Attachment styles and suicidal thoughts and behaviors: a meta-analysis

Introduction: This meta-analysis examined the association between dimensional and categorical conceptualizations of attachment styles and suicidal thoughts and behaviors (STBs). Methods: Random-effects meta-analysis was conducted to examine the associations between categorical secure attachment, categorical insecure attachment, and insecure attachment dimensions and STBs. Methodological moderators were also explored. This protocol was registered in PROSPERO (CRD42020152604). Results: Systematic search for articles published by December 2020 returned 58 eligible studies and 159 cross-sectional effects. Secure attachment was inversely associated with suicidal thoughts and not associated with suicide attempts. All categorical insecure attachment styles were positively associated with suicidal thoughts. Only fearful and preoccupied attachment were associated with risk for suicide attempts. Dimensional attachment anxiety was more strongly associated with suicidal thoughts and attempts than dimensional attachment avoidance. Discussion: Overall, attachment styles characterized by high attachment anxiety were associated with greatest vulnerability to STBs. Longitudinal studies are needed to better understand the association between attachment insecurity and STBs.