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Attachment Styles and Posttraumatic Growth Among Suicide-Loss Survivors

The Mediating Role of Interpersonal Factors

Published Online:October 12, 2018https://doi.org/10.1027/0227-5910/a000550

Abstract

Abstract.Background and aims: The world loses approximately one million people to suicide every year, leaving behind many suicide-loss survivors, family members and friends, who are significantly affected by the traumatic loss. Yet some suicide-loss survivors not only manage to cope with the loss, but actually experience posttraumatic growth (PTG). To date, no studies have fully examined the psychological processes that underlie this personal positive change. We hypothesized that attachment style would predict PTG and this association would be mediated by self-disclosure and social support. Method: A community sample of 131 suicide-loss survivors (108 women), aged 18–70, self-reported on attachment style, self-disclosure, social support, and PTG. Results: Securely attached individuals scored highest on PTG compared with other attachment styles. A structural equation model confirmed that self-disclosure and social support mediated the association between attachment and PTG. Suicide-loss survivors with secure attachment tended to self-disclose more and to perceive greater support from others than did suicide-loss survivors with insecure attachment, thus enhancing their chances of PTG. Limitations: The sample comprised mostly female participants, and the findings may not be directly generalizable to male suicide-loss survivors. Conclusion: Our results suggest that different psychological interventions should be utilized for suicide-loss survivors with particular attachment styles. Psychotherapies aiming to modify internal working models may be useful for enhancing PTG among survivors characterized by insecure attachment styles.

References

  • Andriessen, K., Rahman, B., Draper, B., Dudley, M., & Mitchell, P. B. (2017). Prevalence of exposure to suicide: A meta-analysis of population-based studies. Journal of Psychiatric Research, 88, 113–120. First citation in articleCrossref Medline, Google Scholar

  • Arikan, G., Stopa, L., Carnelley, K. B., & Karl, A. (2016). The associations between adult attachment, posttraumatic symptoms, and posttraumatic growth. Anxiety, Stress, & Coping, 29, 1–20. 10.1080/10615806.2015.1009833 First citation in articleCrossref Medline, Google Scholar

  • Ammaniti, M., Van Ijzendoorn, M. H., Speranza, A. M., & Tambelli, R. (2000). Internal working models of attachment during late childhood and early adolescence: An exploration of stability and change. Attachment & Human Development, 2(3), 328–346. First citation in articleCrossref Medline, Google Scholar

  • 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, 226–244. 10.1037/0022-3514.61.2.226 First citation in articleCrossref Medline, Google Scholar

  • Bentler, P. M., & Bonett, D. G. (1980). Significance tests and goodness of fit in the analysis of covariance structures. Psychological Bulletin, 88, 588–606. 10.1037/0033-2909.88.3.588 First citation in articleCrossref, Google Scholar

  • Bowlby, J. (1980). Attachment and loss (Vol. 3). New York, NY: Basic Books. First citation in articleGoogle Scholar

  • Brown, E. J., & Heimberg, R. G. (2001). Effects of writing about rape: Evaluating Pennebaker's paradigm with a severe trauma. Journal of Traumatic Stress, 14, 781–790. 10.1023/a:1013098307063 First citation in articleCrossref Medline, Google Scholar

  • Browne, M. W., & Cudeck, R. (1993). Alternative ways of assessing model fit. Sage Focus Editions, 154, 136–162. First citation in articleGoogle Scholar

  • Centers for Disease Control and Prevention. (2015). Suicide: Facts at a glance. Retrieved from http://www.cdc.gov/violenceprevention/pdf/suicide-datasheet-a.PDF First citation in articleGoogle Scholar

  • Cerel, J., McIntosh, J. L., Neimeyer, R. A., Maple, M., & Marshall, D. (2014). The continuum of "survivorship": Definitional issues in the aftermath of suicide. Suicide and Life-Threatening Behavior, 44, 591–600. 10.1111/sltb.12093 First citation in articleCrossref Medline, Google Scholar

  • Cohen, O., & Katz, M. (2015). Grief and growth of bereaved siblings as related to attachment style and flexibility. Death Studies, 39, 158–164. 10.1080/07481187.2014.923069 First citation in articleCrossref Medline, Google Scholar

  • Drapeau, C. W., & McIntosh, J. L. (2015). U.S.A. suicide 2014: Official final data [Internet]. Washington, DC: American Association of Suicidology. Retrieved from http://www.suicidology.org/Portals/14/docs/Resources/FactSheets/2014/2014datapgsv1b.pdf First citation in articleGoogle Scholar

