Attachment and social adjustment: Relationships to suicide attempt and major depressive episode in a prospective study

Objective: To study two aspects of interpersonal function - attachment security and social adjustment - in relation to suicide attempt and major depressive episode (MDE) during naturalistic follow-up of up to one year after presentation with MDE. Method: 136 adults who presented with a DSM-IV MDE completed the Adult Attachment Scale and the Social Adjustment Scale-Self Report at study entry. Based on follow-up interviews at three months and one year, we used survival analysis to investigate the relationship of scores on these measures with time to a suicide attempt and time to recurrent MDE. Results: Less secure/more avoidant attachment predicted increased risk of suicide attempt during the 1-year follow-up (Wald chi(2) = 9.14, df = 1, p = 0.003, HR = 1.16, 95% CI =1.05 to 1.27). Poorer social adjustment predicted increased risk of recurrent MDE (Wald,chi(2) = 6.95, df = 1, p = 0.008, HR = 2.36, 95% CI = 1.25 to 4.46), and that in turn increased the risk of a suicide attempt (z = 4.19, df = 1, p < 0.001, HR = 17.3, 95% CI = 4.6 to 65.5). Conclusions: Avoidant attachment in the setting of major depressive disorder is a potential therapeutic target to prevent suicidal behavior. Enhancing social adjustment may reduce relapse in major depressive disorder and thereby reduce risk of a suicide attempt. Study limitations include small sample size and use of a self-report attachment scale. 2009 Elsevier B.V. All rights reserved.