Attachment Concepts and Suicidal Thoughts and Behaviours in Adolescents: A Systematic Review and Meta-Analysis.

This review provided a meta-analysis, narrative synthesis and quality appraisal of quantitative studies examining associations between adolescent attachment concepts and suicidal ideation and suicide attempts among adolescents. A systematic search of PsycINFO, PubMed, EMBASE, Web of Science and CINAHL was undertaken. Studies on attachment and suicidal ideation or attempts in adolescents aged 10-24 years were included. Fifty-four studies met inclusion criteria. Subgroup meta-analyses showed small associations with suicidal ideation for attachment security (r = -0.161) and attachment anxiety (r = 0.198). Avoidance was not significantly associated with ideation (r = 0.061). Narrative synthesis suggested a weak link between attachment anxiety and suicide attempts, while the association with avoidance remained uncertain. Lower attachment quality, lower parental care and higher parental overprotection were associated with both ideation and attempts. Heterogeneity was high across most subgroups, and potential publication bias was detected for the parental overprotection group, warranting caution in interpretation. Findings also suggested mediating roles for interpersonal and emotional difficulties and moderating roles for social support and environmental sensitivity. These findings align with adult models of suicidal thoughts and behaviour, suggesting they can be extended to adolescents. Based on these findings, clinical implications could include enhancing attachment security, improving emotional management, addressing difficulties in developing relationships with others, providing support for adolescents experiencing low social support and fostering positive family and school environments. Future research should evaluate these interventions using randomised controlled trials with sufficient samples to examine mediators and moderators of change.