Phd in CLINICAL EXPERIMENTAL NEUROSCIENCE AND PSYCHIATRY

Thesis title: Abuso emotivo e stati mentali pre-suicidari: studio dei potenziali mediatori in un campione di pazienti con diagnosi psichiatrica

The presence of childhood traumas and abuse, associated with insecure attachment and mentalization deficits, can lead to harmful consequences for both mental and physical health, exacerbating psychopathological symptoms and promoting the adoption of dysfunctional coping strategies. In this context, suicide risk is one of the potential outcomes associated with abnormal developmental trajectories. Therefore, it is crucial to identify the reciprocal relationships among these constructs to design more effective prevention strategies and interventions. The main aim of the present study was to assess a sample of psychiatric inpatients and explore the associations between childhood maltreatment, adult attachment styles, reflective functioning, and pre-suicidal mental states. The measures used to test the hypothesis were: the Childhood Trauma Questionnaire (CTQ) to assess childhood maltreatments, the Attachment Style Questionnaire (ASQ) to evaluate adult attachment styles, the Reflective Functioning Questionnaire (RFQ) to investigate reflective functioning deficits, and the Suicide Crisis Evaluation Scale (SCES) to assess the pre-suicidal mental states. The sample included 255 inpatients at the psychiatric ward of Sant’Andrea Hospital in Rome. The first part of the study examined specific characteristics associated with the SCES and the results showed that patients with depressive disorders and personality disorders had significantly higher SCES scores; moreover, individuals with a suicide attempt within the past 3 months reported higher SCES scores, suggesting that these mental states may represent a prodromal framework for suicide risk and may persist in those who have recently attempted suicide. The second part focused on the association between childhood maltreatment, reflective functioning, adult attachment styles, and pre-suicidal mental states. The findings have highlighted that higher SCES scores were associated with childhood emotional abuse, reflective functioning deficits, and adult attachment styles. Linear regression analysis has shown that the SCES score was predicted by emotional abuse, secure attachment, secure and anxious attachment, and hypomentalization. Finally, the mediation model has shown that the relationship between childhood emotional abuse and pre-suicidal mental states was mediated by anxious attachment and hypomentalization, beyond the effect of secure attachment. In summary, exposure to psychological abuse during childhood increases the likelihood of developing mental states prodromal of suicide risk, through its impact on the development of anxious attachment and mentalization deficits. These findings underline the need of considering and understanding the complexity and uniqueness of individual’s experiences to build a treatment and a therapeutic relationship that consider both the potential and actual implications of trauma while providing a secure base to elaborate adverse events and restore a more adaptive trajectory in which suicidal behavior is no longer considered as the only option.