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Exploring the Mediating Role of Mentalization in the 
Relationship Between Attachment Styles and Suicidal 

Ideation in a Non-Clinical Pakistani Sample
Hamna Ali Khan, Haya Naseem, Zara Sohail, & Arshi Shabnam

Institute of Professional Psychology, Bahria University, Karachi, Pakistan
The aim of the current study is to determine the relationship between attachment styles, mentalization, and suicidal 
ideation using a quantitative correlational survey design in a non-clinical Pakistani sample. A purposive-convenience 
sampling technique was employed to recruit N = 295 adults (males, n = 81; females, n = 214) from Pakistan, aged 18 
to 55 years (M = 23.07, SD = 5.37), using a Google survey. It was hypothesized that there is a relationship between 
attachment styles, mentalization, and suicidal ideation. Moreover, it was also hypothesized that there is a relationship 
between anxious attachment style and self-mentalization. To test the hypotheses, data were collected through three 
questionnaires: the Mentalization Scale (MentS), the Revised Adult Attachment Scale (RAAS), and the Suicidal Ide-
ation Attributes Scale (SIDAS). The study's results were analyzed using SPSS 29.0.1.0. The findings revealed that at-
tachment styles have a relationship with mentalization, self-mentalization (MentS-S), and suicidal ideation, whereas 
no significant correlation was found between mentalization and suicidal ideation. Only self-mentalization was found 
to have a negative correlation with suicidal ideation (r = −0.14, p = .01). Anxious attachment style was found to have 
a negative correlation with self-mentalization (r = −0.42, p = .01) and a positive correlation with suicidal ideation (r 
= 0.26, p = .01). The current findings underscore the importance of integrating emotional regulation strategies in 
therapeutic work with individuals with anxious attachment styles to prevent the development of suicidal ideation. 
 Keywords: attachment styles, mentalization, suicidal ideation

 Suicidal ideation and attempts are growing con-
cerns across Pakistani society, as literature highlights 
that 40% of Pakistani university students have report-
ed a history of suicidal ideation, out of which 30% 
experienced suicidal ideation in 2018, explicitly indi-
cating the need for the development of suitable inter-
ventions (Bibi et al., 2019). To comprehend the under-
lying mechanisms of suicidal ideation, it is necessary to 
investigate attachment style and mentalization as two 
significant predisposing psychological factors (Green 
et al., 2021). This study was conducted to explore the 
relationship between attachment styles, mentaliza-
tion, and the increasing rate of suicidal ideation in a 
non-clinical Pakistani sample.
 To contextualize the present study within broader 
psychological literature, the following sections aim to 
provide a brief overview of attachment styles, men-
talization, and suicidal ideation. Each construct was 
analyzed in relation to its theoretical underpinnings, 
empirical evidence, and previously established associa-
tions with one another. This conceptual overview in-
forms the rationale for the proposed mediation model 
that hypothesizes that mentalization may mediate the 
relationship between attachment styles an individual 
has and suicidal ideation in a non-clinical Pakistani 
population.
 Attachment styles refer to a person’s way of relat-
ing in intimate, receiving, and caregiving relationships, 
primarily with attachment figures such as parents, ro-

mantic partners, and children (Levy et al., 2011). Early 
caregiving relationships are fundamental to normative 
developmental processes in human beings (Hofer, 
1994).
 The evolutionary role that attachment plays ex-
tends far beyond providing physical protection to the 
child. A child’s attachment responses are triggered 
when their environment makes them feel insecure in 
some way. It has been found that the aim of develop-
ing an attachment system is to create a feeling of safety 
and security. Thus, the attachment system is consid-
ered the primary regulator of emotional experience 
(Warren et al., 1997). Across an individual’s lifespan, 
internal representations and attachment styles remain 
moderately stable, progressing into adulthood (Fraley, 
2002).
 Attachment styles have been conceptualized across 
a continuum between secure and insecure, drawing on 
Bowlby’s (1969) foundational theory of secure attach-
ment (Sheinbaum et al., 2015). A securely attached 
child typically has a sense of reassurance that their pri-
mary attachment figure will be consistently available 
to fulfil their needs (Main & Morgan, 1996). This se-
cure attachment fosters a positive self-image and op-
timistic expectations of others, especially within close 
relationships, leading to higher relational satisfaction 
and overall well-being (Aronoff, 2012).
 Ainsworth et al. (1971) further delineated inse-
cure attachment into two primary categories: anxious 

Graduate Student Journal of Psychology
Fall 2025 - Vol. 25

Copyright 2025 by the Department of Counseling and Clinical Psychology
Teachers College, Columbia University



37

KHAN ET AL.

and avoidant. These insecure attachment styles stem 
from inconsistent or unstable caregiving experiences 
during infancy and childhood and are often associ-
ated with difficulties in adult relationships and lower 
occupational functioning (Ainsworth et al., 1971). 
Insecure attachment is further categorized into inse-
cure-avoidant and insecure-anxious subtypes. 
 Individuals who exhibit an insecure-avoidant 
attachment style tend to minimize their emotional 
reliance on their primary caregiver and avoid seeking 
proximity or comfort while distressed (Behren et al., 
2007). As they grow older, these individuals tend to 
devalue their close relationships, become emotionally 
distant, and struggle with emotional regulation (Main 
& Morgan, 1996). Furthermore, they may express 
frustration and anger towards their caregivers as dys-
functional efforts to gain attention and connection 
(Solomon et al., 1995). In contrast, individuals with 
an insecure-anxious attachment style tend to be over-
ly emotionally sensitive and have an anxious fixation 
with the availability of their primary caregiver. They 
tend to seek excessive reassurance and can become ex-
tremely distressed when their need for closeness is not 
consistently met (Cassidy & Berlin, 1994). The height-
ened activation of the attachment system often stems 
from inconsistency in caregiving during childhood, 
usually when the response to distress is unpredictable. 
As these individuals mature, they may struggle with 
feelings of abandonment, heightened need for reassur-
ance, and emotional volatility in their personal rela-
tionships (Mikulincer & Shaver, 2007).
 Mentalization, operationalized through the con-
struct of reflective functioning, is defined as the abil-
ity to make sense of one’s own and others’ behaviors 
through the attribution of thoughts, feelings, and in-
tentions (Fonagy et al., 2002). Mentalization has also 
been referred to as ‘mind-mindedness’, a process by 
which an individual understands that the mind me-
diates one’s experience of the external world through 
the interpretation and the representation of different 
psychological states (Liotti & Gumley, 2009). Litera-
ture also defines mentalization as a deliberate stance 
that emphasizes interpersonal awareness, which brings 
about specific emotions, beliefs, intentions, and de-
sires, subsequently producing a similar behavior (Liot-
ti & Gumley, 2009).
 Bateman and Fonagy (2006) identified three core 
dimensions of mentalization: the distinction between 

