Stagaki, MariaNolte, TobiasFeigenbaum, JanetCasas, BrooksLohrenz, TerryFonagy, PeterPersonality Mood Disorder Research ConsortiumMontague, P. Read2022-06-092022-06-092022-060145-2134105576http://hdl.handle.net/10919/110517Background: Although the relationship between childhood maltreatment, self-harm and suicidality is well-established, less is known about the mediating mechanisms explaining it. Based on a developmental mentalisation-based theoretical framework, childhood adversity compromises mentalising ability and attachment security, which in turn increase vulnerability to later stressors in adulthood.Objective: This study aimed to investigate the role of attachment and mentalising as potential mechanisms in the relationship between childhood maltreatment, self-harm and suicidality. Participants and setting: We recruited 907 adults from clinical and community settings in Greater London.Methods: The study design was cross-sectional. Participants completed self-report questionnaires on retrospectively rated childhood trauma, and current attachment to the romantic partner, mentalising, self-harm, suicidal ideation and attempt. We used structural equation modelling to examine the data and conceptualized childhood maltreatment as a general factor in a confirmatory bifactor model.Results: The results showed that childhood maltreatment was both directly associated with self harm and suicidality and indirectly via the pathways of attachment and mentalising.Conclusions: These findings indicate that insecure attachment and impaired mentalising partially explain the association between childhood maltreatment, self-harm and suicidality. Clinically, they provide support for the potential of mentalisation-based therapy or other psychosocial interventions that aim to mitigate the risk of self-harm and suicidality among individuals who have experienced childhood maltreatment via increasing understanding of self and other mental states.application/pdfenCreative Commons Attribution 4.0 InternationalNon-suicidal self-injury (NSSI)SuicidalityChildhood traumaAttachmentMentalisingStructural equation modelArticle - Refereedhttps://doi.org/10.1016/j.chiabu.2022.105576128353131271873-7757