The Relationship between Childhood Parental Bonding and Adulthood Anxiety Disorders, Self-esteem and Risk of Suicide among Lebanese Adults
The Relationship between Childhood Parental Bonding and Adulthood Anxiety Disorders, Self-esteem and Risk of Suicide among Lebanese Adults
العلاقة بين الترابط الوالدي في مرحلة الطفولة واضطرابات القلق واحترام الذات وخطر الانتحار بين البالغين اللبنانيين
لمى حمود([1])Lama Hamdoun
تاريخ الإرسال: 22-11-2023 تاريخ القبول: 4-12-2023
Abstract: Research has shown that poor parental bonding is associated with adulthood psychopathology. Hence, the study aimed to investigate the predictability of anxiety disorders, lowered self-esteem, risk of suicide from child-parental bonding among the Lebanese adults. Six hypotheses were tested using a convenience sampling of 200 university students with an age range between 18 and 30 years. Data was collected through the administration of four questionnaires using a survey method, the Parental Bonding Instrument (PBI), Beck anxiety scale (BAI), Suicide Behaviors Questionnaire-Revised (SBQ-R) and Rosenberg Self-esteem Scale. Collected scores were analyzed using correlational methods. The study’s findings were indicative of a positive association between affectionless control (low care, high control) and lower self-esteem and higher anxiety level and suicide risk. The study’s results indicated a positive association between optimal parenting elements (high care, low control) and higher self-esteem, lower anxiety level and lower suicidal risk.
Keywords: parental bonding, anxiety disorders, self-esteem, suicide risk, Lebanese.
الملخص: أظهرت الأبحاث أنّ ضعف التّرابط الأبوي يرتبط بالاضطربات النّفسيّة في مرحلة البلوغ. ومن هنا، هدفت الدّراسة إلى التّحقق من إمكانيّة التّنبؤ باضطرابات القلق، وانخفاض تقدير الذات عند البالغين اللبنانيين ، وخطر الانتحار من خلال معاينة الترابط بينهم كالأطفال وأبويهم. اختُبِرت ست فرضيات مع 200 طالب جامعي تتراوح أعمارهم بين 18 و30 عامًا. جُمِعت البيانات من خلال إدارة أربعة استبيانات باستخدام (PBI) أداة الترابط الأبوي مقياس بيك للقلق, (BAI) استبيان السلوكيات الانتحارية (SBQ-R) ومقياس روزنبرغ لتقدير الذات. أشارت نتائج الدراسة إلى وجود علاقة إيجابيّة بين عناصر التربية الأمثل (الرعاية العالية/الاهتمام العاطفي، وانخفاض السيطرة) وارتفاع احترام الذات، وانخفاض مستوى القلق ومخاطر الانتحار.
الترابط الوالدي، اضطرابات القلق، تقدير الذات، خطر الانتحار، لبناني. الكلمات المفاتيح:
Introduction
In the past few decades, the world has experienced a mounting concern over the increased prevalence and burden of mental health disorders that is affecting people worldwide including the Arab world (Kessler, Aguilar-Gaxiola, Alonso, Chatterji, Lee, Ormel & Wang, 2009; Steel, Marnane, Iranpour, Chey, Jackson, Patel & Silove; Yahia, 2012). A study conducted on a Lebanese national representative sample of 2,857 adults revealed that about one-fourth of the sample (N= 714) met at least one criteria of the DSM-IV psychiatric disorders at some point in their lives; indicating that mental disorders in Lebanon are quite common (Karam et al., 2008). This points to the need for extensive work on understanding the treatment and prevention of the mental disorders in Lebanon at large. Studies have revealed numerous causes for the onset of psychiatric symptoms originating mainly childhood adverse parental bonding (Bahreini, Akaberian, Ghodsbin, Yazdankhah, Fard and Baghmollaei, 2011; Lima, Mallo and Mari, 2010). For instance, previous research demonstrated how adverse parental bonding was associated with various psychiatric conditions among which are anxiety disorders (Ambruster and Witherington, 2016; Lima et al., 2011; Dekel and Solomon, 2015), suicidal thought and behavior (Freudenstein et al., 2011; Yterdal, 2016; Heider, 2000) as well as a decrease in the levels of self-esteem (Bahreini et al., 2011; Ngai and Cheung., 2009; Passanisi, Gensabella and Pirrone, 2015). The present study examines specifically the inter relationships between childhood parental bonding and adulthood anxiety disorders, self-esteem and risk of suicide among Lebanese adults.
In the first two formative years of life, infants show profound dependence on the parents where the loving bond and the attachment relationship with the parent is highly indispensable (Winston and Chicot, 2016). Parental bonding is referred to as the primary attachment between the child and his caregivers, with this bond influencing the child’s future social, cognitive, emotional experiences as well as his/her personality development (Cailian & Shihan, 2012). According to the American Psychological Association, “parental bonding is considered as one of the most fundamental aspects of a child’s upbringing; it is critical as to ensuring children’s health and safety, as it prepares them for becoming productive adults” (American Psychological Association, 2014). Current data indicate that parent–child relationships may play a role in preventing or promoting the development of psychiatric symptoms (Lima, Mello, Mari, 2010). More specifically, adverse parenting acts as a potential risk factor for adult psychopathology (Enns, Cox and Clara, 2002; Lima, Mari & Mello, 2010).