implicit and explicit functioning; the focus on two re-
lational objects—the self and the other—and the inte-
gration of cognitive and affective aspects of both the 
content and process of mentalizing. 
 Implicit mentalization refers to the unconscious, 
involuntary, or procedural processes within an individ-
ual and their ability to imagine their own and others’ 
various mental states (Bateman & Fonagy, 2006). For 
example, a parent responds to their infant’s distress in-
tuitively by soothing them without verbally reflecting 
on their child’s state of distress (Fonagy et al., 2002). 
On the other hand, explicit mentalization is a pro-
cess that is deliberately implied and used consciously. 
Explicit mentalization can be illustrated through the 
process of psychotherapy. The therapist and patient 
work collaboratively to consciously highlight and re-
flect upon the patient’s mental states, encouraging 
the patient to deliberately imagine and focus on their 
cognitions, hence developing insight (Bateman & Fon-
agy, 2006). Self-mentalization emphasizes the impor-
tance of understanding and being aware of what an 
individual is feeling, as well as having insight into the 
way we react towards other individuals (Oldershaw et 
al., 2010). Self-mentalizing leads to the development 
of self-regulation, and thus, it plays a role in under-
standing our own individual feelings (Fonagy et al., 
2002). Other-mentalization is defined as the ability 
to understand and interpret other individuals’ mental 
states. An appropriate interpretation of others’ mental 
states is linked to better social functioning (Perera & 
DiGiacomo, 2013) and a lower level of interpersonal 
conflicts (García-Sancho et al., 2014).
 The third dimension of mentalization encom-
passes both cognitive and affective aspects, involving 
the content of mentalizing activity. The focus of this 
dimension is the ‘intentional mental state’ in the self 
and others, which is cognitively focused and affective-
ly weighted to varying degrees. Mentalization requires 
the display of intact cognitive skills that enable an in-
dividual to imagine mental states with flexibility, plau-
sibility, and complexity, while optimally integrating 
reason and insight with emotion. The integration of 
the affective and cognitive aspects of both the process-
es and content of understanding mental states helps 
individuals to “feel clear” and increases “emotional 
knowing” (Choi-Kain & Gunderson, 2008).
 Literature indicates that the theory of mind, also 
referred to as mentalization, occurs within the pre-



38

ATTACHMENT, MENTALIZATION, AND SUICIDAL IDEATION

 frontal cortex (Fonagy et al., 2002). This brain region 
is associated with social intelligence and plays a vital 
role in controlling and processing behavior. The later-
al fronto-temporoparietal network facilitates mental-
ization that is focused externally, enabling individuals 
to read facial expressions and posture. The bridge that 
connects affect regulation and social detection is pri-
marily divided between the hypothalamus, amygdala, 
and bed nucleus of the stria terminalis, which gives 
emotional meaning to social cues and enables healthy 
individuals to react accordingly (Kateryna & Tanas, 
2019).
 To develop mentalizing skills, children must expe-
rience proximity and care from their primary caregiv-
ers early on (Meins et al., 2002). Research suggests that 
children's capacity to mentalize is closely intertwined 
with the quality of their attachment relationships 
(Fonagy et al., 2002). Primary caregivers aid them in 
understanding their own mental states and the mental 
states of others, which in turn helps the development 
of mentalization. However, if a child were to devel-
op an insecure attachment, their capacity to engage 
in mentalization would be impaired (Fonagy & Luy-
ten, 2009). Primary caregivers’ constructive feedback 
helps the child reflect on their thoughts, feelings, and 
intentions (Sroufe, 2005). Self-reflection and reflective 
functioning are integral components of the interac-
tions between children and their caregivers (Fonagy et 
al., 2002). 
 The development of mentalization is associated 
with emotion regulation, impacting certain aspects of 
an individual’s functioning and possibly contributing 
to abnormal psychopathology. One product of this 
abnormal psychopathology can be the risk of suicidal 
ideation (Allen et al., 2003). Inability to understand 
mental states and insufficient regulation of emotions 
have been found to lead to problems in functioning 
(Allen et al., 2003). 
 A study by Venta and Sharp (2015) exploring 
the relationship between mentalization, attachment 
insecurity, and peer difficulties among adolescent in-
patients found that mentalization mediated the rela-
tionship between disorganized attachment and peer 
problems. These findings highlight the central role of 
reflective functioning in shaping interpersonal out-
comes and point to the potential relevance of mental-
ization as a psychological mechanism through which 
attachment-related vulnerabilities may influence 

broader emotional and relational difficulties (Venta & 
Sharp, 2015). In light of evidence linking peer prob-
lems and interpersonal dysfunction with a range of 
adverse mental health outcomes, these results offer a 
valuable framework for exploring how disruptions in 
mentalization may contribute to more severe internal-
izing experiences in vulnerable populations.
 Mentalization is also influenced by the quality 
of specific attachment relationships (Bączkowski & 
Cierpiałkowska, 2015). Attachment avoidance within 
particular relationships has been found to be associ-
ated with impaired perspective-taking ability in those 
contexts, whereas general mentalizing capabilities were 
not significantly influenced by overall attachment 
quality. Therefore, the association between attach-
ment and mentalization may be relationship-specific, 
with differences in reflective functioning being shaped 
by the emotional quality of each interpersonal bond 
(Bączkowski & Cierpiałkowska, 2015).
 Suicidal ideation is an intricate public health issue 
that has its roots in social, etiological, biological, and 
psychological factors (Joe et al., 2008). Pakistan has 
a weak health system and even weaker mental health 
resources, as mental health is still widely considered a 
taboo due to the low literacy rate, financial disparity, 
and lack of awareness (Mashood, 2025). As a function 
of these deficits, attention is required to consider and 
address the alarming prevalence of suicidal ideation. 
Literature revealed that 35.6% of Pakistani students 
experienced suicidal ideation in the past, out of which 
13.9% of students made a plan for death by suicide, 
and 4.8% of them died by suicide (Osama et al., 2014). 
Other similar studies show that 31.4% Pakistani stu-
dents experience suicidal ideation, and there was no 
significant gender difference between males (29.2%) 
and females (33%) experiencing suicidal ideation 
(Khokher & Khan, 2005).
 Adam (1994) explored the connection between 
attachment processes in suicidal behaviors, postulat-
ing that childhood attachment insecurities were con-
sidered a predisposing factor for developing suicidal 
ideation later in adolescence or adulthood. When an 
individual with an insecure attachment style faces loss 
or rejection, it leads them to an attachment crisis and 
distress, thus triggering the usage of maladaptive de-
fense mechanisms. As a result, they become at high risk 
for indulging in self-destruction, self-harm, and devel-
oping suicidal ideation. In contrast, individuals who 



39

KHAN ET AL.

