. A., & Erkoç, Ş. N. (2015). Relationship of Suicidal Ideation and Behavior to Attachment Style in Patients with Major Depression. Archives of Neuropsychiatry, 52, 283-288. https://doi.org/10.5152/npa.2015.7459
• Patten, S. B., Williams, J., Lavorato, D. H., Bulloch, A., Wiens, K., & Wang, J. (2016). Why is major depression prevalence not changing?. Journal of Affective Disorders, 190, 93–97. https://doi.org/10.1016/j.jad.2015.09.002
• Pearce, J., Simpson, J., Berry, K., Bucci, S., Moskowitz, A., & Varese, F. (2017). Attachment and dissociation as mediators of the link between childhood trauma and psychotic experiences. Clinical Psychology & Psychotherapy, 24(6), 1304-1312. https://doi.org/10.1002/cpp.2100
• Pistole, M. C. (1996). After love: Attachment styles and grief themes. The Family Journal, 4(3), 199-207. https://doi.org/10.1177%2F1066480796043003
• Ponizovsky, A. M., Vitenberg, E., Baumgarten‐Katz, I., & Grinshpoon, A. (2013). Attachment styles and affect regulation among outpatients with schizophrenia: Relationships to symptomatology and emotional distress. Psychology and Psychotherapy: Theory, Research, and Practice, 86(2), 164-182. https://doi.org/10.1111/j.2044-8341.2011.02054.x
• Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40(3), 879-891.
• Prinstein, M. J., Boergers, J., Spirito, A., Little, T. D., & Grapentine, W. L. (2000). Peer functioning, family dysfunction, and psychological symptoms in a risk factor model for adolescent inpatients' suicidal ideation severity. Journal of Clinical Child Psychology, 29(3), 392-405. https://doi.org/10.1207/S15374424JCCP2903_10
• Reinherz, H. Z., Giaconia, R. M., Silverman, A. B., Friedman, A., Pakiz, B., Frost, A. K., & Cohen, E. (1995). Early psychosocial risks for adolescent suicidal ideation and attempts. Journal of the American Academy of Child & Adolescent Psychiatry, 34(5), 599-611. https://doi.org/10.1097/00004583-199505000-00012
• Ribeiro, J. D., Huang, X., Fox, K. R., & Franklin, J. C. (2018). Depression and hopelessness as risk factors for suicide ideation, attempts, and death: meta-analysis of longitudinal studies. The British Journal of Psychiatry, 212(5), 279-286. https://doi.org/10.1192/bjp.2018.27
• Schernhammer, E. (2005). Taking their own lives—the high rate of physician suicide. New England Journal of Medicine, 352(24), 2473-2476.
• Shi, M., Liu, L., Wang, Z. Y., & Wang, L. (2015). The mediating role of resilience in the relationship between big five personality and anxiety among Chinese medical students: a cross-sectional study. PloS One, 10(3), e0119916.
• Strand, J., Goulding, A., & Tidefors, I. (2015). Attachment styles and symptoms in individuals with psychosis. Nordic Journal of Psychiatry, 69(1), 67-72. https://doi.org/10.3109/08039488.2014.929740
• Suicide Prevention Now (Spetember, 2022). Public Perception of Mental Health and Suicide Prevention Survey Results. https://suicidepreventionnow.org/static/executive-summary-2022-9c5a59e0f8016f1803570b11cfd3cb29.pdf
• Sümer, N., & Güngör, D. (1999). Psychometric evaluation of adult attachment measures on Turkish samples and a cross-cultural comparison. Türk Psikoloji Dergisi, 14(43), 71-106.
• Şahin, N. H., & Batıgün, A. D. (2000). Suicide Probability and Reasons for Living. Unpublished Research.
• Şenses Dinç, G., Çöp, E., Göker, Z., Şahin, M., Bilgili, D., Hekim, Ö., Dibek Mısıroğlu, E., Kurt, F., & Üneri, Ö. Ş. (2020). The Relationship Between Suicidal Behavior and Features of Mother Attachment in Adolescents. Turkish Journal of Pediatric Disease, 14(1), 16-21. https://doi.org/10.12956/tchd.654301
• Turkish Language Association (TDK). (2022). Current Turkish Dictionary. Retrieved August 16, 2022, from https://sozluk.gov.tr/
• Turkish Statistical Institute (TUIK). (2020). Death and Cause of Death Statistics, 2019. Retrieved from https://data.tuik.gov.tr/Bulten/Index?p=Olum-ve-Olum-Nedeni-Istatistikleri-2019-33710
• Turkish Statistical Institute (TUIK). (2022). Suicide statistics for 2019. https://biruni.tuik.gov.tr/medas/?kn=115&locale=tr
• Uzbaş Uğur, E. (2021). The Relationship Between Attachment Styles, Self -Compassion, Coping Styles and Psychological Symptoms among University Students (Publication no: 671687) [Master Thesis, Hacettepe University]. CoHE Thesis Center.
• Ventriglio, A., Watson, C., & Bhugra, D. (2020). Suicide among doctors: A narrative review. Indian Journal of Psychiatry, 62(2), 114-120.
• World Health Organization (‎2019)‎. Suicide in the world: global health estimates. Retrieved from  https://apps.who.int/iris/handle/10665/326948.
• World Health Organization (2021). Suicide worldwide in 2019; Global Health Estimates. Retrieved from https://www.who.int/publications/i/item/9789240026643
• Yalvaç, H. D., Kaya, B., & Ünal, S. (2014). Personality disorders and some clinical variables in suicidal individuals, Anadolu Psikiyatri Dergisi, 15(1), 24-30. https://dx.doi.org/10.5455/apd.40634
• Yıldız Miniksar, D., Kılıç, B., Kılıç, M., Miniksar, Ö. H., Topçu, Y., & Aydın, K. (2022). Evaluation of suicide probability in children and adolescents with epilepsy. Pediatrics International, 64(1), e15130. https://doi.org/10.1111/ped.15130
• Zeyrek, E. Y., Gençöz, F., Bergman, Y., & Lester, D. (2009). Suicidality, problem-solving skills, attachment style, and hopelessness in Turkish students. Death Studies, 33(9), 815-827, https://doi.org/10.1080/07481180903142407