A Serial Model of Psychological Strain and Early Adverse Life Experiences with Adolescent Suicidal Probability: The Mediating Role of Depression and Rumination

Document Type : Original Article

Authors

1 Department of Psychology, North Tehran Branch, Islamic Azad University, Tehran, Iran.

2 Assistant Professor of Psychology, Faculty of Humanities, Sayyed Jamaleddin Asadabadi University, Asadabad, Hamedan, Iran

Abstract

This study aimed to investigate the serial pattern of psychological strain and early adverse life experiences with the suicide probability in adolescents due to the mediating role of depression and rumination.

Method: The research method was descriptive-correlational,.The statistical population of this study consisted of all adolescents aged 14 to 19 years in Lorestan province in 2024. The sample consisted of 623 adolescents in Lorestan province who were selected by random cluster sampling method and answered the questions of the Psychological Stress Scale Short Form Questionnaire (PSS Siau et al., 2024), Early Life Experiences (Gilbert & Allen, 1998), Hospital Depression and Anxiety Scale (HADS, Zigmond, & Snaith, 1983), and Rumination Questionnaire Short Form (O'Connor & Williams, 2014). The results obtained from the structural equation modeling in the overall model and based on gender had a good fit. The results from the gender moderator analysis showed that in girls, early adverse life experiences have a direct positive and significant effect on depression, rumination and the suicidal probability (P< 0.05). Moreover, psychological strain has a direct positive and significant effect on depression, rumination, and the suicidal probability (P> 0.05).

Conclusion: The present study, considering the theory of psychological strain and early adverse life and disturbing experiences, provides a unique conceptual and theoretical framework to identify the antecedents of suicide risk in adolescents based on depression and rumination before committing suicidal behavior and attempts.

