The mediating role of attachment and mentalising in the relationship between childhood trauma, self-harm and suicidality
Although the relationship between childhood trauma, self-harm and suicidality is well-established, less is known about the mediating mechanisms explaining it. Based on a developmental mentalisation-based theoretical framework, childhood adversity compromises mentalising ability and attachment security, which in turn increase vulnerability to later stressors in adulthood. This study aimed, thus, to investigate the role of attachment and mentalising as potential mechanisms in this relationship. In a cross-sectional design, 907 adults from clinical and community settings completed self-report questionnaires on retrospectively rated childhood trauma, and current attachment to the romantic partner, mentalising, self-harm, suicidal ideation and attempt. Structural equation modelling was used to examine the data and childhood trauma was conceptualised as a general factor in a confirmatory bifactor model. The results showed that childhood trauma was both directly associated with self-harm and suicidality and indirectly via the pathways of attachment and mentalising. These findings indicate that insecure attachment and impaired mentalising partially explain the association between childhood trauma, self-harm and suicidality. Clinically, they provide support for the potential of mentalisation-based therapy or other psychosocial interventions that aim to mitigate the risk of self-harm and suicidality among individuals who have experienced childhood maltreatment via increasing understanding of self and other mental states.