Interpersonal Constructs in the Mediation of Early Maladaptive Schemas and Suicidal Ideation Among Outpatients With...

Four early maladaptive schemas (EMSs) are known to increase suicidal ideation: defectiveness/shame, social isolation/alienation, failure, and dependence/incompetence. However, no mechanisms through which EMSs may increase suicidal ideation have been studied. We aimed to examine important mechanisms that may underlie the association between specific EMSs related to heightened suicidal ideation (defectiveness/shame, social isolation/alienation, failure, and dependence/incompetence) and present suicidal ideation in outpatients with major depressive disorder (MDD) through 2 interpersonal constructs: perceived burdensomeness and thwarted belongingness.

We conducted parallel mediation analysis for 247 outpatients with MDD to test the hypothesis that each of the four EMSs would exhibit positive correlations with suicidal ideation, while perceived burdensomeness and thwarted belongingness would concurrently mediate these associations.

Perceived burdensomeness and thwarted belongingness fully mediated the associations between early maladaptive schemas and suicidal ideation, with significant total indirect effects for defectiveness/shame schema (95% confidence interval [CI], 0.28-0.47; B = 0.38), social isolation schema (95% CI, 0.27-0.48; B = 0.37), failure schema (95% CI, 0.25-0.41; B = 0.33), and dependence/incompetence schema (95% CI, 0.23-0.40; B = 0.31), after controlling for age and sex.

Through greater perceived burdensomeness and thwarted belongingness, outpatients with MDD with higher levels of the schemas previously known to be associated with elevated suicidal ideation were likely to exhibit a more severe level of current suicidal ideation. These findings highlight the potential benefits of including components that can reduce the severity of both interpersonal constructs in antisuicidal strategies.