Parental Bonding Typology. According to Parker, Tupling and Brown (1979), parental bonding is composed of two patterns. The first pattern is known as the caring parental bonding which displays warm, close and sympathetic parent-child relationship (Parker et al., 1979). Such pattern comes in opposition to the cold, repelling and neglectful parent-child relationship (Parker et al., 1979; Xu, Morin, marsh, Richards and Jones, 2016). The second pattern is known as the controlling parental bonding which displays the level of control that parents exert over their children; such pattern is characterized by overprotection, intrusion and prevention of independent behavior of their children, and is considered a form of negative parenting (Parker et al., 1979; Wilhelm, Gillis and Parker, 2016; Xu, Morin, marsh, Richards and Jones, 2016). The combination of these two patterns produces the following four sub-parental bonding categories (1) high care/low control, designated as ‘optimal Parenting’ (2) high care/high control, designated as ‘affectionate constraint (3) ’low care/low control, designated as ‘neglectful parenting’ (4) low care/high control, designated as ‘affectionless control’ (Parker et al., 1979). It has been shown that the parental bonding style “affectionless control is considered to possess the highest association with psychological distress and later development of psychiatric conditions (Young, Lennie and Minnis, 2011). Seen that parental bonding style is composed of elements that might provide negative effects on the children and later in their adulthood (Bahreini et al., 2011; Lima et al., 2010), these elements remain essential understanding how parental bonding might be a precursor for psychiatric problems. Parental Bonding can be identified as paternal parental bonding style or maternal parental bonding style. Each parenting style consists of components of Care and Control. Therefore, an individual can be subjected to one paternal bonding style and/or one maternal bonding style. (Anno et al., 2015)
Association between Parental Bonding and psychopathology
Previous research has demonstrated that close, loving, responsive relationships between children and parents creates a medium where aggression and negative emotional behaviors of their children become less likely to appear, which in turn will help in serving a better bonding function between the parents and their children; thus, helping these children acquire the behavioral and emotional benefits needed (Cailian and Shihan, 2012). On the other hand, a vast amount of research evidence from developmental psychology shows that lack of love, neglect, and parental inconsistency can lead to long-term mental health problems and reduced happiness that set limit to overall potential actualization of their children. (Winston and Chicot, 2016).
The ability of the parent-child early interactions to influence the later mental health of the individuals is mainly based on the attachment theory principles which explains how the individual is able to incorporate a set of emotive and behavioral responses (Lima et al., 2011). Secure attachment style achieved by presence of care parental dimension in the parent-child relationship, offers the capacity for emotion regulation as well as the capacity for self-perception and the perception of others which helps in managing positive and adaptive relationship with other people (Lima et al., 2011; Ngai and Cheung, 2009). Furthermore, parental support reflecting the care dimension plays a critical role in enhancing self-confidence and self-regulation throughout the individual’s development (Baumrind, 1987). Elsewise, insecure attachment style, which results from parental over control or rejection, may result in increasing the risk for the infant’s confrontation with later problems in self-regulation, self-confidence and the experience of emotional difficulties, thus, predisposing the child for future psychopathological conflict (Baumrind, 1987; Ngai and Chueng, 2009). Therefore, and as started before, adverse parenting factors may entail the formation of emotive and behavioral symptoms that are precursors for later development of anxiety disorders, suicide risk and lowered self-esteem.
Studies have demonstrated the existence of a link between adverse parental bonding and development of adulthood psychopathology (Lima et al., 2010; Young et al., 2011; Ngai and Cheung, 2009; Derkel and Solomon; 2015). Numerous studies have particularly pointed to the association between low parental care and high parental control bonding style with poor mental illness (Dekel and Solomon, 2015).
Anxiety Disorders and Parental Bonding
As discussed previously, poor parental bonding forms a risk factor for anxiety disorders. The relationship between adverse parental bonding and anxiety symptoms can be explained through the following. Primarily, the majority of the research which investigates the role of parenting in the maintenance of anxiety has pointed to the parental bonding concepts of care and control as the factors that play a role in causing anxiety (Gallagher and Cartwright-Hatton, 2008). As defined previously, the care dimension is referenced to the warmth and acceptance that parents provide their children with, while the control dimension is referenced to the limitation that parents deposit to their children and the interference that they make in their children’s activities that can be done independently (Gallagher and Cartwright-Hatton, 2008). More specifically, it is vital to note that the care and control concepts where primarily developed from the attachment literature (Gallagher and Cartwright-Hatton, 2008).