Keywords

Main Subjects


  1. منابع

    1. Millner AJ, Robinaugh DJ, Nock MK. Advancing the Understanding of Suicide: The Need for Formal Theory and Rigorous Descriptive Research. Trends Cogn Sci. 2020;24(9):704-16. https://doi.org/10.1016/j.tics.2020.06.007
    2. Pirkis J, Dandona R, Silverman M, Khan M, Hawton K. Preventing suicide: a public health approach to a global problem. The Lancet Public Health. 2024;9(10):e787-e95. https://doi.org/10.1016/S2468-2667(24)00149-X
    3. Huertes-del Arco A, Izquierdo-Sotorrío E, Carrasco MA, Caro-Cañizares I, Holgado-Tello FP. Suicidal Ideation in Adolescents and Young Adults: The Role of Defeat, Entrapment, and Depressive Symptoms—From a Systematic Review to a Tentative Theoretical Model. Behav Sci (Basel). 2024;14(12):1145. https://doi.org/10.3390/bs14121145
    4. Cha CB, Franz PJ, E MG, Glenn CR, Kleiman EM, Nock MK. Annual Research Review: Suicide among youth - epidemiology, (potential) etiology, and treatment. J Child Psychol Psychiatry. 2018;59(4):460-82. https://doi.org/10.1111/jcpp.12831
    5. Klonsky ED, Pachkowski MC, Shahnaz A, May AM. The three-step theory of suicide: Description, evidence, and some useful points of clarification. Prev Med. 2021;152:106549. https://doi.org/10.1016/j.ypmed.2021.106549
    6. Klonsky ED, May AM. The three-step theory (3ST): A new theory of suicide rooted in the “ideation-to-action” framework.  Int. J. Cogn. Behav. Ther. 2015;8(2):114-29. Doi:10.1521/ijct.2015.8.2.114
    7. Bagian Kulemarzi MJB, Moosivand M, Zaremohzzabieh Z. Evaluation of the Validity and Reliability of the Entrapment Scale in Iranian Adolescents and Its Relationship with Suicidal Ideation. Illness, Crisis & Loss. 2025;33(2):342-61. https://doi.org/10.1177/10541373231224518
    8. Demirkol ME, Tamam L, Namlı Z, Yeşiloğlu C, Yılmaz H. Validity and Reliability Study of the Turkish Version of the Orbach Mikulincer Mental Pain Scale-8 in a Clinical Population. Neuropsychiatr Dis Treat. 2024;20:429-38. https://doi.org/10.2147/NDT.S449012
    9. American Psychiatric Association, DSM-5-TR Task Force. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). 2024 https://doi/book/10.1176/appi.books.9780890425787
    10. Emile D. Suicide: a study in sociology. Translated by Spaulding JA and Simpson G Reprint Glencoe, IL: Free Press[Google Scholar]. 1951. https://www.academia.edu/35289121
    11. Freud S. Trauer und melancholie–Mourning and melancholia. The Complete Psychological Work of Sigmund Freud, Vol 14, London (The Hogarth Press) 1966. 1917. https://doi.org/10.1590/0047-2085000000137
    12. Neuringer C. Rigid thinking in suicidal individuals. J Consult Psychol. 1964;28(1):54. https://doi.org/10.1037/h0045809
    13. Beck AT. Hopelessness as a predictor of eventual suicide. Ann N Y Acad Sci. 1986;487:90-6. https://doi.org/10.1111/j.1749-6632.1986.tb27888.x
    14. Baumeister RF. Suicide as escape from self. Psychol Rev. 1990;97(1):90-113. https://doi.org/10.1037/0033-295x.97.1.90
    15. Williams JMG, Williams M. Suicide and attempted suicide: Understanding the cry of pain: Mark Williams; 2002. https://books.google.com/books/about/Cry_of_Pain.html
    16. Joiner T. Why People Die By Suicide Cambridge, MA: Harvard Univ. Press Describes a pioneering theory of suicide, the first to explicitly provide separate explanations for suicidal desire and suicide capability. 2005. https://record/2006-06716-000
    17. O'Connor RC, Kirtley OJ. The integrated motivational–volitional model of suicidal behavior. Philos Trans R Soc Lond B Biol Sci. 2018; 373(1754):20170268. https://doi.org/10.1098/rstb.2017.0268
    18. Rajabi M, Bagian Kulehmarzi MJB, Dastnaei TM. A Structural Model of Cognitive Reactivity and Early Life Experiences with Suicide Resiliency: The Mediation of Psychological Pain. Int J High Risk Behav Addict. 2024;13(4). https://doi.org/10.5812/ijhrba-147076
    19. Muneeb NUA, Hassan SMU. Psychological strain and suicidal ideation in young university students during Covid-19 outbreak: the mediating roles of rumination and depression. Curr Psychol. 2023;42(27):23731-42. Doi:10.1007/s12144-022-03551-8
    20. Nolen-Hoeksema S. Responses to depression and their effects on the duration of depressive episodes. J Abnorm Psychol. 1991;100(4):569-82. Doi:10.1037//0021-843x
    21. Rogers ML, Joiner TE. Rumination, suicidal ideation, and suicide attempts: A meta-analytic review. Reviw of Gen Psych. 2017;21(2):132-42. https://doi.org/10.1037/gpr0000101