form a secure attachment with their caregivers tend to de-
velop a more positive representation of not only themselves 
but also of others. When they experience interpersonal 
difficulties, they tend to be more resilient and manage dis-
tress better than those who have insecure attachment styles 
(Adam, 1994).
 The Interpersonal Theory of Suicide explains that 
suicidal ideation is a result of low belongingness and per-
ceived burdensomeness. It is this desire that leads towards 
the act of suicide (Orden et al., 2010). Rohani and Esmaeili 
(2020) aimed to elaborate on the susceptibility of suicidal 
ideation by examining the associations between psycho-
logical factors such as coping strategies, attachment styles, 
and dysfunctional attitudes. Their findings revealed that 
dysfunctional attitudes and insecure attachment styles 
function as stress-diathesis models in predicting increased 
susceptibility of suicidal ideation by affecting emotion-fo-
cused coping strategies (Rohani & Esmaeili, 2020). Em-
pirical research has illustrated that attachment avoidance 
and anxiety are considered common risk factors for many 
psychological difficulties, including suicidal ideation (Shef-
tall et al., 2014). Furthermore, it has been found that those 
who have survived a suicide attempt reported significantly 
higher attachment avoidance and anxiety (Sheftall et al., 
2014). When conditional logistic regression analysis con-
trolled for family alliance and depression, suicide attempt 
status was predicted by attachment avoidance and anxiety 
(Sheftall et al., 2014).
 Apart from deficits in attachment, deficits in men-
talization are also independently linked to a higher risk of 
suicide. It is reported that compared to individuals with 
low risks of dying by suicide, individuals with moderate 
to severe risks of dying by suicide are 1.7 times more like-
ly to report problems with mentalization (Pompili et al., 
2020). Literature demonstrates that childhood trauma or 
distress can be directly associated with suicidal behaviors 
and indirectly associated through the pathways of attach-
ment and mentalizing, indicating that an individual’s inse-
cure attachment style, along with an impaired mentalizing 
ability, can explain the link between childhood trauma and 
suicidal behaviors (Stagaki et al., 2022).
Theorized Pathways Between Mentalization, 
Attachment Styles, and Suicidal Ideation 
 Figure 1 illustrates the direction of the relationship be-
tween the study's variables. It is proposed that attachment 
styles can have an impact on one’s ability to mentalize their 
risk of suicidal ideation. This can be attributed to early 
childhood attachment to the primary caregiver. If the at-

tachment is not secure, when the child faces distress 
and feels insecure, it influences their mentalization. 
The primary caregiver facilitates the healthy develop-
ment of mentalization (self, other, and motivation) 
by providing constructive feedback on the child’s 
experience and motivating them to reflect upon and 
pay attention to their various feelings, thoughts, and 
intentions. This fosters more social and situational 
awareness and indicates a relationship between at-
tachment and mentalization (Sroufe, 2005). Indi-
viduals who have developed an insecure attachment 
style with their primary caregiver tend to have a 
higher predisposition to various psychopathologies, 
such as suicidal ideation, which can further develop 
into suicidal behaviors (Adam, 1994).
 Moreover, it was postulated that stress and 
threatening situations (proximal factors), as well as 
disruptions in the formation of secure attachment 
styles (distal factors) with the primary caregiver, 
disengage individuals’ mentalization capabilities, 
which can elicit psychopathologies, such as suicidal 
ideation (Fonagy & Luyten, 2009). Hence, it creates 
a relationship between attachment styles, suicidal 
ideation, and mentalization.
 The significance of determining the relation-
ship between attachment styles, mentalization, 
and suicidal ideation is essential and multifactorial. 
Alarmingly, suicide is now a leading issue in Pakistan 
that requires immediate attention (Mashood, 2025). 
It is imperative to determine the underlying psy-
chological mechanisms that serve as a precursor to 
suicidal ideation. There are many predisposing and 
distal factors identified that lead to the development 
of suicidal ideation among individuals; among them 
are attachment styles and mentalization. Hence, 
the researchers decided to test these variables with a 
non-clinical sample, trying to understand early indi-
cators of suicide risk.
 In times of stress, individuals with insecure at-
tachment become predisposed to maladaptation of 
the mentalization capacity and, in turn, become vul-
nerable to suicidal ideation (Green et al., 2021). The 
primary purpose of this research is to shed light on 
the role of attachment styles in early childhood that 
is linked to the development of mentalization and 
the development of suicidal ideation among individ-
uals in later life.
 Furthermore, these variables have not been pre-



40

ATTACHMENT, MENTALIZATION, AND SUICIDAL IDEATION

viously studied specifically in Pakistan. As suicidal ide-
ation is on the rise, finding a relationship between at-
tachment styles, suicidal ideation, and the relationship 
between mentalization might help to create insight, 
identify early precursors for suicidal intent, and devel-
op strategies for the betterment of the community. 
 Considering the prevalence of suicidal ideation 
across all age groups in Pakistan and around the globe, 
this is a pivotal area of study (Mashood, 2025). Deter-
mining the relationship between these variables can 
help in having a better understanding and identifying 
early indicators of suicidal ideation and the predispos-
ing mechanisms behind it. 
 Linking attachment styles with mentalization 
and suicide will help us understand their impact on 
the developmental period of the child. It will help 
us understand how early childhood trauma, neglect, 
and inconsistent care can impact their mentalization 
and eventually lead to psychopathology such as sui-
cidal ideation. Moreover, the findings of this research 
can help in the development and implementation of 
effective therapeutic strategies that take into account 
attachment style and mentalization.
 To accomplish the aforementioned research objec-
tives, we hypothesized that:

1. There is a significant relationship between 
mentalization, attachment styles, and suicidal 
ideation.

2. Mentalization mediates the relationship be-
tween attachment styles and suicidal ideation.

3. There is a relationship between anxious attach-
ment style and self-mentalization.

Method
 A quantitative correlational survey design was car-
ried out to determine the relationship between attach-
ment styles, suicidal ideation, and mentalization in a 
non-clinical sample. The present study was conducted 
during the COVID-19 pandemic, a time when there 
were widespread restrictions on physical access to clin-
ical settings and the vulnerable population. Moreover, 
due to the cultural stigma and taboo surrounding sui-
cidal ideation in Pakistani society, a non-clinical sam-
ple, selected through purposive convenience sampling, 
was used in this study. This research included respons-
es from 295 adults aged between 18 and 55 years old, 
approached through a Google survey. The researchers 
in this study were females, and data were collected 

