Association of adult attachment and suicidal ideation in primary care patients with multiple chronic conditions

Abstract Background Suicidal ideation is a common health concern in primary care. Attachment theory indicates that subjects with higher anxiety and/or avoidance may be more susceptible to suicidal ideation. Therefore, the aim of our study was to examine the association of attachment anxiety, avoidance, and suicidal ideation in middle-aged to elderly, chronically ill primary care patients. Methods The APRICARE Study comprised 207 patients aged 50–85 years with a minimum of three chronic diseases. Adult attachment, depressive symptoms and suicidal ideation were measured via the self-report questionnaires Experiences in Close Relationships–Revised (ECR-RD12) and Patient Health Questionnaire – 9 (PHQ-9). Univariable and adjusted associations of suicidal ideation with ECR-RD12-attachment anxiety, ECR-RD12-attachment avoidance, and ECR-RD12-insecure adult attachment were examined via logistic regression analyses. Results Suicidal ideation was present in 13% of all patients. ECR-RD12-anxiety was significantly associated with suicidal ideation (OR = 1.88, CI 1.44–2.44), while ECR-RD12-avoidance was not associated. In patients with suicidal ideation, 85% were insecurely attached compared to 63% in those without suicidal ideation – thus the OR for suicidal ideation in insecurely attached patients was 3.33 (CI = 1.10–10.04) with securely attached patients as reference. Further variables associated with suicidal ideation were depressive symptomatology, living alone (especially in men) and obesity (especially in women). Limitations The study was cross-sectional in design, and suicidal ideation was assessed using a single item self-report measure. Conclusion General practitioners should be aware of attachment styles in order to have a better chance to identify patients at risk for suicide.