Parental Bonding in relation to Anxiety through Attachment Theory. On the basis of the attachment literature, insecure attachment, which mainly consists of the combination of parental over involvement, inconsistent caregiving and rejection i.e. parental bonding elements (Parker et al., 1979), is a leading factor in causing anxiety (Bowlby, 1982). Additionally, in support to the significance of the parental bonding elements i.e. over involvement, rejection and inconsistent caregiving as the factors leading to anxiety (Gallagher and Cartwright-Hatton, 2008), a number of studies have demonstrated the link between insecure attachment in early childhood and anxiety in later adulthood (Gallagher and Cartwright-Hatton, 2008; Picardi et al., 2013; Burningham, 2016).
For example, when parents are responsive, caring and nurturing, a secure attachment is formed between the child and the parent; this leads to the emergence of an internal working model that allows the child to feel that his/her needs will be met and that the world is a safe place (Bowlby, 1982; Bowlby, 1977). With the formation of this secure attachment between the parent and the child, the child will be offered the capacity for emotion regulation as well as the capacity for self-perception and the perception of others; thus, helping the child in later adulthood with the capacity in managing positive and adaptive relationship with others (Lima et al., 2011; Ngai and Cheung, 2009). On the contrary, when a parent responds to the child’s needs in rejection, an insecure attachment is formed between the child and the parent which in turn leads to the child’s formation of a dysfunctional mental representation depicting the world as an unsafe place where there is uncertainty in the needs being met (Bowlby, 1982; Bolwby 1977). Hence, it can be concluded that the insecure attachment style which is manifested through dysfunctional parental bonding impairs the maintenance of the child’s emotion regulation capacity (Lima et al., 2011; Ngai and Chueng, 2009) as well as increases his/her risk in the diminished capacity of self-regulation (Bowlby, 1982; Bowlby, 1977; Ngai and Chueng, 2009). This forms a precursor for the formation of anxiety because dysfunctional emotion regulation is associated with anxiety (Picardi et al., 2013). In fact, the exposure to stressful experiences in the presence of insecure attachment and dysfunctional parenting bonding coupled with poor emotion regulation strategies during childhood impairs the child’s detection and the processes of fear –related cues and anxiety states with these deficits persisting into adulthood (Picardi et al., 2013).
Self-esteem and Parental bonding
The association between self-esteem and parental bonding can be explained by the following. Primarily, the relationship between self-esteem and parental bonding can also be explained in the sense that the parent-child bonding provides a safe and a secure basis for the child to investigate and control his/her environment (Bahreini et al., 2012). Based on the attachment theory, when the child is exposed to a caring and supporting parental bond, the cognitive-emotional facets of this secure bonding will influence the mental and emotional capabilities of the child throughout his/her development (Bahreini et al., 2012); thus, enhancing the child’s self-confidence and self-regulation throughout the later years (Baumrind, 1987). However, when the child is exposed to inconsistent and unsupportive parenting, this causes the development of an internal working model that induces in the individual an inclination to interpret events negatively (Morly & Morgan, 2011) which leads the individual to possess lower levels of self-esteem and lower capabilities in handling stressful times (Bowlby, 1977). This also leads the individual to view any failure as a result of his/her inadequacy and incompetency rather than ascribing the failures to external challenging events (Burningham, 2016; Bahreini et al., 2012). This is further supported by what cognitive behavioral theories contend with regard to children who internalize negative cognitive schema about themselves due to their exposure to negative child-rearing experiences (Young, 1990).
Additionally, it has been indicated that the parental bonding “control” dimension which is reflected in parental practices that induce intrusiveness and control over their children prevent the child from developing an autonomous self (Ngai and Cheung, 2009). The level of autonomy satisfaction is lowered when parents’ high levels of control forge children to feel that they are enforced to enroll in activities that do not exhibit their own values or their own inclinations (Sonens and Vansteekiste, 2010). Since autonomy is an element incorporated into the self-esteem (Hodgins, Brown and Carven, 2007), the aforementioned consequences of paternal control play a role in lowering the self-esteem levels as well. Hence, such explanations support the notion that inconsistent, controlling and unsupportive parenting incorporating the basic elements of parental bonding (Parker et al., 1977) possesses the capability to lower one’s self-esteem.
Suicide and Parental Bonding
It is contended that the onset of suicidality in adulthood is triggered by the exposure to stressful life events (Heider, 2000). The skills that one possesses to ward off suicide risk is associated with positive experiences of the early child-parent bonding; thus, indicating that poor parental bonding plays a critical role in hindering the development of skills that advocate one’s resiliency and the capacity to handle stressful situations (Heider, 2000).
Factors influencing relationship between Suicide and Parental Bonding. Primarily, parental affection (low parental care) is considered to play a role in accentuating the probability of engaging in suicide behaviors because low parental care play instills in the individual a sensation of low belongingness and burdensomeness; such sensations form a risk factor for the engagement in suicide (Safer et al., 2015). High parental control might also act as a risk factor for suicide because heightened parental control might have adverse effect on the possibility of acquiring developmental strengths such as problem-solving skills (Matheson et al., 2005). Hence, when the individual comes to possess developmental deficiencies like impaired problem-solving skills, the individual will be less susceptible to encounter adaptive solutions to his/her problems; thus, allowing the individual to act out on their suicidal thoughts (Safer et al., 2015).