from their social and academic groups, resulting in a 
disproportionate number of female respondents. Gen-
der disproportion emerged as a consequence of the 
sampling method rather than intentional selection. 
Gender was not controlled for in this study. Individ-
uals diagnosed with a mental health disorder or those 
who did not disclose a reason to consult a psychologist 
were not included in this study. 
Measures
Mentalization Scale
 The Mentalization Scale (MentS) is a 28-item 
self-report measure of self-related mentalization, mo-
tivation to mentalize, and other related mentalization, 
with higher scores suggesting a more sophisticated 
capacity for mentalization (Dimitrijević et al., 2017). 
The age range for this scale is 18 to 65 years old. MentS 
has three subscales which include self-related mental-
ization (MentS-S) (items: 8, 11, 14, 18, 19, 21, 22, 26) 
other-related mentalization (MentS-O) (items: 2, 3, 5, 
6, 10, 12, 20, 23, 25, 28), and motivation to mentalize 
(MentS-M) (items: 1, 4, 7, 9, 13, 15, 16, 17, 24, 27). 
Mean and median scores were used to calculate the 
overall mentalization. 
 MentS-S measures one’s ability to mentalize or 
imagine mental states for one's own emotions and af-
fect, MentS-O measures one’s ability to mentalize or 
imagine mental states of others’ emotions and affect, 
and MentS-M measures one’s internal motivation to 
mentalize or imagine mental states for one's own or 
others' emotions and affect. The MentS is suitable for 
measuring mentalization in both clinical and non-clin-
ical samples. It utilizes a 5-point Likert scale that rang-
es from completely incorrect (1) to completely correct 
(5), with higher scores suggesting a more sophisticated 
capacity for mentalization. As determined by Nun-
nally (1967), the MentS has an acceptable reliability 
in clinical and non-clinical samples. The internal con-
sistency of the scale, or Cronbach's alpha, is .84 for 
non-clinical samples and .75 for clinical samples (Dim-
itrijević et al., 2018).
Revised Adult Attachment Scale 
 The Revised Adult Attachment Scale (RAAS) 
measures interpersonal relationship attachments of 
individuals between the ages of 18 and 72 years old, us-
ing a 5-point Likert scale. The scale ranges from not at 
all characteristic of me (1) to very characteristic of me 
(5), with higher scores reflecting stronger tendencies 
within the respective attachment (DEPEND, CLOSE, 



41

KHAN ET AL.

or ANXIETY). Developed by Collins (1996), the 
RAAS is based on the earlier Adult Attachment Scale 
(Collins & Read, 1990). RAAS was normed using 
406 students at the University of Southern California, 
and the age range for this test is 18–72 years. Revised 
Adult Attachment Scale is an 18-item scale that con-
tains three dimensions: DEPEND, (items: 1, 6, 8, 12, 
13, 17), CLOSE (items: 2, 5, 7, 14, 16, 18), and ANX-
IETY (items: 3, 4, 9, 10, 11, 15; Collins, 1996). 
 The DEPEND subscale measures an individual’s 
belief that others can be available or relied upon when 
needed. The CLOSE subscale assesses an individual’s 
comfort with intimacy and closeness. The ANXIETY 
subscale measures the extent to which a person feels 
anxious about elements such as abandonment or not 
being loved. The internal consistency of the RAAS 
subscales lies in an acceptable range (α = .78 for DE-
PEND, α = .77 for CLOSE, and α = .85 for ANXI-
ETY; Collins, 1996; Nunnally, 1967).
Suicidal Ideation Attribute Scale 
  The Suicidal Ideation Attributes Scale (SIDAS) 
was developed using a sample of 1,352 Australian 
adults. The measure assesses the severity of suicidal 
ideation on a 10-point scale, with higher scores indi-
cating greater persistence and severity of suicidal ide-
ation, in individuals over the age of 18 years old (van 
Spijker et al., 2014). The reliability of the SIDAS lies 
within the acceptable range, exhibiting high internal 
consistency (α = .91) with good convergent validity 
(Nunnally, 1967). Suicidal ideation is classified as hav-
ing ideas, plans, or thoughts of ending one’s life. Indi-
viduals with scores that are greater than or equal to 21 
are considered to have a high risk of suicidal behavior. 
The SIDAS consists of five items, each targeting an 
attribute of suicidal thoughts: frequency, closeness to 
attempt, controllability level of distress associated with 
the thoughts, and impact on daily functioning (van 
Spijker et al., 2014).
Procedure
 From inception to the culmination of the data-col-
lecting procedure, a rigorously functional hierarchy of 
supervision was maintained to ensure that all work 
involved in this research met high-quality standards, 
integrity, and the probability of errors was effectively 
minimized. Initially, a research proposal was designed, 
which explicitly outlined the research objectives to for-
mally request authorization to collect data using the 
MentS, RAAS, and SIDAS. 

 After receiving approval from the university, a 
Google Survey was created based on the topic “Rela-
tionship between Attachment Styles, Mentalization, 
and Behavioral Tendencies” and disseminated across 
social and academic groups. Participants completed 
consent and demographics forms prior to responding 
to the three-scale questionnaire. The demographics 
collected included participants’ gender, age, and socio-
economic class. All data were kept confidential. 
 Supervisors remained involved at every step of the 
data collection process. To incentivize participation, 
researchers included all participants' emails in a raffle. 
The emails of three participants were selected using a 
random picker tool to receive a gift basket or a one-
month Netflix subscription. Upon selection, the win-
ning participants were contacted via email and award-
ed one of two gift baskets, which included snacks or a 
one-month free Netflix subscription. The researchers 
made several ethical considerations, such as maintain-
ing confidentiality by only discussing results with peers 
involved in the study. Furthermore, participants were 
informed of their right to withdraw from the study at 
any point. Additionally, no physical or mental harm 
was induced during the study. Although slight decep-
tion was used where “Suicidal Ideation” was masked 
as “Behavioral Tendencies” to minimize the chances of 
self-report bias, participants were debriefed following 
their participation.
Data Analysis 
  The data were first arranged in Microsoft Excel be-
fore being transferred to SPSS (Statistical Package for 
the Social Sciences) 29.0.1.0 for analysis. To explore 
the internal consistency, Cronbach’s alpha coefficient 
was calculated for each scale used in the survey. De-
scriptive results include means, standard deviations, 
skewness, and kurtosis for the variables. Skewness and 
kurtosis were used to assess the normality of the data. 
Results indicated that all variables were normally dis-
tributed except for suicidal ideation. Then, inferential 
statistical tests, which included correlation analyses, 
were used to examine the strength and direction of re-
lationships between key variables, with the significance 
level set to p < .05. To examine the simultaneous ef-
fect of mentalization, attachment styles, and suicidal 
ideation, a multiple regression analysis was conducted 
to find out their unique contribution to the variable 
of suicidal ideation. To investigate whether anxious 
attachment style is associated with self-mentalization, 



42

ATTACHMENT, MENTALIZATION, AND SUICIDAL IDEATION

a simple linear regression analysis was conducted. This 
helped to determine the direction and evaluate the pre-
dictive relationship. Following the regression analysis, 
a mediation analysis was conducted where attachment 
style was entered as the independent variable, suicidal 
ideation as the dependent variable, and mentalization 
as a mediator. Bootstrapping was used to estimate di-
rect and indirect effects with a confidence interval of 
95%. All statistical tests conducted used a significance 
level of p < .05. The findings were then interpreted 
and discussed in detail, along with consideration of 
the study’s limitations, recommendations for future 
research, and practical implications.

