The Mediating Role of Emotional Dysregulation in the Relationship Between Anxious Attachment and Suicidal Behavior in Children Admitted to an Emergency Department

Child suicide rates and emergency department visits due to suicidal thoughts and behaviors (STB) are rising at an alarming rate globally. In the United States, suicide deaths among children aged 5-12 increased by 195% from 1990 to 2020, highlighting an urgent need for greater understanding of the underlying risk factors. Although poor parent-child relationships and child emotional dysregulation have been identified as correlates of STB, the precise mechanisms linking these factors remain insufficiently explored. This study aimed to examine the associations between insecure attachment styles (anxious and avoidant), emotional dysregulation and STB in children. Grounded in attachment theory, it was hypothesized that emotional dysregulation would mediate the relationship between insecure attachment and STB. A sample of 111 children aged 7-12, admitted to a pediatric emergency department (ED) for STB, completed self-report measures assessing attachment styles (ECR-RC), emotional dysregulation (DERS), and STB (C-SSRS). Cross-sectional mediation regression analyses revealed that emotional dysregulation significantly mediated the relationship between anxious attachment and suicidal behaviors. However, no mediation effect was found between avoidant attachment and suicidal thoughts. These findings suggest that children with anxious attachment styles are particularly vulnerable to experiencing emotional dysregulation associated with suicidal behaviors. The absence of a similar mediation effect for avoidant attachment and suicidal thoughts may point to distinct psychological pathways underlying different forms of STB. These results highlight the potential importance of targeting the parent-child relationship to enhance children's emotional regulation abilities, which may, in turn, reduce the risk of suicidal behaviors.