The psychological configuration of suicidal ideation in depressive disorder: an integrative and predictive approach

Suicidal ideation in depression is increasingly understood as a multidetermined phenomenon shaped by emotional distress, emotion regulation deficits, maladaptive coping, and contextual vulnerability. The present study examined the psychological correlates and predictors of suicidal ideation and tested the mediating roles of emotion regulation difficulties and quality of life in adults with depressive disorder.

A cross-sectional study was conducted on 172 adults with depressive disorder. Participants completed standardized measures of suicidal ideation and suicidal behavior (C-SSRS), depressive severity (MADRS), emotional distress (DASS-21R), emotion regulation difficulties (DERS-SF), coping strategies (Cognitive Emotion Regulation Questionnaire [CERQ] and Strategic Approach to Coping Scale [SACS]), and quality of life (QOLI). Spearman correlations, hierarchical regression analyses, and mediation models with bootstrapping (5,000 samples) were performed.

Suicidal ideation was positively associated with depressive severity, anxiety, stress, several dimensions of emotion regulation difficulties, and maladaptive coping strategies, and negatively associated with quality of life. Hierarchical regression analyses identified depressive severity and quality of life as the most robust contributors in the first model, while maladaptive behavioral and cognitive coping strategies contributed additional explanatory value in the second model. Mediation analyses indicated that emotion regulation difficulties significantly mediated the association between depressive severity and suicidal ideation, and that a significant serial indirect effect also operated through reduced quality of life. In both models, the direct effect of depressive severity remained significant, indicating partial mediation.

Suicidal ideation in depressive disorder is associated with a broader psychological configuration involving emotional distress, emotion regulation difficulties, maladaptive coping, and diminished quality of life. These findings support an integrative, multivariable approach to understanding suicidal ideation in depression and highlight clinically relevant psychological factors that may inform assessment and intervention.