Secondary attachment and mental health in Pakistani and Scottish adolescents: A moderated mediation model.

OBJECTIVES: Research into adolescent mental health has tended to focus on primary attachment relationships. However, the effect of secondary attachment relationships and the role of culture remain under-explored. This study examined the associations between primary attachment, secondary attachment, and coping strategies (task-focused, emotion-focused, and avoidant coping) with psychological well-being and psychological distress in adolescents across two cultural settings. DESIGN: A cross-sectional study. METHOD: An identical test battery was used across two geographic sites in Pakistan (N = 510; 12-18 years; 51.5% male; mean age = 14.50) and Scotland (N = 610; 12-18 years; 53.6% male; mean age = 13.97). Associations were tested separately in each sample using moderated mediation modelling for the outcome variables: psychological well-being and psychological distress. RESULTS: For psychological well-being, all three coping strategies were significant partial mediators and secondary attachment was a significant moderator in both samples. Secondary attachment moderated the association between emotion-focused coping and psychological well-being in the Pakistani sample only. For psychological distress, task-focused coping was a significant full mediator in the Pakistani sample only. In contrast, for the Scottish sample, task-focused coping and emotion-focused coping were significant partial mediators. Secondary attachment's direct effect on psychological distress was significant in both samples. Secondary attachment also moderated the association between emotion-focused coping and psychological distress in the Pakistani sample only. CONCLUSIONS: The cross-cultural evidence suggests that alongside primary attachment, it is important to target secondary attachment through coping strategies, in order to enhance psychological well-being and lessen psychological distress in adolescents. PRACTITIONER POINTS: Secondary attachment plays a different role from primary attachment in adolescents. Therefore, it is important to target both primary attachment and secondary attachment security to enhance psychological well-being and lessen psychological distress. Cross-cultural differences in coping suggest that differential strategies to target different coping dimensions may enhance adolescent well-being across cultures. These cross-cultural differences highlight the ethical importance of cultural sensitivity among clinicians working with adolescents globally.