    22. Vidal INS, Nieto M, Ricarte J, Alcantud MDV, Hallford D, Ros L. Effects of defeat and entrapment on suicide risk in university population: the role of rumination and sex. Peer J. 2024;12:e18673. Doi:10.7717/peerj
    23. Tucker RP, O'Connor RC, Wingate LR. An Investigation of the Relationship Between Rumination Styles, Hope, and Suicide Ideation Through the Lens of the Integrated Motivational-Volitional Model of Suicidal Behavior. Arch Suicide Res. 2016;20(4):553-66. Doi:10.1080/13811118.2016.1158682
    24. Sandford DM, Thwaites R, Kirtley OJ, O’Connor RC. Utilising the Integrated Motivational Volitional (IMV) model to guide CBT practitioners in the use of their core skills to assess, formulate and reduce suicide risk factors. The Cognitive Behaviour Therapist. 2022;15:e36. Doi:10.1017/S1754470X22000344
    25. Johnson SL, Robison M, Anvar S, Swerdlow BA, Timpano KR. Emotion-related impulsivity and rumination: Unique and conjoint effects on suicidal ideation, suicide attempts, and nonsuicidal self-injury across two samples. Suicide Life Threat Behav. 2022; 52(4):642-654. Doi:10.1111/sltb.12849
    26. Mousavi SM, Narimani M, Asgari SS. Suicidal Ideation Modeling based on Body Image and Rumination with the Mediation of Social Phobia in Individuals with Gender Dysphoric Disorder. J of Clin Psychol. 2022;14(4):39-51 [Persian]. Doi:10.22075/jcp.2022.26298.2394
    27. De Beurs D, Fried EI, Wetherall K, Cleare S, O’Connor DB, Ferguson E, et al. Exploring the psychology of suicidal ideation: A theory driven network analysis. Behav Res Ther. 2019;120:103419. Doi: 10.1016/j.brat.2019.103419
    28. Wang YH, Shi ZT, Luo QY. Association of depressive symptoms and suicidal ideation among university students in China: A systematic review and meta-analysis. Medicine (Baltimore). 2017;96(13):e6476. Doi:10.1097/MD.0000000000006476
    29. Peng B, Wang R, Zuo W, Liu H, Deng C, Jing X, et al. Distinct correlation network of clinical characteristics in suicide attempters having adolescent major depressive disorder with non-suicidal self-injury. Transl Psychiatry. 2024;14(1):134. Doi:10.1038/s41398-024-02843-w
    30. Grossberg A, Rice T. Depression and Suicidal Behavior in Adolescents. Med Clin North Am. 2023;107(1):169-82. Doi:10.1016/j.mcna.2022.04.005
    31. Hink AB, Killings X, Bhatt A, Ridings LE, Andrews AL. Adolescent Suicide-Understanding Unique Risks and Opportunities for Trauma Centers to Recognize, Intervene, and Prevent a Leading Cause of Death. Curr Trauma Rep. 2022;8(2):41-53. https://doi.org/10.1007/s40719-022-00223-7
    32. Birmaher B, Brent D, Bernet W, Bukstein O, Walter H, Benson RS, et al. Practice parameter for the assessment and treatment of children and adolescents with depressive disorders. J Am Acad Child Adolesc Psychiatry. 2007;46(11):1503-26. Doi:10.1097/chi.0b013e318145ae1c
    33. Nelemans SA, Boks M, Lin B, Oldehinkel T, van Lier P, Branje S, et al. Polygenic Risk for Major Depression Interacts with Parental Criticism in Predicting Adolescent Depressive Symptom Development. J Youth Adolesc. 2021;50(1):159-76. Doi:10.1007/s10964-020-01353-4
    34. Orri M, Galera C, Turecki G, Forte A, Renaud J, Boivin M, et al. Association of Childhood Irritability and Depressive/Anxious Mood Profiles With Adolescent Suicidal Ideation and Attempts. JAMA Psychiatry. 2018;75(5):465-73. Doi:10.1001/jamapsychiatry.2018.0174
    35. Etemadi Z, Abbaspour S, Tirgari A, Bagian Koulemarzi MJ. The Mediating Role of Depression and Hopelessness in the Relationship of Psychological Strain, Rejection Sensitivity, and Defeat With Suicide Ideation in Adolescents in Iran. IJPCP 2023; 29 (2):170-187. [Persian]. http://ijpcp.iums.ac.ir/article-1-3850-fa.html
    36. Senaratne DNS, Koponen M, Barnett KN, Smith BH, Hales TG, Marryat L, et al. Impact of adverse childhood experiences on analgesia-related outcomes: a systematic review. Br J Anaesth. 2025;134(2):461-91. Doi:10.1016/j.bja.2024.09.015
    37. Hughes K, Bellis MA, Hardcastle KA, Sethi D, Butchart A, Mikton C, et al. The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis. Lancet Public Health. 2017;2(8):e356-e66. Doi:10.1016/S2468-2667(17)30118-4
    38. Brindle RC, Pearson A, Ginty AT. Adverse childhood experiences (ACEs) relate to blunted cardiovascular and cortisol reactivity to acute laboratory stress: A systematic review and meta-analysis. Neurosci Biobehav Rev. 2022;134:104530. https://doi.org/10.1016/j.neubiorev.2022.104530