Additionally, parental control is also explained to be related to suicide attempts since parental overprotection causes frustration particularly during the adolescent period as they struggle to gain independence and autonomy (Ytredal, 2016). It also causes prolonged exposure of the individual to parental control in the form of violence as well as can lead to interpersonal stressors such as the arising conflict between oneself and the parent (Yredal, 2016). Additionally, high control and low care of the authoritarian parental style are associated with anxiety sensitivity which is a risk factor of suicide (Timpano, Carbonella, Keough, Abramowitz and Schmidt, 2015). Consequently, it has also been explained that psychological control reflected by parental control plays a vital role in allowing the child to experience hopelessness which is also a factor of suicide risk (Li, Li, Wang & Bao, 2001; Yterdal, 2016).
Association between Parenting Style and Parental Bonding. There are four parenting styles that were developed by Baumrind (1971, 1989), and Maccoby and Martin (1983). The four quadrants are neglectful/uninvolved parenting, authoritarian parenting, authoritative parenting, and permissive/indulgent parenting. Demandingness is described as level of control, supervision, and maturity demands from the child and responsiveness is described as warmth, acceptance, and involvement (Aunola et al., 2000; Glasgow et al., 1997). Parents are placed in one of the four parenting styles based on adolescents’ responses on a parenting style index, which includes questions regarding two different scales: acceptance/involvement and strictness/supervision (Glasgow et al., 1997; Lamborn, Mounts, Steinberg, & Dornbusch, 1991). For example, according to Baumrind (1991), the authoritarian parenting style is characterized by the parents’ exertion of high control over their children and restriction of their autonomy accompanied by minimal expressions of affection (Baumrind, 1991). In fact, the warmth and the control dimensions are the basic elements of parental bonding as well (Parker et al., 1979); hence, rendering the authoritarian parenting style equivalent to the affectionless control parenting style (Yterdal, 2016). There are two commonly used models for describing and studying parenting styles. The first was developed by Baumrind (1971, 1989) and Maccoby and Martin (1983) and can be referred to as “parenting styles.” The second was developed by Parker, Tupling, and Brown (1979) and will be referred to in this review as “parental bonding styles.” Both are four-quadrant models with two scales representing different bipolar parenting factors. These models are used separately but often for the same purposes in research, therefore the importance of keeping this model in mind as we discuss parental bonding and differentiate between both approaches to parenting.
Background of the Study
The research background behind the association between parental bonding and each of anxiety disorders, self-esteem and suicide risk is well-documented in the research literature. The relationship between each of anxiety disorders, suicide risk and self-esteem was empirically investigated in various studies. However, targeting simultaneously anxiety disorders, suicide risk and self-esteem and their association with parental bonding has not been seriously researched. More specifically, an increase in the prevalence of anxiety disorders in the Arab world (Tanios, Karam, karam and Abou-Saleh, 2008) and particularly in Lebanon (karam et al., 2008) has taken place which solidifies the need for development of further studies examining anxiety disorders in Lebanon. Also, Suicide’s prevalence in Lebanon has become noticeable (Mafroud et al., 2011) and the notion that lowered self-esteem is contended to play a role in increasing the vulnerability for the onset of psychiatric disorders such as anxiety (Silverstone and Salsali, 2003) is salient. Since a relationship exists between adverse parental bonding and each of anxiety, suicide risk and lowered self-esteem (Lima et al., 2013) and since developments in the prevalence rates of anxiety and suicide risk as well the understanding that lowered self-esteem is a critical value in promoting psychiatric symptoms, investigating this research’s topic is of vital importance.
Significance of the Study
The study sheds light over the parental bonding’s role in the onset of mental disorders particularly anxiety disorders, lowered self-esteem and risk of suicide particularly in the Lebanese context. More specifically, the impact of parental care-rejection factor of parental bonding was found to possess a robust effect on the individual’s mental health in most of the countries and cultures (Dwairy et al., 2006a); thus, indicating that the parental care (or parental rejection) is considered a universally pivotal element in influencing the mental health of the individuals (Dwairy et al., 2006b).
Hypotheses
Therefore, the associations between parental bonding and each of anxiety disorders, suicide risk, and low self-esteem is well documented in the literature and provides the basis for constructing a set of hypotheses for the present study:
Hypothesis 1 (H1). There is a positive correlation between parental control ((a) mother control, (b) father control) and suicide risk.
Hypothesis 2 (H2). There is a negative correlation between parental care ((a) mother care, (b) father care) and suicide risk.
Hypothesis 3(H3). There is a negative correlation between parental care ((a) mother care, (b) father care) and anxiety.