  • Ein-Dor, T., Mikulincer, M., Doron, G., & Shaver, P. R. (2010). The attachment paradox: How can so many of us (the insecure ones) have no adaptive advantages? Perspectives on Psychological Science, 5, 123–141. 10.1177/1745691610362349 First citation in articleCrossref Medline, Google Scholar

  • Feigelman, W., Gorman, B. S., & Jordan, J. R. (2009). Stigmatization and suicide bereavement. Death Studies, 33, 591–608. 10.1080/07481180902979973 First citation in articleCrossref Medline, Google Scholar

  • Feigelman, W., Cerel, J., & Sanford, R. (2018). Disclosure in traumatic deaths as correlates of differential mental health outcomes. Death Studies, 42(7), 456–462. 10.1080/07481187.2017.1372533 First citation in articleCrossref Medline, Google Scholar

  • Field, N. P., & Sundin, E. C. (2001). Attachment style in adjustment to conjugal bereavement. Journal of Social and Personal Relationships, 18, 347–361. 10.1177/0265407501183003 First citation in articleCrossref, Google Scholar

  • Fonagy, P. (2001). The human genome and the representational world: The role of early mother-infant interaction in creating an interpersonal interpretive mechanism. Bulletin of the Menninger Clinic, 65, 427–448. 10.1521/bumc.65.3.427.19844 First citation in articleCrossref Medline, Google Scholar

  • Fraley, R. C. (2007). Using the Internet for personality research: What can be done, how to do it, and some concerns. In R. W. RobinsR. C. FraleyR. F. KruegerEds., Handbook of research methods in personality psychology (pp. 130–148). New York, NY: Guilford Press. First citation in articleGoogle Scholar

  • Hayes, A. F. (2009). Beyond Baron and Kenny: Statistical mediation analysis in the new millennium Communication Monographs, 76(4), 408–420. 10.1080/03637750903310360 First citation in articleCrossref, Google Scholar

  • Hesse, E. (2008). The Adult Attachment Interview: Protocol, method of analysis, and empirical studies. In J. CassidyP. R. ShaverEds., Handbook of attachment: Theory, research, and clinical applications, (2nd ed., pp. 552–598). New York, NY: Guilford Press. First citation in articleGoogle Scholar

  • Ho, S. M., Chan, I. S., Ma, E. P., & Field, N. P. (2013). Continuing bonds, attachment style, and adjustment in the conjugal bereavement among Hong Kong Chinese. Death Studies, 37, 248–268. 10.1080/07481187.2011.634086 First citation in articleCrossref Medline, Google Scholar

  • Jayawickreme, E., & Blackie, L. E. (2014). Post-traumatic growth as positive personality change: Evidence, controversies and future directions. European Journal of Personality, 28, 312–331. 10.1002/per.1963 First citation in articleCrossref, Google Scholar

  • Jordan, J. R. (2001). Is suicide bereavement different? A reassessment of the literature. Suicide and Life-threatening Behavior, 31, 91–102. 10.1521/suli.31.1.91.21310 First citation in articleCrossref Medline, Google Scholar

  • Jordan, J. R. (2008). Bereavement after suicide. Psychiatric Annals, 38, 679–685. 10.3928/00485713-20081001-05 First citation in articleCrossref, Google Scholar

  • Kahn, R. L., & Antonucci, T. C. (1980). Convoys over the life course: Attachment, roles, and social support. Life-span Development and Behavior, 3, 253–286. First citation in articleGoogle Scholar

  • Kahn, J. H., & Hessling, R. M. (2001). Measuring the tendency to conceal versus disclose psychological distress. Journal of Social and Clinical Psychology, 20, 41–65. 10.1521/jscp.20.1.41.22254 First citation in articleCrossref, Google Scholar

  • Kanninen, K., Punamäki, R. L., & Qouta, S. (2003). Personality and trauma: Adult attachment and posttraumatic distress among former political prisoners. Peace and Conflict: Journal of Peace Psychology, 9, 97–126. 10.1207/s15327949pac0902_01 First citation in articleCrossref, Google Scholar

  • Levi-Belz, Y. (2015). Stress-related growth among suicide survivors: The role of interpersonal and cognitive factors. Archives of Suicide Research, 19, 305–320. 10.1080/13811118.2014.957452 First citation in articleCrossref Medline, Google Scholar

  • Levi-Belz, Y. (2016). To share or not to share? The contribution of self-disclosure to stress-related growth among suicide survivors. Death Studies, 40, 405–413. 10.1080/07481187.2016.1160164 First citation in articleCrossref Medline, Google Scholar