    39. Antoniou G, Lambourg E, Steele JD, Colvin LA. The effect of adverse childhood experiences on chronic pain and major depression in adulthood: a systematic review and meta-analysis. Br J Anaesth. 2023;130(6):729-46. Doi:10.1016/j.bja.2023.03.008
    40. Franke HA. Toxic Stress: Effects, Prevention and Treatment. Children (Basel). 2014;1(3):390-402. https://doi.org/10.3390/children1030390
    41. Santini ZI, Koyanagi A, Stewart-Brown S, Perry BD, Marmot M, Koushede V. Cumulative risk of compromised physical, mental and social health in adulthood due to family conflict and financial strain during childhood: a retrospective analysis based on survey data representative of 19 European countries. BMJ Glob Health. 2021;6(3). Doi:10.1136/bmjgh-2020-004144
    42. Gal G, Levav I, Gross R. Child/adolescent abuse and suicidal behavior: are they sex related? Suicide Life Threat Behav. 2012;42(5):580-8. Doi:10.1111/j.1943-278X.2012.00118.x
    43. Laporte N, Ozolins A, Westling S, Westrin Å, Wallinius M. Adverse childhood experiences as a risk factor for non-suicidal self-injury and suicide attempts in forensic psychiatric patients. BMC Psychiatry. 2023;23(1):238. Doi:10.1186/s12888-023-04724-w
    44. Flaherty EG, Thompson R, Dubowitz H, Harvey EM, English DJ, Proctor LJ, et al. Adverse childhood experiences and child health in early adolescence. JAMA Pediatr. 2013;167(7):622-9. Doi:10.1001/jamapediatrics.2013.22
    45. Yüce M, Karabekiroğlu K, Yildirim Z, Şahin S, Sapmaz D, Babadaği Z, et al. The Psychiatric Consequences of Child and Adolescent Sexual Abuse. Noro Psikiyatr Ars. 2015;52(4):393-9. Doi:10.5152/npa.2015.7472
    46. Kozak RS, Gushwa M, Cadet TJ. Victimization and Violence: An Exploration of the Relationship Between Child Sexual Abuse, Violence, and Delinquency. J Child Sex Abus. 2018;27(6):699-717. Doi:10.1080/10538712.2018.1474412
    47. Larsson S, Andreassen OA, Aas M, Røssberg JI, Mork E, Steen NE, et al. High prevalence of childhood trauma in patients with schizophrenia spectrum and affective disorder. Compr Psychiatry. 2013;54(2):123-7. Doi:10.1016/j.comppsych.2012.06.009
    48. Nouraei N, Goodarzi M, Aflakseir A. The Mediating Role of Mentalization and Self-Emotion Regulation in the Relationship between Childhood Trauma and Suicidal Ideation. J of Clin Psychol. 2024;16(2):13-25 [Persian]. Doi:10.22075/jcp.2024.33846.2880
    49. Zhang J, Liu Y, Sun L. Psychological strain and suicidal ideation: A comparison between Chinese and US college students. Psychiatry Res. 2017; 255:256-262. Doi:10.1016/j.psychres.2017.05.046
    50. Zhang J. Psychological Strain as a Source of Mental Disorder and Suicidality. The Palgrave Encyclopedia of Disability: Springer; 2024. p. 1-7. https://doi.org/10.1007/978-3-031-40858-8_130-1
    51. Huen JMY, Zhang J, Osman A, Lew B, Yip PSF. Using contemporary psychometric methods to construct and validate scores on a short-form version of the Psychological Strain Scales. J Affect Disord. 2021; 281:1-8. Doi:10.1016/j.jad.2020.11.069
    52. Zhang J, Lu J, Zhao S, Lamis DA, Li N, Kong Y, et al. Developing the Psychological Strain Scales (PSS): Reliability, validity, and preliminary hypothesis tests. Soc Indic Res. 2014;115(1):337-361. Doi:10.1007/s11205-012-0222-6
    53. Siau CS, Zhang J, Chen WS, Mohd Saat NZ, Lew B, Ma X, et al. Measuring Psychological Strains: A Psychometric Study to Develop a Shortened Version of the Psychological Strain Scales. Behav Sci (Basel). 2024;14(12):1157. Doi:10.3390/bs14121157
    54. Moosivand M, Bagian Kulemarzi MJ, Zaremohzzabieh Z, Zarean M, Rajabi M, Khanjani S. The Structural Model of the Effects of Psychological Strain, Defeat, and Thwarted Belongingness on Suicidal Ideation in Adolescents via the Mediation of Depression and Hopelessness. Arch Suicide Res. 2024; 28(4):1077-1092. Doi:10.1080/13811118.2024.2314518
    55. Soper D. A-priori sample size calculator for structural equation models [Software]. 2021. URL: https://www danielsoper com/statcalc [accessed 2023-05-25]. 2021
    56. Cull JG, Gill WS. Suicide probability scale. J of Consul and Clinic Psych. 1988. https://doi.org/10.1037/t01198-000
    57. Tatman SM, Greene A, Karr LC. Use of the Suicide Probability Scale (SPS) with adolescents. Suicide Life Threat Behav. 1993; 23(3):188-203. PMID: 8249031