Hypothesis 4 (H4). There is a positive correlation between parental control ((a) mother control, (b) father control) and anxiety.
Hypothesis 5 (H5). There is a positive correlation between parental care ((a) mother care, (b) father care) and self-esteem.
Hypothesis 6 (H6). There is a negative correlation between parental control ((a) mother control and (b) father control) and self-esteem.
The hypotheses were tested using correlation methods and multiple regression analysis.
Method
General Perspective
The proposed study is an empirical quantitative survey design that use with Lebanese young adults for data collection, the study seeks to examine of the relationship between childhood parental bonding and the development of adulthood anxiety disorders, self-esteem and risk of suicide among Lebanese adults.
Participants
A total of 200 participants were recruited for this study using snowball and convenient sampling. The sample consisted of males and female young adults above age 18 and residing in Beirut region. The choice of young adults as the participants for the study is because unlike westernized countries, in Lebanon the youth continue to experience parenting practices of their parents through adulthood (Saleh, 2014).
Descriptive Analyses
Table 1
Individual demographic characteristics as a percentage of the sample (N =447)
| Characteristics | N (percentage) |
| Sex
Male Female |
96 (48%) 104 (52%) |
| Age
Majority range (18-30) |
193 (95.5%) |
Ethical considerations
Participation in the present research was voluntary and anonymous. Participants were informed about their right to withdraw from the study whenever they want. Additionally, they were assured that all information obtained from them will remain private, confidential. An informed consent was provided to participants.
Because adverse parental bonding is a sensitive topic and might invoke negative emotions or memories when the individual was instructed to complete the parental bonding survey, participants were asked if they are interested in a referral to support or mental health services; they were then provided with contact details of contact numbers and names of hospitals with psychiatric and psychological services.
Procedure
Participants were sampled through two non-probability sampling methods: Convenience sampling and snowball sampling. Concerning convenience sampling, participants were approached on the streets, in public places, in shopping centers, outer gates of universities. First, they were asked about their nationality, and age. If the participant met the following characteristics (Lebanese nationality, Lebanese resident, and aged above 18) he/she was asked to participate in the study. Due to feasibility reasons, participants were approached solely in the Beirut district. Concerning Snowball sampling, some participants were asked to pass the surveys along with the informed consent form to other individuals with the recommended characteristics. Also, all the surveys were administered in a paper and pencil format. After the participant fills the survey, he/she puts the survey in a sealed envelope and it is given to the administrator directly, for confidentiality purposes.
Materials
In the present study the materials that were used included a survey consisting of 4 questionnaires (all scales used present internal validity and reliability): The Parental Bonding Instrument (PBI) (Parker, Tupling and brown, 1979), Beck anxiety scale (BAI) (Beck, Epstein, Brown and Steer; 1988), Suicide Behaviors Questionnaire-Revised (SBQ-R) (Osman, Bagge, Guitierrez, Konick, Kooper and Barrios, 2001) and Rosenberg Self-esteem Scale (Rosenberg, 1965). In addition to those questionnaires, a demographic sheet and a consent form were included in the survey. An introduction to each questionnaire was included in the section below. Participants were asked to provide information concerning their (1) age (2) gender (3)socio-economic information (occupation/education) (5) Mother age (6) father age (7) Mother educational background (8) father educational background (9) parental marital status.
Parental Bonding Instrument (PBI) (1979). This 4-point scale reports parental behaviors and the child-rearing styles of each parent. The PBI is a 25-item self-report; participants were required to recall maternal and paternal behavior for the first 16 years of life and each parent’s attitudes and behaviors are measured separately than the other. There are items that represent Caring (12 items) and Protection (13 items).
Beck Anxiety Scale (BAI) (1988). The scale BAI consists of 21 items; 13 of the items portray physical symptoms (e.g., heart pounding), 5 represent cognitive aspects of anxiety (fear of the worst), and 3 have a physical as well as cognitive implications (e.g., terrified). Each item is on a four-point scale ranging from 0 (not at all) to 3 (severely, I could barely stand it).
Suicide Behaviors Questionnaire-Revised (SBQ-R) (2001). This is a psychological self-report questionnaire designed to identify risk factors for suicide . SBQ-R asks 4 questions about future anticipation of suicidal thoughts or behaviors as well as past and present thoughts or behavior and includes a question about lifetime suicidal ideation, plans to commit suicide, and actual attempts (Osman et al., 2001).
Rosenberg Self-Esteem scale (1965). Is a 10-item scale that measures global self-worth by measuring both positive and negative feelings about the self. The scale is believed to be uni-dimensional. All items are answered using a 4-point Likert scale format ranging from 1 “strongly agree” to 4”strongly disagree”.
Projected Data Analysis
After collection of the data and tracking the responses, the statistical tool SPSS was used to produce the statistical results. Primarily, descriptive statistics (frequency, mean, standard deviation) and inferential statistics were used. Pearson Correlation Coefficient “r” was used to test if childhood parental bonding predicts the development of adulthood anxiety disorders, self-esteem and risk of suicide among Lebanese adults.