Results
 The following tables represent the results of the 
study,illustrating the statistical relationship between 
the variables of attachment styles, mentalization, and 
suicidal ideation examined in a non-clinical Pakistani 
sample.
Table 1
Frequency and Percentages of Demographic Variables 
(N = 295)
  Table 1 summarizes the demographic characteris-
tics of the sample, including age, education level, and 
gender. The frequency and percentages of the demo-
graphic variables illustrate the composition of the sam-
ple. 
Table 2
Descriptive Statistics and Alpha Reliability Coefficients, 
Univariate Normality of Study Variables (N = 295)
 Table 2 illustrates the mean, standard deviation, 
skewness, and Cronbach’s alpha reliability coefficient 
for each variable. The data demonstrate normal distri-
bution for all variables except suicidal ideation. The 
reliability of all scales and subscales falls within an ac-
ceptable range. 
Table 3
Correlations Between Attachment Styles (CLOSE, DE-
PEND, and ANXIETY), Mentalization (MentS-S, 
MentS-O, MentS-M), and Suicidal Ideation in the 
Sample of Pakistani Adults (N = 295)
 Table 3 illustrates a positive weak correlation (r = 
0.19) between attachment style and suicidal ideation. 
The table indicates a significant positive weak correla-
tion between a close attachment style and mentaliza-
tion (r = 0.18) and between a close attachment style 
and self-mentalization (r = 0.25). A close attachment 

style was additionally found to demonstrate a negative 
weak correlation with suicidal ideation (r = −0.13). 
Moreover, a dependent attachment style was found to 
have a significantly positive, extremely weak correla-
tion with mentalization (r = 0.06) and a significantly 
positive moderate correlation with self-mentalization 
(r = 0.31). A significant negative weak correlation ex-
ists between a dependent attachment style and suicidal 
ideation (r = −0.14). Close and dependent attachment 
styles were found not to correlate significantly with 
others' mentalization and motivation to mentalize (r 
= .01 and r = .07 for close; r < .001 and r = −.05 for 
dependent).  Furthermore, an anxious attachment 
style was found to have a significant moderate negative 
correlation with self-mentalization (r = −0.42) and a 
positive weak correlation with others' mentalization 
(r = −0.11). An anxious attachment style was also 
measured to have a significant, weak positive correla-
tion with the motivation to mentalize (r = 0.23). An 
anxious attachment style demonstrated a significant 
positive weak correlation with suicidal ideation (r = 
0.26). No significant correlation of mentalization (r = 
−0.06), others' mentalization (r < .001), and motiva-
tion to mentalize (r = .02) was found with suicidal ide-
ation. However, self-mentalization was found to have 
a significantly weak negative correlation with suicidal 
ideation (r = -0.14).
Table 4
Multiple Regression Analysis for Attachment Style, 
Mentalization, and Suicidal Ideation
 Table 4 indicates the impact of attachment style 
on mentalization and suicidal ideation. The R2 = .03 
revealed that the predictors explained 3% variance in 
the outcome variable (F [3.33, 5.38] = 0.03, p < .05). 
Table 5 
Simple Linear Regression Between Anxiety Attachment 
and Self-Mentalization (n = 294) 
Table 6
Simple Linear Regression Between Anxiety Attachment 
and Self-Mentalization (n = 294)
Table 7
Regression Coefficients of Self-Mentalization on Anxi-
ety Attachment 
 Tables 5, 6, and 7 demonstrate that the overall re-
gression model was statistically significant (F [1, 293] 
= 63.57, p < .001), indicating that anxious attachment 
accounted for 4.4% of the variance in self-mentaliza-
tion (R² = .0442). The results revealed that anxious 



43

KHAN ET AL.

attachment was a significant negative predictor of 
self-mentalization (β = −.422, B = −.42, p < .001). 
Therefore, findings suggest that individuals with an 
anxious attachment style tend to report low self-men-
talization.
Table 8
Mediation Model for the Effect of Attachment Style on 
Suicidal Ideation Through Mentalization
 Table 8 indicates a mediation model that revealed 
a significant direct effect of attachment style on suicid-
al ideation (B = .20, SE = .06, p < .001), whereas the 
indirect effect of attachment style and suicidal ideation 
through mentalization was not significant (B = .00, SE 
= .00, 95% CI [−.00, .02]).
This study shows a significant positive weak correla-
tion (r = 0.19) between suicidal thoughts and attach-
ment style. The association between attachment and 
suicidal ideation was not mediated by mentalization 
(indirect effect: B = .00, SE = .00, 95% CI [−.00, .02]). 
With a prediction value of 4.42%, the current study 
shows an association between self-mentalization and 
anxiety attachment type.

Discussion
 The aim of the current study was to explore the 
relationship between attachment styles, mentaliza-
tion, and suicidal ideation in a non-clinical sample. It 
was hypothesized that there is a relationship between 
attachment styles, mentalization, and suicidal ide-
ation. More specifically, we proposed that there is a sig-
nificant relationship between an anxious attachment 
style and self-mentalization. Furthermore, it was also 
hypothesized that mentalization would mediate the 
relationship between attachment styles and suicidal 
ideation.
 The first hypothesis proposed that there is a re-
lationship between attachment styles, mentalization, 
and suicidal ideation. Results show several weak cor-
relations between attachment styles, mentalization, 
and suicidal ideation. Results indicate there is a weak 
positive correlation between closeness (r = 0.18) and 
mentalization. Primarily, this finding may indicate 
that mentalization, particularly self-mentalization, is 
associated with certain aspects of an individual’s at-
tachment style; however, given that the correlation was 
weak, other factors may also be precursors to this cor-
relation. Consistent with previous research (Sroufe, 
2005), the present study found that individuals with 

