Secure Attachment Buffers the Impact of Early Childhood Emergency Room Encounters on Long-Term Emotional Problems

Abstract Childhood medical experiences in the emergency room, including pain, injury, and fear of uncertainty, are known as risk factors for later psychological stress. However, there is limited empirical research on protective factors that can mitigate the adverse effects of children’s early emergency room experiences on later psychological outcomes. This study employed hierarchal moderated linear regression to examine the moderating role of children’s attachment security at age 3 in the association between emergency room visits at age 3 and emotional and behavioral difficulties at age 5. The moderation regression model without covariates indicated emergency room visits (0 = no , 1 = one or more in the past year ) were a significant predictor of long-term emotional and behavioral difficulties (β = .10, p = < .001). Furthermore, attachment security moderated this association (β = − .06, p = .003). For children with low attachment security (M-1SD), emergency room visits predicted greater emotional and behavioral difficulties (β = .10, p = < .001). Meanwhile, this association was not significant for children with average or high (M+1SD) attachment security (β = .04, p = .07; β = − .02, p = .41). This moderation remained significant in the final moderation model with covariates. These results suggest that attachment security may serve as a protective factor that buffers the negative effects of emergency room experiences on later psychological outcomes. Further research should explore contextual mechanisms of emergency room visits and evaluate the efficacy of attachment-based interventions.