After a suicide attempt, the patient's attachment anxiety meets the clinician's
- Patients surveyed 2 to 14 days after a suicide attempt (n = 185, aged 16–27) scored higher on attachment anxiety than psychiatrists with at least five years of hospital experience (n = 168): 3.77 (SD 1.37) versus 2.81 (SD 1.23), t(351) = -6.77, Cohen's d = 0.74.
- Attachment avoidance did not differ significantly: 2.96 (SD 1.07) in patients and 3.14 (SD 1.10) in psychiatrists, d = 0.17.
- Attachment anxiety rose with suicidal history: 3.2 among patients who denied suicidal intent, 3.9 after one attempt and 4.1 after several. Only the one-attempt and several-attempt groups differed significantly from the psychiatrists (2.8).
- The authors warn that an anxiously attached, "clingy" patient may irritate the doctor and be seen as intrusive, with a risk of rejection and early termination of treatment. They advise against abruptly cutting off this way of relating.
A patient two days after an overdose asks the ward doctor the same question for the third time. A Moscow study measured the attachment of patients like this and, with the same questionnaire, of the psychiatrists who treat them.
Three groups, one questionnaire
Chistopolskaya and Enikolopov surveyed 185 patients aged 16 to 27 in the acute toxicology units of the Sklifosovsky Institute, 2 to 14 days after a suicide attempt. Forty-two denied suicidal intent, 108 reported one attempt and 35 reported two or more. The comparison groups were 168 psychiatrists from Tula and Saint Petersburg with at least five years in a psychiatric hospital, and 156 Moscow humanities students. Attachment was measured with a short Russian version of Experiences in Close Relationships – Revised, alongside time perspective, hardiness, depression and attitudes to death. The pooled patient–psychiatrist comparison is reproduced from the authors' 2019 paper in Suitsidologiya.
Anxiety, not distance
Patients scored 3.77 on attachment anxiety and psychiatrists 2.81 (t(351) = -6.77, d = 0.74). On avoidance the two sides were close, 2.96 and 3.14 (d = 0.17). Among patients, anxiety climbed from 3.2 in those who denied intent to 3.9 after one attempt and 4.1 after several.
The authors see a friction point here. A patient who keeps seeking reassurance may strike the doctor as intrusive. Their advice is to help the patient build a trusting relationship instead of abruptly cutting off the way they relate. They add that Russia currently has no full guidelines on psychotherapy for suicidal patients.
Your own score is in the room
The study did not pair patients with their own doctors. It does show a gap of almost one point between the two sides of the conversation. A clinician low on attachment anxiety may hear a third phone call as pressure. For the patient it may be a way of checking that the connection still holds.
So when a patient after an attempt starts to feel clingy, name your own reaction before acting on it. Then give the checking somewhere to go: a fixed time for the next conversation and a stated way to reach you.
When a patient after a suicide attempt starts to feel clingy, name your own irritation first, then offer a predictable time for the next contact instead of shortening it.
The authors note that the study compared groups and did not examine patients together with their treating doctors. The patient groups were surveyed once each, so the rise in attachment anxiety across them is not followed within the same people. Attachment was not measured in the student comparison group.