a secure attachment style were also skilled at mental-
ization of self. Literature also showed that the prima-
ry caregiver of a child facilitates the development of 
overall mentalization and specifically, the self-mental-
ization by understanding the child’s subjective experi-
ence and creating a link by giving feedback on the par-
ticular experience (Bowlby, 1978). This can influence 
the culmination of children paying attention to what 
they are experiencing, reflecting upon it, and having an 
understanding of their own emotional or mental state. 
Moreover, a caregiver’s regulatory assistance can help 
develop secure abilities in a child while coping in times 
of stress, which may serve as a protective factor later 
on in life (Bowlby, 1978). The findings of this study 
align with previous theoretical findings, further sup-
porting the notion that early attachment experiences 
may contribute to the development of mentalization 
capabilities. 
 Similarly, it has been found that the parents' men-
talizing style may also contribute to the child's mental-
ization development (Fonagy & Campbell, 2019). If 
parents have strong self-mentalization, they are likely 
to provide a secure base for the child, which is like-
ly to lead to a secure attachment; hence, the child is 
more likely to develop a healthy overall mentalization 
as well as a healthy capacity to self-mentalize (Fonagy 
& Campbell, 2019). A positive relationship between 
children's mentalization and mothers' reflective func-
tioning was seen in previous research (Rosso et al., 
2015). In line with prior studies, the present research 
also found a weak correlation between attachment 
styles and self-mentalization, reinforcing that attach-
ment style may be crucial for the development of men-
talization.
 A close attachment style was found to have a 
weak negative correlation with suicidal ideation (r = 
−0.13), and a significant negative weak correlation ex-
ists between dependent attachment style and suicidal 
ideation (r = −0.14). Literature showcased that indi-
viduals with secure attachment tend to have a positive 
perspective of others and themselves. Such individ-
uals also develop a positive inner sense of self-worth 
and reassurance with their close figures (Hietanen & 
Punamäki, 2009). Thus, there is a chance that those 
who have consistent positive beliefs may adjust better 
to situations as compared to insecurely attached indi-
viduals who are detached from their significant figures 
(Hietanen & Punamäki, 2009). Along with this, indi-



44

ATTACHMENT, MENTALIZATION, AND SUICIDAL IDEATION

viduals who have a secure attachment may develop a 
positive inner working model about themselves (Bowl-
by, 1988), consistent with the findings of this study.
 The findings of this study may also support the 
model proposed by Bowlby (1988), postulating that 
closely attached individuals are more susceptible to 
asking for help when in a crisis or threatening situa-
tion, instead of feeling helpless or worthless, which, 
after long exposures, could turn into suicidal ideation 
later turning into action. Additionally, it can be an-
ticipated that, as securely attached individuals might 
have a positive thought pattern and schema about 
themselves, they are more likely to seek professional 
help in comparison to anxiously attached individu-
als (Hong & Park, 2012; Simpson & Rholes, 2017). 
Thus, supporting the idea that individuals with secure 
attachment style may have a lower tendency to resort 
to suicidal ideation.
 Furthermore, various studies reported that there 
exists an inverse statistically significant correlation 
between suicidal ideation and close or dependent 
attachment style (Ozouni-Davaji et al., 2013), and 
participants who have a secure attachment style with 
their fathers are less involved in sibling bullying and de-
pression or suicidal ideation when compared to those 
who had an anxious or insecure attachment with their 
fathers, hence consistent with Bowlby’s model (Bar-
Zomer & Klomek, 2018).
 There is a weak positive correlation between sui-
cidal ideation and anxious attachment style (r = 0.26), 
as indicated by the results. Adam (1994) proposed that 
when an individual with an anxious or avoidant at-
tachment style faces distress or threatening situations, 
they are unable to draw resources from their close in-
terpersonal relationships in comparison to an individ-
ual who has formed a close attachment with their pri-
mary caregiver. Additionally, individuals with anxious 
or avoidant styles have an increased sensitivity to in-
terpersonal threats like disappointment, rejection, and 
loss; this leads to increased and frequent activation of 
their attachment system (Adam, 1994). 
 Furthermore, individuals with an anxious attach-
ment style lack adaptive strategies, which is why they 
resort to suicidal ideation, thinking, and behavior to 
elicit support and care from others (Adam, 1994). The 
findings of this research may support the developmen-
tal model provided by Adam (1994). Similar results 
were also found, postulating that those with anxious 

and avoidant attachment styles may face distress; 
they may feel overwhelmed, worthless, and hopeless. 
Hence, this may later contribute to the development 
of suicidal ideation and behavior (Kerns & Stevens, 
1996). Additionally, literature states that the intensity 
of suicidal ideations and related behavior increases as 
the crisis upsurges in their life for those who are anx-
iously attached, which may be an explanation of the 
results of this research (Sheftall et al., 2014). 
 Durkheim (1951), in his theory of suicide, pro-
posed that individuals who opt for egoistic suicide are 
unable to find their place and face numerous short-
comings in adjusting to their given situations, as they 
feel abandoned by society itself. Then gradually, they 
may resort to suicidal ideation and view suicide as the 
only solution to free themselves from the loneliness 
they are feeling (Tremblay, 2005). Other literature 
also provided similar findings, highlighting that two 
psychological states that are likely to increase the oc-
currence of suicidal ideation and suicidal behavior 
are social alienation and a sense of low belongingness 
(Joiner, 2007). It can be presumed that if a person does 
not form a secure attachment, there is a chance that 
they may not have a secure sense of belongingness, and 
this may increase the probability of suicidal ideation 
(Joiner, 2007). 
 Results indicate that self-mentalization has a sig-
nificantly weak negative relationship with suicidal 
ideation (r = −0.14). Literature proposes that individ-
uals who lie in the higher range of emotional dysreg-
ulation tend to have a low level of mentalization. The 
two domains of emotional dysregulation that show 
close association with mentalization are the inability 
to develop an understanding of emotional responses 
and a deficiency of emotional clarity. This leads to var-
ious issues, including the inability of a person to make 
sense of experience, acting out, the use of splitting, etc. 
As a process to cope with the overbearing emotional 
content, these individuals tend to show suppression 
of emotional experience, distortion, denial, and a sud-
den upsurge in impulsivity (Marszał & Jańczak, 2018). 
Disapproval and rejection of emotional responses are 
associated with low levels of mentalization, which are 
characterized by poor representation of experience, 
limited capacity of abstract and symbolic relation, and 
a lack of comprehensive emotional content (Marszał 
& Jańczak, 2018). 
 Another significant finding of the study is that 



45

KHAN ET AL.

no relationship was found between mentalization and 
suicidal ideation. It can be inferred that this may be 
due to the cultural non-acceptance of suicidal ideation 
(Ahmed et al., 2016). Suicide is considered a controver-
sial topic in Pakistani culture, due to which individu-
als find it difficult to display their intent or ideation of 
suicide (Khan, 2025). This could be one of the factors 
for why no significant relationship between suicidal 
ideation and mentalization appeared in the statistical 
analyses, as individuals might be hesitant in answer-
ing questions regarding the topic. However, since this 
study ensured that the anonymity of the participants 
was a priority, it is a more likely conclusion that there 
was no correlation between the two variables, as the 
sample chosen is from a non-clinical population who 
may be better adjusted. 
 An additional explanation of the sample being less 
prevalent in suicidal ideation is that the majority of the 
participants were in their adulthood, which is a more 
stable time comparatively; hence, it may lead to the de-
velopment of stable ideologies and thought processes, 
given the prefrontal cortex has developed and stabi-
lized (Cash & Bridge, 2009). The sample was selected 
from the non-clinical population as a deliberate step 
by researchers, as they were keen to study the results in 
a population unaffected by mental health difficulties 
to see a general, holistic picture of the relationship be-
tween these variables. 
 Another explanation that may be attributed to 
there being a weak correlation between suicidal ide-
ation and all other variables and a lower level of sui-
cidal ideation in the overall sample is that suicide is 
considered a contentious topic in Pakistan. It is said to 
be a punishable act in Islam and Pakistan (Mashood, 
2025). Hence, a lower prevalence of the variable has 
been seen in the sample, as individuals may be hesitant 
to talk about it and reveal their ideation. Furthermore, 
Section 325, which is a criminal law in the Pakistan 
Penal Code, 1860, and is practiced throughout Paki-
stan, states that “Whoever attempts to commit suicide 
and does any act towards the commission of such of-
fense, shall be punished with simple imprisonment for 
a term which may extend to one year, or with fine, or 
with both” (Macaulay, 1860). 
 Results also showed a lower prevalence of suicid-
al ideation, which may be attributed to the possibility 
that, in the pandemic, individuals may have developed 
a beneficial coping mechanism; therefore, even in times 

