The Role of Suicidal Intrusions and Rumination in the Relationship between Depressive Symptoms and Suicidal Ideation

Abstract

This study aimed to identify risk factors for suicidal ideation (SI) and inform treatment for depressed individuals at risk for suicide by exploring the relationship between depressive symptoms, suicidal intrusions, rumination, and SI. Specifically, we examined whether suicidal intrusions mediate the relationship between depressive symptoms and SI, and whether rumination moderates the relationship between depressive symptoms and suicidal intrusions. A cross-sectional multicenter design with 178 outpatients was implemented, measuring constructs with the Suicidal Intrusions Attributes Scale (SINAS), the Suicidal Ideation Attributes Scale (SIDAS), the Beck Depression Inventory II (BDI-II), and the Dutch version of the Ruminative Response Scale (RRS-NL). A moderated mediation analysis was conducted using the PROCESS macro program for SPSS, model 7 for hypotheses testing. Results revealed a significant direct relationship between depressive symptoms and SI, as well as an indirect mediating effect via suicidal intrusions. The relationship between depressive symptoms and suicidal intrusions was not moderated by rumination. The findings provide evidence for depressive symptoms and suicidal intrusions as important risk factors for SI that may be targeted in treatment.