Results
Hypothesis 1: There is a positive correlation between parental control ((a) mother control, (b) father control) and suicide risk.
A Pearson Correlation coefficient was done between parental control and suicide risk. Results show a positive correlation between father control and suicide risk and suicide attempt ideation. The data support the hypothesis and there is a positive correlation between parental control and suicide risk. Check Table 3 for Pearson Coefficients.
Hypothesis 2: There is a negative correlation between parental care ((a) mother care, (b) father care) and suicide risk.
A Pearson Correlation coefficient was done between parental care and suicide risk. Results show a negative correlation between father care and suicide risk and suicide attempt ideation. A negative correlation was obtained between mother care and suicide risk, but no correlation was obtained between mother care and suicide attempt. However, the hypothesis remains confirmed as seen in Table 3.
Hypothesis 3: There is a negative correlation between parental care ((a) mother care and (b) father care) and anxiety.
A Pearson Correlation coefficient was done between parental care and anxiety. Results show a negative correlation between mother care and anxiety. A negative correlation was also obtained between father care and anxiety.
Hypothesis 4: There is a positive correlation between parental control ((a) mother control, (b) father control) and anxiety.
A Pearson Correlation coefficient was done between parental control and anxiety. Results show a positive correlation between father control and anxiety. No correlation was obtained between mother control and anxiety. Check Table 3 for Pearson Coefficients. The data support the hypothesis and there is a positive correlation between parental control and anxiety.
Hypothesis 5: There is a positive correlation between parental care ((a) mother care, (b) father care) and self-esteem.
A Pearson Correlation coefficient was done between parental care and self-esteem. Results show a positive correlation between father care and self-esteem and mother care and self-esteem. Therefore, the hypothesis is confirmed as seen in Table 3 below. However, the correlation between father care and self-esteem was stronger than the mother care; thus, there will be a stronger positive correlation between mother care and self-esteem.
Hypothesis 6: There is a negative correlation between parental control ((a) mother control, (b) father control) and self-esteem.
A Pearson Correlation coefficient was done between parental care and self-esteem. Results show a negative correlation between father control and self-esteem. However, no correlation was obtained between mother overprotection and self-esteem. Check Table 3 for Pearson Coefficients. The data support the hypothesis and there is a negative correlation between parental control and self-esteem.
Table 3
| Correlation Matrix between the various independent and dependent variables: mother care, father care, mother control, father control, anxiety, self-esteem and suicide risk | |||||
| M-care |
F-care |
M-control |
Fcontrolll |
||
| Suicide risk | Pearson Correlation | -.27** |
-.28** |
.07 |
.24** |
| Sig. (2-tailed) | .000 | .000 | .438 | .000 | |
| N | 200 | 200 | 200 | 200
|
|
| Suicide ideation | Pearson Correlation | -.13 | -.19** | .05 | .14** |
| Sig. (2-tailed) | .055 | .000 | .315 | .038 | |
| N | 200 | 200 | 200 | 200
|
|
| Anxiety | Pearson Correlation | .23** | -.30** | .05 | .25**
|
| Sig. (2-tailed) | .001 | .000 | .480 | .000 | |
| N | 200 | 200 | 200 | 200
|
|
| Self-esteem | Pearson Correlation | .19** | .22** | .07 | -.21** |
| Sig. (2-tailed) | .005 | .009 | .296 | .002 | |
| N | 200 | 200 | 200 | 200 | |
Discussion
The purpose of the study was to examine parental bonding and its effects on the development of adult psychopathology, specifically, anxiety disorders, self-esteem and risk of suicide in a sample of Lebanese adult. In order to investigate the relationship between perceived parental bonding dimensions and anxiety, self-esteem and suicide risk, a series of correlational analyses were initially conducted.
The first hypothesis stated that there is a positive correlation between parental control (mother control and/or father control) and suicide risk. This hypothesis was confirmed and it is in line with previous research. The analyses revealed that father’s control and not mother’s control was positively correlated with suicide risk and suicide attempt.
The second hypothesis stated that there will be a negative correlation between parental care (mother care and/or father care) and suicide risk. This hypothesis was confirmed and it is in line with previous research. Primarily, with regard to the relationship between parental bonding and suicide risk, the analyses indicated that mother care as well as father care was negatively correlated with suicide risk, and father care was negatively correlated with suicide risk. Father care and not mother care was negatively correlated with suicide ideation and attempt.
In further support to both hypothesis 1 and 2, the examination of the between – group differences with regard to the relationship between parental bonding dimensions and suicide risk further revealed that those with maternal affectionless control (low care, high control) had more suicidal risk than those with affectionate constraint mother parental bonding (high care, high control) and even more risk than those with maternal optimal parenting (high care, low control); thus, indicating that maternal affectionless control has the highest suicide risk. Similarly, with regard to the father’s parental bonding, the results revealed that those with higher affectionless control had more suicide risk compared to those with paternal affectionate constraint and even more risk than those with paternal optimal parenting; thus, indicating that paternal affectionless control has the highest suicide risk in comparison to other parental bonding dimensions.