of uncertainty, loneliness, and isolation, individuals 
did not resort to suicidal ideation. This is supported 
by recent studies revealing that healthy coping mech-
anisms and strategies were used by Pakistanis during 
COVID-19 to maintain their well-being, resulting in 
individuals' contributions to social welfare, new hob-
bies, exercise, eating healthy, and getting good sleep 
(Khan et al., 2021). 
 We further hypothesized that there is a significant 
relationship between anxious attachment style and 
self-mentalization. The findings confirmed a weak 
negative correlation between anxious attachment style 
and self-mentalization (r = −0.42). The development 
of mentalization is said to be correlated with differ-
ent types of attachment systems, which are primarily 
associated with interactions with caregivers. During 
development, with the help of a caregiver, children 
learn to recognize and understand emotions. They do 
this through mirroring emotions around them and re-
ceiving an adequate affect response. These contingent 
representations created by the child’s state of mind 
are shaped by the extent of security in attachment re-
lationships, which in turn facilitates the development 
of children's abilities to mentalize (Fonagy & Target, 
1996); hence, it can be concluded that those with an 
anxious attachment style may have low mentalization 
of self (Fonagy & Target, 1996). One of the predom-
inant concerns of individuals with an anxious attach-
ment style is that they are very fearful of being aban-
doned by someone they love, so they are continuously 
searching for signs that it might happen (Campbell & 
Marshall, 2011). The mentalization model proposed 
that the understanding that the caregiver has of the 
child’s experience and the reaction given to them pro-
vides a model for the child to understand the emotion-
al states within the world. This modelling ultimately 
leads to children learning to reflect upon and under-
stand their states of mind. This progression from ini-
tial assistance to current independent observation of 
the self and others is dependent on a healthy, consis-
tent, and reliable emotional interaction between the 
child and the caregiver. These healthy encounters oc-
cur only when close attachment is present. 
 In contrast, when early caregivers are unable to 
reflect on the child’s state of mind or are unable to 
provide the modelling required for them to learn to 
perceive different states of mind, children do not re-
ceive the correct instructions they require to develop 



46

ATTACHMENT, MENTALIZATION, AND SUICIDAL IDEATION

this extremely essential capability. Therefore, anxious 
attachment may impact the development of the capac-
ity to mentalize (Allen et al., 2012). Moreover, litera-
ture suggests that individuals who have an insecure at-
tachment style face difficulties in regulating their own 
emotions, have unsatisfactory relationships with their 
peers, and experience anxiety symptoms (Bosquet & 
Egeland, 2006). Given the results of the current study, 
a similar correlation has been found between self-men-
talization and anxious attachment, where a significant, 
weak negative correlation has been found, pertaining 
to all the aforementioned reasons (Dimitrijević et al., 
2018). 
 The third hypothesis was that mentalization will 
mediate the relationship between attachment styles 
and suicidal ideation. However, no mediation effect 
was found between the variables. This may be at-
tributed to multiple underlying factors. Firstly, this 
was a self-report survey; thus, there is a chance that the 
mentalization scale used in the study might not have 
been sensitive enough to capture its role as a media-
tor, as the scale is newly developed and lacks extensive 
research based on it. Interviews or observation-based 
assessments or experiments might provide a better 
chance to find out the role of mentalization as a me-
diator in this study (Stagaki et al., 2022). Secondly, the 
study was conducted on a normal and non-clinical 
population; the sample characteristics, size, range, and 
variability might have affected the mediation effect. 
Thirdly, there is a chance that other psychological or 
cognitive processes may mediate the relationship be-
tween attachment style and suicidal ideation, such 
as mental pain (Lutzman & Sommerfeld, 2024) or 
self-criticism (Falgares et al., 2017), and several other 
variables, which were not explored in the study, may 
have confounded the mediation effect. 
 Furthermore, several reasons can be identified for 
weak correlations between the tested variables. Firstly, 
various sample characteristics, such as size, diversity, 
and representativeness, may have influenced the study's 
results. The study was conducted on a non-clinical 
population; therefore, it might have shown low sui-
cidal ideation, thus affecting the other variables. More-
over, the study design was a self-report measure; there-
fore, it didn’t capture the depth of these constructs as 
interview-based assessments, experiments, or observa-
tional assessments could have. Furthermore, there is a 
chance that mood, trauma, stress, or recent experienc-

es could have influenced both attachment patterns and 
mentalizing capacities; hence, weak or no relationships 
were observed (Bateman & Fonagy, 2006).
 This study holds significant relevance within the 
Pakistani cultural context, as its findings may contrib-
ute to increasing awareness of attachment patterns, 
mentalization capacities, and suicidal ideation, and 
help with the identification of early precursors of sui-
cidal risk within non-clinical populations. The find-
ings of this study show that there is a significant weak 
correlation between attachment anxiety and suicidal 
ideation. These findings can have positive implications 
in the Pakistani population, as those who have attach-
ment anxiety can benefit from learning more about 
emotional regulation and coping strategies to prevent 
themselves from developing suicidal ideation. They 
may also benefit from interventions such as Mental-
ization-Based Therapy (MBT) or Attachment-Based 
Family Therapy (ABFT) that strengthen emotional 
regulation and reflective functioning within such indi-
viduals. 
 Moreover, this also provides insight into individ-
uals struggling with such attachment styles, offering 
an opportunity for professionals to tailor therapy 
accordingly. It can also suggest that parents should 
be brought into the conversation to prevent further 
attachment issues, eventually leading to a decrease in 
suicidal ideation. Furthermore, it highlighted that at-
tachment styles and mentalization can pose as early 
indicators for suicidal risk, and preventative strategies 
can be developed for those who struggle with insecure 
attachment styles or low mentalization. 
 Additionally, this finding offers valuable insights 
for counselors, clinicians, and educators, enabling 
them to tailor interventions to address attachment 
vulnerabilities. Furthermore, integrating psychoed-
ucation about attachment styles, mentalization, and 
their relationship with suicidal intent into school and 
university counselling programs can help young adults 
build and develop resilience against suicidal ideation. 
 Several limitations were identified throughout 
this study. This was a correlational survey, making it 
difficult to draw causal interpretations of the data, and 
as the sample was recruited through a purposive-con-
venience sampling, it was difficult to understand the 
underlying mechanisms in-depth. Therefore, as cau-
sality could not be determined, it was unclear whether 
attachment styles influence suicidal ideation or if oth-



