Disentangling how Depressive Symptoms, Rumination, and Hopelessness Relate to Suicidal Intrusions: A Moderated-Mediation Analysis

Abstract

Suicidal intrusions – vivid, involuntary thoughts or images of suicide – have recently gained attention in research and relate to suicidal ideation. While research could link depressive symptoms to suicidal intrusions, the mechanisms underlying the relationship remain unclear. This study proposed a moderated-mediation model in which rumination was hypothesized to mediate the relationship between depressive symptoms and suicidal intrusions. Hopelessness was hypothesized to moderate the pathway between rumination and suicidal intrusions. In a cross-sectional design, 178 suicidal and depressed outpatients in the Netherlands completed questionnaires, measuring depression (Beck Depression Inventory-II), rumination (Ruminative Response Scale), suicidal intrusions (Suicidal Attributes Scale), and hopelessness (Beck’s Hopelessness Scale). A moderated-mediation analysis yielded non-significant results (B = 0.013, SE = 0.016, 95% CI [-0.016, 0.048]). Hopelessness was not supported as a moderator, and rumination did not mediate the relationship between depressive symptoms and suicidal intrusions. While the role of rumination and hopelessness remains inconclusive, a significant direct relationship between depressive symptoms and suicidal intrusions suggests that depressive symptoms represent a direct risk factor for suicidal intrusions. Finally, we discuss strengths, limitations, implications, and future directions.