Exploring associations between mentalisation, expressed emotion, self-harm, and attachment: a research portfolio
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Date
01/12/2021Item status
Restricted AccessEmbargo end date
01/12/2022Author
Kennedy-Turner, Jamie
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Abstract
Background: Research indicates that both familial Expressed Emotion (EE) and
attachment security are associated with mental health outcomes for children and
young people. This research portfolio investigates the associations between EE and
attachment. It aims to determine whether there is a relationship between the two
constructs, and how they may be connected to adolescent self-harm, a common
transdiagnostic behaviour which is a major public health concern given its associations
with psychological disorder and attempted and completed suicide.
Objectives: A systematic review was conducted to identify, collate, and appraise
research reporting associations between parental EE and caregiver-child attachment.
An empirical project was conducted to better understand the associations between
adolescent self-harm and perceived EE, attachment insecurity, and reflective
functioning (RF), each of which has been associated with self-harm in past studies.
Methods: Systematic review: A thorough search of electronic databases was
conducted to identify eligible studies which investigated the associations between
parental EE and caregiver-child attachment. These studies were assessed for quality
using a standardised set of criteria and a narrative synthesis was conducted to collate
research findings. Empirical project: A cross-sectional design was used. Participants
aged 16 to 24 years completed an online survey containing a series of self-report
questionnaires. A hierarchical serial mediation model, whereby attachment insecurity
and RF mediated the relationship between perceived EE and adolescent self-harm,
was tested using path analysis in IBM SPSS Amos.
Results: Systematic review: Nine studies were identified. From the extant evidence,
no conclusive associations between parental EE and caregiver-child attachment have
been established. Several studies reported that higher levels of parental EE were
associated with attachment insecurity and disorganisation, but variability in
measurement methods and study populations make comparisons challenging to draw.
Empirical study: 377 participants aged 16 to 24 years gave full responses to the
survey, reporting on one or two caregivers each. Responses were split into female
and male caregiver databases. Statistical analyses revealed significant direct effects
of perceived EE on attachment insecurity, and significant direct effects of RF on
self-harm in both databases. A significant indirect effect of perceived EE on self-harm
through attachment anxiety and RF was obtained in the female caregiver dataset only.
Conclusions: Systematic review: Previous studies have not evidenced a robust
association between parental EE and child attachment, and the current evidence base
has several methodological issues. Empirical study: Both attachment anxiety and RF
mediated the relationship between perceived EE and adolescent self-harm for female
caregivers only, and direct effects on self-harm were obtained for RF only.
This suggests that family-based approaches, attachment-focused interventions,
and mentalization-based therapy may be useful interventions for adolescent
self-harm.