47

KHAN ET AL.

er unmeasured variables were at play.
 Moreover, the study was conducted in Pakistani 
society, where suicide is viewed as a taboo topic. Hence, 
the possibility of response bias, including social desir-
ability effects, could have led to an underreporting of 
suicidal thoughts as all of the tests used in this study 
were objective tests. Therefore, it is recommended to 
use projective tests in the future to capture an accurate 
understanding of suicidal ideation in Pakistan.
 Another limitation of our study was that due to 
the pandemic, we ran an online survey that included 
a greater number of questions, so there is a possibili-
ty that participants might have felt fatigued or bored 
during the completion of the form, which could have 
produced biased answers. Moreover, due to the pan-
demic, the available sample to recruit from was the 
community around us, which could have led to bias 
within the results or demand characteristics. As indi-
viduals were able to self-refer to the study and enter 
without consideration, this is why we have mostly fe-
male data and a mean age of 23 years. This limited the 
generalizability of the results to other genders and old-
er adults, and other demographic groups, potentially 
reducing the applicability of the results across a wider 
population. Therefore, it is recommended for future 
studies to conduct in-person surveys to eliminate bias. 
It is also recommended to conduct the study on an 
equal number of males and females to increase gener-
alizability. 
 The scale of mentalization was not an indigenous 
scale; therefore, it is also recommended that an indige-
nous survey be developed to understand the capability 
of mentalization in the Pakistani population in detail, 
so that it can facilitate the improvement of mentaliza-
tion-based interventions within the native population. 
Moreover, to completely capture the essence of the 
mediation effect of mentalization, interview-based as-
sessments or experiments should be used.
 As the researchers only chose a non-clinical popu-
lation, there was no or very low suicidal ideation found 
in the sample; hence, it is recommended to replicate 
the study with individuals who are diagnosed or strug-
gle with different mental health difficulties, giving a 
different perspective to the study itself. 
 Researchers could also choose to work with dif-
ferent age cohorts and test various attachment styles as 
well as types of mentalization, such as looking into in-
tergenerational gaps and transfer of attachment. Since 

this research was only a cross-sectional study, a longitu-
dinal study could be conducted to gain better insight 
into the relationship between different variables.
 Researchers found a gender disproportion with-
in the sample, as due to the sampling style, mainly 
females opted to answer the questionnaire. Future re-
searchers could control the study for gender and see 
whether there is a difference between the genders and 
how that plays a role in suicidal risk. 
Conclusion
 The purpose of the present study was to test the 
relationship between attachment styles, mentalization, 
and suicidal ideation. Furthermore, the researchers 
wanted to find out if mentalization mediates the rela-
tionship between attachment styles and suicidal ide-
ation. In conclusion, it was found that there is a partial 
correlation between the variables, and mentalization 
does not mediate the relationship between attach-
ment styles and suicidal ideation. Attachment styles 
were found to have a relationship with mentalization, 
self-mentalization, and suicidal ideation, whereas no 
significant correlation was found between mentaliza-
tion and suicidal ideation overall. Only self-mentaliza-
tion was found to have a significant negative weak cor-
relation with suicidal ideation. Anxious attachment 
style was found to have a significant moderate negative 
correlation with self-mentalization and a significant 
positive weak correlation with suicidal ideation.

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Figure 1

Theorized pathways between the constructs of mentalization, attachment styles, and suicidal ideation

Note. The model draws links between the three hypotheses: (1) attachment styles, mentalization, and suicidal 

ideation are significantly interrelated; (2) mentalization functions as a mediating mechanism between attach-

ment styles and suicidal ideation; and (3) anxious attachment is specifically associated with self-mentalization.



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Table 1

Frequency and Percentages of Demographic Variables (N = 295)



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Table 2

Descriptive Statistics and Alpha Reliability Coefficients, Univariate Normality of Study Variables (N = 295)

Note. MentS = Mentazlization, MentS-S = Mentalization of Self, MentS-M = Motivation of Mentalization, 

MentS-O = Mentalization of Others (**p < 0.01, *p < 0.05),, SK = Skewness, K = Kurtosis, Actual = Actual 

Range, Potential = Potential Range



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Table 3

Correlations Between Attachment Styles (Close, Depend, and Anxiety), Mentalization (MentS_-S, MentS-O, 

MentS- M), and Suicidal Ideation in the Adult Sample of Pakistan (N = 295)

Note. MentS = Mentalization, MentS-S = Mentalization of Self, MentS-O = Mentalization of Others, and 

MentS-M = Motivation of Mentalization  

**p < 0.01, *p < 0.05. 



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Table 4

Multiple Regression Analysis for Attachment Style, Mentalization, and Suicidal Ideation

Note. (p < 0.01), B = Unstandardized beta coefficient, SE = Standard Error, Df = Degrees of Freedom, F = F-sta-

tistic, t = t-value, p = Significance Level



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Table 5

Simple Linear Regression Between Anxiety Attachment and Self-Mentalization (N = 294) 

Note. R = Correlation Coefficient, R² = Coefficient of Determination, Adj R² = Adjusted R-squared, ᵃ Predic-

tors: (Constant), Anxiety Attachment



58

Note. Sum of Squares = Total Variation, Df = Degrees of Freedom, Mean Square = Average Variation 
(Sum of Squares divided by Df), F = F-statistic, Sig. = Significance Level, ᵇ Predictors: (Constant), 
Anxiety Attachment

Table 6

Simple Linear Regression Between Anxiety Attachment, and Self-Mentalization (N = 294)

ATTACHMENT, MENTALIZATION, AND SUICIDAL IDEATION



59

Table 7

Regression Coefficients of Self-Mentalization on Anxiety Attachment

KHAN ET AL.

Note. B = Unstandardized Beta Coefficient, SE = Standard Error, β = Standardized Beta Coefficient, t = 
t-value, p = Significance Level



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Table 8

Mediation Model for the Effect of Attachment Style on Suicidal Ideation Through Mentalization

Note. B = Unstandardized Beta Coefficient, SE = Standard Error, t = t-value, p = Significance Level, LL 
= Lower Limit of Confidence Interval, UL = Upper Limit of Confidence Interval

ATTACHMENT, MENTALIZATION, AND SUICIDAL IDEATION