According with this study’s findings, affectionless control which is the joint low care and high control parental bonding of the mother and father was documented in numerous studies to be related to increase in suicide risk. For example, a study that investigated the relationship between parenting style and suicidal ideation and attempts, revealed that affectionless control (low care and high control) in the PBI quadrant doubled the risk of suicidal thoughts (Huang & Tzeng, 2016). In the same vein, a study conducted by Safer, Catherene, Glenn and Klonsky (2015) revealed that suicide attempters had significantly lower maternal and paternal care scores than non-suicidal adolescents. However, their results did not reveal a significant difference between suicide attempters and non-suicidal adolescents on maternal or paternal overprotection (Safer et al., 2015). Also, a study conducted Dale, Power, Kane, Stewart and Murray (2010) also revealed that repetitive suicidal behavior was associated with low levels of parental care and high level of parental control (Dale et al., 2010). More evidence was also obtained from a meta-analysis of 12 which pointed to the finding that decreased parental care ratings as well as affectionless control were significantly related to higher levels of suicidality (Goschin, Briggs, Blanco-Lutzen, Cohen, & Galynker, 2013).
Consonant to the study’s findings that reported separate associations between maternal and paternal bonding with suicide risk, Goschin et al. (2013) emphasized that the substantial effect on suicide attempt and ideation was specifically the low maternal care (Goschin et al., 2013). In the same vein, those who reported suicide ideation and attempt were the ones exposed to less caring and more overprotective mothers; hence, to maternal affectionless control bonding (Kovess-Masfety et al., 2011). Also, those who perceived their fathers as less caring reported higher suicide ideation and suicide attempts, but no significant association immerged between suicidality and father’s overprotectiveness (Kovess-Masfety et al., 2011). Similarly, perceived care by father and mother was negatively correlated with suicide intent (Sharaf et al., 2016). Equivalent to the study’s findings also, Sharaf et al. (2016) revealed that participants who experienced affectionless control had higher suicide intent than those who experienced optimal parenting (Sharaf, Thompson and El-Salam, 2016). While it was found that it found that maternal overprotection was positively correlated with suicide intent (Sharaf et al., 2016), no correlation was obtained between mother’s overprotection and suicide risk in the study’s sample; this is in contrast to numerous studies that have documented the strong association between maternal control and suicide risk (Sharaf et al., 2016; Kovess-Masfety et al., 2011; Goschin et al., 2013). This is finding can be explained in the sense that because mothers had a more dominant role in the family environment than fathers did (McKinney & Renk, 2008) and they are considered to be the primary figure in raising and educating their children (Gotshin et al., 2013). In the Lebanese culture, as a collectivistic country, the mother’s overprotectiveness might be perceived by her child as an act of care since the mother figure is mainly associated with kindness, warmth and affection and leniency with their children, while fathers are seen to be more concerned with maintaining strictness and discipline as well the obedience for propriety and necessity (Hu, 1987; Shek, 1995); thus, marking the overprotectiveness as more salient in the father’s rather than in the mothers especially in the Lebanese culture whereby the father is considered as dominant figure in the household and the one who is in authority and control (Usta & Hamieh, 2011). Also, the finding that those with affectionate constraint had higher suicide risk than those with optimal parenting is explained in the sense that despite the high control component acting as a risk factor for suicide risk, heightened parental care is also explained to possess an adverse effect on the possibility of acquiring developmental strengths such as problem solving skills (Matheson et al., 2005). Hence, an impaired problem solving skill will negatively influence one’s encountering of adaptive solutions to his/her problems; thus, allowing the individual to act out on their suicidal thoughts (Safer et al., 2015).
The existing association between parent care and suicide risk is explained in the light that low levels of parental care allow the development of an intrinsically and socially alienating self-schema that negatively influences the sense of self; thus, mediating the relationship between parental bonding and repetitive suicide behavior (Dale et al., 2010). Also, low parental care leads to feelings of rejection and worthlessness, such feelings threaten the self-esteem and advocate helplessness and hopelessness which consequently lead to the increase in suicide behaviors (Dale et al., 2010). Further evidence indicates that low parental care play instills in the individual a sensation of low belongingness and burdensomeness; such sensations form a risk factor for the engagement in suicide (Safer et al., 2015). The negative relationship existing between parental control and increased suicide risk is explained in the light that parental overprotection causes frustration particularly during the adolescent period as they struggle to gain independence and autonomy (Ytredal, 2016). Increased parental control also plays a role in causing prolonged exposure of the individual to parental control in the form of violence which can lead to interpersonal stressors such as the arising conflict between oneself and the parent (Yredal, 2016). Additionally, the exposure to high control and low care of the authoritarian parental style is associated with anxiety sensitivity, which is considered a risk factor of suicide (Timpano, Carbonella, Keough, Abramowitz and Schmidt, 2015). Also, since parental control promotes the child’s experience of hopelessness (Li, Li, Wang & Bao, 2001), this factor is considered a risk component for suicide; hence, indicating that psychological control increases the risk of suicide through the mediating role of hopelessness (Yterdal, 2016). Overall, the study’s findings as well as the exiting empirical evidence supported the agreement that suicide intent and risk appears to be the highest with those who perceived their mothers and fathers as less caring, and with affectionless control parental bonding (Low care, and high control).
