First Responder Attachment-Related Distress and Suicide: A Cross-Sectional Parallel Mediation Model

Objective For first responders, their cumulative trauma exposure can lead to negative mental health consequences, including posttraumatic stress disorder (PTSD), depression, and generalized anxiety, which places them at an elevated risk for suicide. To mitigate the impact of this exposure, attachment theory offers a framework for conceptualizing these complex interactions. Methods In this study of treatment-seeking first responders ( N = 190), we used measures of PTSD, depression, and generalized anxiety as predictor variables and conducted ten PROCESS parallel mediation models with attachment avoidance and attachment anxiety as the mediators to the dependent variable, suicide. Results Attachment anxiety significantly mediated every parallel model, whereas attachment avoidance only significantly mediated dysphoric arousal, anxious arousal, and generalized anxiety. Conclusion Attachment anxiety amplifies distress, which makes it a theoretical construct that deserves attention in clinical practice to prevent suicide.