  • Levi-Belz, Y. (2017). Relationship with the deceased as facilitator of posttraumatic growth among suicide-loss survivors. Death Studies, 41(6), 376–384. 10.1080/07481187.2017.1285372 First citation in articleCrossref Medline, Google Scholar

  • Levi-Belz, Y., Gvion, Y., Horesh, N., Fischel, T., Treves, I., Or, E., … Apter, A. (2014). Mental pain, communication difficulties, and medically serious suicide attempts: A case-control study. Archives of Suicide Research, 18, 74–87. 10.1080/13811118.2013.809041 First citation in articleCrossref Medline, Google Scholar

  • 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. First citation in articleMedline, Google Scholar

  • Main, M., & Solomon, J. (1990). Procedures for identifying infants as disorganised/disoriented during the Ainsworth Strange Situation. In M. T. GreenbergD. CicchettiE. M. CummingsEds., Attachment in the preschool years (pp. 121–160). Chicago, IL: University of Chicago Press. First citation in articleGoogle Scholar

  • Mallinckrodt, B. (2000). Attachment, social competencies, social support, and interpersonal process in psychotherapy. Psychotherapy Research, 10, 239–266. 10.1093/ptr/10.3.239 First citation in articleCrossref, Google Scholar

  • Mikulincer, M. (1997). Adult attachment style and information processing: Individual differences in curiosity and cognitive closure. Journal of Personality and Social Psychology, 72, 1217–1230. 10.1037/0022-3514.72.5.1217 First citation in articleCrossref Medline, Google Scholar

  • Mikulincer, M., & Florian, V. (1998). The relationship between adult attachment styles and emotional cognitive reactions to stressful events. In J. A. SimpsonW. S. RholesEds., Attachment theory and close relationships (pp. 143–165). New York, NY: The Guilford Press. First citation in articleGoogle Scholar

  • Mikulincer, M., & Nachshon, O. (1991). Attachment styles and patterns of self-disclosure. Journal of Personality and Social Psychology, 61, 321–331. 10.1037/0022-3514.61.2.321 First citation in articleCrossref, Google Scholar

  • Mikulincer, M., & Shaver, P. R. (2002). Attachment-related psychodynamics. Attachment and Human Development, 4, 133–161. 10.1080/14616730210154171 First citation in articleCrossref Medline, Google Scholar

  • Mikulincer, M., & Shaver, P. R. (2008). An attachment perspective on bereavement. In M. S. StroebeR. O. HanssonH. SchutW. StroebeEds., Handbook of bereavement research and practice: Advances in theory and intervention (pp. 87–112). Washington, DC: American Psychological Association. First citation in articleGoogle Scholar

  • Mitchell, A. M., Kim, Y., Prigerson, H. G., & Mortimer-Stephens, M. (2004). Complicated grief in survivors of suicide. Crisis, 25, 12–18. 10.1027/0227-5910.25.1.12 First citation in articleLink, Google Scholar

  • Mitchell, A. M., & Terhorst, L. (2017). PTSD symptoms in survivors bereaved by the suicide of a significant other. Journal of the American Psychiatric Nurses Association, 23, 61–65. 10.1177/1078390316673716 First citation in articleCrossref Medline, Google Scholar

  • Mohr, J. J., & Fassinger, R. E. (2003). Self-acceptance and self-disclosure of sexual orientation in lesbian, gay, and bisexual adults: An attachment perspective. Journal of Counseling Psychology, 50, 482–495. 10.1037/0022-0167.50.4.482 First citation in articleCrossref, Google Scholar

  • Moore, M. M., Cerel, J., & Jobes, D. A. (2015). Fruits of trauma? Posttraumatic growth among suicide-bereaved parents. Crisis, 36, 241–248. 10.1027/0227-5910/a000318 First citation in articleLink, Google Scholar

  • Osman, A., Lamis, D. A., Freedenthal, S., Gutierrez, P. M., & McNaughton-Cassill, M. (2014). The multidimensional scale of perceived social support: Analyses of internal reliability, measurement invariance, and correlates across gender. Journal of Personality Assessment, 96, 103–112. 10.1080/00223891.2013.838170 First citation in articleCrossref Medline, Google Scholar

  • Park, C. L. (1998). Implication of posttraumatic growth for individuals. In R. G. TedeschiC. L. ParkL. G. CalhounEds., Posttraumatic growth: Positive changes in the aftermath of crisis (pp. 153–177). Mahwah, NJ: Lawrence Erlbaum Associates, Inc. First citation in articleGoogle Scholar

