Mental pain as a mediator in the association between avoidant attachment and suicidal ideation among older men

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Abstract
In the present study, our aim was to deepen the understanding of suicidality in older men by adopting a biopsychosocial approach. The study focused on older men as they face an elevated risk of suicide, surpassing not only other age groups but also exhibiting higher rates compared to women. We examined the contribution of mental pain as a mediator in the association between attachment avoidance and suicidal ideation among older men, taking into consideration the severity of their physical illnesses. Participants were 200 men in Israel, aged ≥65 years, living in the community and without cognitive impairment. Data collection was based on self-report measures of suicidal ideation (Beck Scale for Suicidal Ideation, BSSI), attachment (Experience in Close Relationships, ECR-R), mental pain (Orbach and Mikulincer Mental Pain Scale, OMMP), and the severity of physical illnesses (Cumulative Illnesses Rating Scale, CIRS). Mental pain was found to mediate the association between attachment avoidance and suicidal ideation, but only among participants with higher levels of physical illnesses. Mental pain should be considered as a complication of an avoidant coping strategy, which increases the risk of suicide among older men, especially those suffering from significant physical illnesses. The theoretical and clinical implications of these findings are discussed.

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