The third hypothesis stated that there will be a negative correlation between parental care (mother care and/or father care) and anxiety. This hypothesis was confirmed and it is in line with previous research. The findings imply that the more the mother cares, the less anxiety is reported. No correlation was found between father care and anxiety level.
The forth hypothesis stated that there is a positive correlation between parental control (mother control and/or father control) and anxiety. The study’s findings mainly indicate that the elements of high care and low control (i.e. optimal parenting) are related to decreased levels of anxiety, while the elements of low care and low control (i.e. neglectful parental bonding) are related to increased anxiety. Also, maternal affectionate constraint parenting which incorporates the high care and high control elements and the affectionless control parenting which incorporates elements of low care and low control were also found to be related to increased anxiety. These results are in concordance with numerous findings found in the literature.
The fifth hypothesis stated that there is a positive correlation between parental care (mother care, and/or father care) and self-esteem. This hypothesis was confirmed and was in line with previous research since a positive correlation was obtained between self-esteem and mother care as well as between self-esteem and father care; thus, supporting hypothesis 5. The analyses also revealed that a negative correlation was obtained between father protection and self-esteem; implying that the more the father exhibits overprotection, the less is the reported self-esteem. However, no correlation was obtained between mother overprotection and self-esteem.
The sixth hypothesis stated that there is a negative correlation between parental control (mother control and father control) and self-esteem. This hypothesis was confirmed and it is in line with previous research. In further support of the hypotheses, the analyses of the between-group differences yielded significant results. It was revealed that those with maternal optimal parenting bonding have higher self-esteem than those exposed to maternal affectionate constraint parental bonding. In accordance, those with paternal optimal parenting reported more self-esteem than those exposed to paternal affectionless control parental boding. Nevertheless, the conduction of regression analyses did not yield any predictive relationships between the parental bonding variables and self-esteem.
The association between high overprotectiveness and low care of the parental bonding dimensions with decreased self-esteem is mainly explained by the notion that excessive control exhibited by parents which incorporates commanding children to do things rather than allowing them to engage in decision making, undermines their autonomy, competence and relatedness development (Saleh, 2014).
Conclusion
The study’s findings were also indicative of a positive association between affectionless control and decreased self-esteem and increased anxiety and suicide risk, indicators of negative mental health (Saleh, 2014; Yterdal, 2016), whereas a negative association between optimal parenting elements (high care, low control) and increased self-esteem, decreased anxiety and suicide risk. These findings are consistent with the Western literature where low parental care and high parental control are associated with negative mental health outcomes (Saleh, 2014; Dwairy et al., 2006b). Hence, these results imply the change in the focus of Lebanese values towards greater emphasis on better parental care and greater child psychological autonomy, which are features that are commonly experienced in the west (Saleh, 2014).
Future Directions
Future research can also aim to examine variables that could be mediating or moderating the association between perceived parenting and levels of each of self-esteem, anxiety and suicide risk. Such mediating factors can be the children’s conflict with their parents, the children’s personality traits (Saleh, 2014).
Limitations
A number of limitations emerged in this study:
– Exclusion of the Lebanese participants who lack the knowledge in speaking English took place; hence, this might have created a restriction of scores and threated the external validity especially that the study aimed to investigate the associations among the variables in the Lebanese cultural setting where Arabic is the official Language (Ayyash-Abdo, 2001).
-Moreover, the generalizability of the results might have also been affected by the collection of data only from the Beirut region, and its target of only young adults rather than representing all adult population of Lebanon.
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[1]– أخصائية نفسية عيادية. حصلت على درجة الماجستير في علم النفس العيادي من جامعة هايكازيان ودرجة البكالوريوس في علم النفس من الجامعة اللبنانية الأمريكية. متخصصة في العلاج السلوكي المعرفي (CBT) وعلاج . (IPT) و تعمل على تحصيل درجة الدكتوراه من الجامعة اللبنانيّة في علم النفس العيادي بما يخص التنظيم العاطفي والتأقلم والمرونة.
Clinical Psychologist. MA degree in Clinical Psychology from Haigazian University and BA degree in Psychology from the Lebanese American University. specialized in Cognitive Behavioral Therapy (CBT) and Interpersonal Therapy (IPT). As a PhD candidate, her PhD from the Lebanese University in Clinical Psychology focuses on emotional regulation, coping and resilience. Email: lama_hamdoun90@hotmail.com