  • Pietromonaco, P. R., & Barrett, L. F. (2000). The internal working models concept: What do we really know about the self in relation to others? Review of General Psychology, 4, 155–175. 10.1037//1089-2680.4.2.155 First citation in articleCrossref, Google Scholar

  • Pompili, M., Lester, D., De Pisa, E., Del Casale, A., Tatarelli, R., & Girardi, P. (2008). Surviving the suicides of significant others. Crisis, 29, 45–48. 10.1027/0227-5910.29.1.45 First citation in articleLink, Google Scholar

  • Salo, J. A., Qouta, S., & Punamäki, R. L. (2005). Adult attachment, posttraumatic growth and negative emotions among former political prisoners. Anxiety, Stress, and Coping, 18, 361–378. 10.1080/10615800500289524 First citation in articleCrossref, Google Scholar

  • Schmidt, S. D., Blank, T. O., Bellizzi, K. M., & Park, C. L. (2012). The relationship of coping strategies, social support, and attachment style with posttraumatic growth in cancer survivors. Journal of Health Psychology, 17, 1033–1040. 10.1177/1359105311429203 First citation in articleCrossref Medline, Google Scholar

  • Smith, A., Joseph, S., & Das Nair, R. (2011). An interpretative phenomenological analysis of posttraumatic growth in adults bereaved by suicide. Journal of Loss and Trauma, 16, 413–430. 10.1080/15325024.2011.572047 First citation in articleCrossref, Google Scholar

  • Stiles, W. B. (1987). I have to talk to somebody: A fever model of disclosure. In V. J. DerlegaJ. H. BergEds., Self-disclosure: Theory, research, and therapy (pp. 257–282). New York, NY: Plenum. First citation in articleGoogle Scholar

  • Sullivan, H. S. (1953). The collected works (Vol. 1). New York, NY: W. W. Norton. First citation in articleGoogle Scholar

  • Taylor, P., Rietzschel, J., Danquah, A., & Berry, K. (2015). Changes in attachment representations during psychological therapy. Psychotherapy Research, 25(2), 222–238. First citation in articleCrossref Medline, Google Scholar

  • Tedeschi, R. G., & Calhoun, L. G. (1995). Trauma & transformation: Growing in the aftermath of suffering. Thousand Oaks, CA: Sage Publications. First citation in articleCrossref, Google Scholar

  • Tedeschi, R. G., & Calhoun, L. G. (1996). The Posttraumatic Growth Inventory: Measuring the positive legacy of trauma. Journal of Traumatic Stress, 9, 455–471. 10.1002/jts.2490090305 First citation in articleCrossref Medline, Google Scholar

  • Tedeschi, R. G., & Calhoun, L. G. (2004). Posttraumatic growth: Conceptual foundations and empirical evidence. Psychological Inquiry, 15(1), 1–18. First citation in articleCrossref, Google Scholar

  • Turunen, T., Haravuori, H., Punamäki, R. L., Suomalainen, L., & Marttunen, M. (2014). The role of attachment in recovery after a school-shooting trauma. European Journal of Psychotraumatology, 5, 22728. 10.3402/ejpt.v5.22728 First citation in articleCrossref, Google Scholar

  • Van Orden, K. A., Witte, T. K., Cukrowicz, K. C., Braithwaite, S., Selby, E. A., & Joiner, T. E., Jr. (2010). The interpersonal theory of suicide. Psychological Review, 117, 575–600. 10.1037/a0018697 First citation in articleCrossref Medline, Google Scholar

  • Wayment, H. A., & Vierthaler, J. (2002). Attachment style and bereavement reactions. Journal of Loss &Trauma, 7, 129–149. 10.1080/153250202753472291 First citation in articleCrossref, Google Scholar

  • Wei, M., Russell, D. W., & Zakalik, R. A. (2005). Adult attachment, social self-efficacy, self-disclosure, loneliness, and subsequent depression for freshman college students: A longitudinal study. Journal of Counseling Psychology, 52, 602–614. 10.1037/0022-0167.52.4.602 First citation in articleCrossref, Google Scholar

  • Worden, J. W. (2008). Grief counseling and grief therapy: A handbook for the mental health practitioner. New York, NY: Springer. First citation in articleCrossref, Google Scholar

  • Zimet, G. D., Dahlem, N. W., Zimet, S. G., & Farley, G. K. (1988). The Multidimensional Scale of Perceived Social Support. Journal of Personality Assessment, 52, 30–41. 10.1207/s15327752jpa5201_2 First citation in articleCrossref, Google Scholar