INFORMATION TO USERS This manuscript has been reproduced from the microfilm master. UMI films the text directly from the original or copy submitted. Thus, some thesis and dissertation copies are in typewriter face, while others may be from any type of computer printer. The quality of this reproduction is dependent upon the quality of the copy submitted. Broken or indistinct print, colored or poor quality illustrations and photographs, print bleedthrough, substandard margins, and improper alignment can adversely affect reproduction. In the unlikely event that the author did not send UMI a complete manuscript and there are missing pages, these will be noted. Also, if unauthorized copyright material had to be removed, a note will indicate the deletion. Oversize materials (e.g., maps, drawings, charts) are reproduced by sectioning the original, beginning at the upper left-hand comer and continuing from left to right in equal sections with small overlaps. Each original is also photographed in one exposure and is included in reduced form at the back of the book. Photographs included in the original manuscript have been reproduced xerographically in this copy. Higher quality 6” x 9” black and white photographic prints are available for any photographs or illustrations appearing in this copy for an additional charge. Contact UMI directly to order. UMI A Bell & Howell Information Company 300 North Zeeb Road, Ann Arbor MI 48106-1346 USA 313/761-4700 800/521-0600 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. ATTACHMENT STYLE, DEPRESSION AND LONELINESS IN ADOLESCENT SUICIDE ATTEMPTERS by Kolleen M. Martin submitted to the Faculty of the College of Arts and Sciences of The American University in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy in Psychology Chair:■ • Alan.L. Berman. Ph.D. g ) r S 'I Vivian. Shavne. P h . D. AnthonVTzm H.SAhrens. Ph.D . £ Janiesinies vJ. Gray. Ph.D. Dean liege Date 1995 The American University Washington, D.C. 20016 S he A E Z ic iii l iip j j vY Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. UMI Number: 9706396 UMI Microform 9706396 Copyright 1996, by UMI Company. All rights reserved. This microform edition is protected against unauthorized copying under Title 17, United States Code. UMI 300 North Zeeb Road Ann Arbor, MI 48103 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. ATTACHMENT STYLE, DEPRESSION AND LONELINESS IN ADOLESCENT SUICIDE ATTEMPTERS by Kolleen M. Martin ABSTRACT Attachment style, depression, loneliness and a variety of pychosocial factors were examined in 31 adolescents who had attempted suicide within the past year to determine if depression played a mediating role between an insecure attachment style and suicide attempts. This group was compared to two control groups, clinical and normal, which were matched for age, gender, SES and race. Loneliness was expected to be associated with an insecure attachment style. The mediating hypothesis was examined by regression and logistic regression equations comparing attempters with both control groups. Partial support was obtained for these hypotheses. Attempters were more insecurely attached and more depressed than normals, but not more than clinical controls. Depression was found to mediate the effects of an insecure attachment style on suicide attempts when comparing attempters to normals, but not to clinical controls. Loneliness scores were higher in individuals with an insecure attachment style than those with a secure style in ii Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. each of the 3 group comparisons. Loneliness predicted depression, but did not predict suicide attempts in any of the comparisons. When comparing adolescent suicide attempters to clinical controls, an insecure attachment appears to be a general risk factor for both suicidality and depression. iii Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. ACKNOWLEDGEMENTS I respectfully acknowledge the support of friends, colleagues and family members, and the sacrifices made by my children. The Chair, Alan Berman, Ph.D. has assisted in understanding the usefulness of this project. Additionally, committee members Vivian Shayne, Ph.D. and Anthony Ahrens, Ph.D. have provided invaluable guidance and displayed admirable patience with regard to the organization and completion of this study. iv Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. TABLE OF CONTENTS ABSTRACT .................................................... ii ACKNOWLEDGEMENTS............................................ iv LIST OF TABLES............................................ vii Chapter 1. INTRODUCTION..................................... 1 Risk factors............................. 4 Current models........................... 12 General model............................ 14 2. METHOD.......................................... 30 Subjects.................................. 30 Materials and procedures................ 34 3. RESULTS......................................... 40 4. DISCUSSION..................................... 57 APPENDICES ................................................ 77 A. Sources of participants........................ 77 B. Group demographics............................. 78 C. Characteristics of suicide attempts........... 79 D. Informed Consent To Participate............... 80 v Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. E. Parental Informed Consent..................... 82 F. Family and Personal History Questionnaire.... 84 G. Beck Depression Inventory..................... 87 H. UCLA Loneliness Scale (Version 3)............ 88 I. DAT and Lethality questions................... 90 J. Attachment Questionnaire...................... 93 REFERENCES ............................................... 94 vi Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. LIST OF TABLES 1. T test results and standard deviations for groups on measures of depression, loneliness and attachment style.................................................. 39 2. Regression of depression on attachment............... 41 3. Logistic regression predicting suicide attempts 45 4. Regression of depression on attachment with all clinical controls..................................... 46 5. Regression of depression on attachment and matching variables with all clinical controls................ 47 6. Logistic regression with all clinical controls...... 47 7. Regression of depression on attachment combining suicide attempters and matching clinical controls... 48 8. Logistic regression predicting suicide attempts from attachment status and depression using attempters and matching clinical controls........................... 49 9. Mean loneliness scores and t tests by attachment style.................................................. 51 10. Multiple regression of depression on loneliness 52 11. Logistic regression predicting suicide attempts from loneliness and depression............................ 53 12. Family characteristics and psychotherapy history.... 54 vii Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 13. Childhood experiences................................ 55 14. Recent and lifetime suicide thoughts and behavior... 56 viii Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. CHAPTER 1 INTRODUCTION Suicidal behavior in adolescents is a serious mental health problem. Final mortality statistics for 1992 show that suicide was the third leading cause of death in the 15-24 year age group (National Center for Health Statistics [NCHS], 1994). This represents a rate of 13.0 per 100,000 and 4,693 actual deaths. Suicide statistics however do not reflect the occurrence of serious suicidal ideation and suicide attempts, the more common types of suicidal behavior. Estimates of suicidal ideation and suicide attempts among adolescents vary somewhat, but in general offer an alarming picture of the number of adolescents who have considered taking their own lives. In a survey of 325 high school students, Smith and Crawford (1986) found that 62.5% of the students reported having had suicidal ideation but had not developed a plan, and 8.4% stated they had made an attempt. Another survey of urban high school students revealed a suicide attempt rate of 9% (Harkavy-Friedman, Asnis, Boeck, & DiFiore, 1987). Results from a survey of almost 600 9th and llth graders indicated that 34% of students had been bothered by thoughts of ending their lives in the past 12 months, and 9% had made 1 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 2 an attempt to kill themselves (Kandel, Raveis & Davies, 1991). A larger study of over 3000 high school students (Garrison, McKeown, Valois, & Vincent, 1993) found that 11% of students reported having serious suicidal thoughts, while 7.5% indicated they had made an attempt. Andrews and Lewinsohn (1992) reported a similar finding among 1700 adolescents of 7.1% for lifetime prevalence of suicide attempts. Hence,