    58. Khanipour H BA, Falsafinejad MR. . Non-suicidal Self-injury in delinquent adolescents and adolescents with history of childhood maltreatment: motivation and suicide probability. Psych of Except Individ. 2016;6(21):59-79 [Persian]. https://doi.org/10.22054/jpe.2016.5281
    59. O’Connor RC, Williams JMG. The relationship between positive future thinking, brooding, defeat and entrapment. Person and Individual Differen. 2014;70:29-34. https://doi.org/10.1016/j.paid.2014.06.016
    60. Polanco-Roman L, Jurska J, Quiñones V, Miranda R. Brooding, reflection, and distraction: relation to non-suicidal self-injury versus suicide attempts. Arch Suicide Res. 2015;19(3):350-65. Doi:10.1080/13811118.2014.981623
    61. Nolen-Hoeksema S. Responses to depression and their effects on the duration of depressive episodes. J Abnorm Psychol. 1991; 100(4):569-82. Doi:10.1037//0021-843x.100.4.569
    62. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983; 67(6):361-70. Doi:10.1111/j.1600-0447.1983.tb09716.x
    63. Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res. 2002; 52(2):69-77. Doi:10.1016/s0022-3999(01)00296-3
    64. White D, Leach C, Sims R, Atkinson M, Cottrell D. Validation of the Hospital Anxiety and Depression Scale for use with adolescents. Br J Psychiatry. 1999; 175:452-4. Doi:10.1192/bjp.175.5.452
    65. Mihalca AM, Pilecka W. The factorial structure and validity of the Hospital Anxiety and Depression Scale (HADS) in Polish adolescents. Psychiatr Pol. 2015;49(5):1071-88. Doi:10.12740/PP/38139
    66. Kaviani H, Seyfourian H, Sharifi V, & Ebrahimkhani N. Reliability and validity of Anxiety and Depression Hospital Scales (HADS): Iranian patients with anxiety and depression disorders. Tehran University Medical Journal. 2009;67(5):379-85 [Persian]. https://sid.ir/paper/445660/fa
    67. Gilbert P, Cheung MSP, Grandfield T, Campey F, Irons C. Recall of threat and submissiveness in childhood: Development of a new scale and its relationship with depression, social comparison and shame. Clin. Psychol. Psychother. 2003;10(2):108-15. Doi:10.1002/cpp.359
    68. Khanjani S, Asl EM, Foroughi A, Kazemini M, Rajabi M. Psychometric properties of the Persian Version of the Early Life experiences Scale (ELES). I J of Psychiatry and Behavioral Sciences. 2023;17(1):e122454. https://www.magiran.com/p2566902
    69. Cain MK, Zhang Z, Yuan K-H. Univariate and multivariate skewness and kurtosis for measuring nonnormality: Prevalence, influence and estimation. Behav Res Methods. 2017; 49(5):1716-1735. Doi:10.3758/s13428-016-0814-1
    70. Leth-Steensen C, Gallitto E. Testing Mediation in Structural Equation Modeling: The Effectiveness of the Test of Joint Significance. Educ Psychol Meas. 2016;76(2):339-51. Doi:10.1177/0013164415593777. Epub 2015 Jul 7
    71. Souza K, Sosu EM, Thomson S, Rasmussen S. A systematic review of the studies testing the integrated motivational-volitional model of suicidal behaviour. Health Psychol Rev. 2024; 18(4):698-722. Doi:10.1080/17437199.2024.2336013
    72. Khani Jeihooni A, Amirkhani M, Rakhshani T, Hasirini PA, Jormand H. Factors associated with suicidal ideation in drug addicts based on the theory of planned behavior. BMC psychiatry. 2021; 26;21(1):372. Doi:10.1186/s12888-021-03387-9
    73. Hildyard KL, Wolfe DA. Child neglect: developmental issues and outcomes. Child Abuse Negl. 2002; 26(6-7):679-95. Doi:10.1016/s0145-2134(02)00341-1
    74. Taillieu TL, Brownridge DA, Sareen J, Afifi TO. Childhood emotional maltreatment and mental disorders: Results from a nationally representative adult sample from the United States. Child Abuse Negl. 2016; 59:1-12. Doi:10.1016/j.chiabu.2016.07.005
    75. Rohner RP, Khaleque A, Cournoyer DE. Parental acceptance‐rejection: Theory, methods, cross‐cultural evidence, and implications. Ethos. 2005; 33(3):299-334. https://doi.org/10.1525/eth.2005.33.3.299
    76. Merrick MT, Ports KA, Ford DC, Afifi TO, Gershoff ET, Grogan-Kaylor A. Unpacking the impact of adverse childhood experiences on adult mental health. Child Abuse Negl. 2017; 69:10-9. Doi:10.1016/j.chiabu.2017.03.016
    77. Martin LL, Tesser A. Some ruminative thoughts. Ruminative thoughts: Psychology Press; 2013. p. 1-47. https://doi.org/ record/1996-97335-001
    78. Watkins ER. Constructive and unconstructive repetitive thought. Psychol Bull. 2008;134(2):163-206. Doi:10.1037/0033-2909.134.2.163
    79. Nock MK, Borges G, Bromet EJ, Cha CB, Kessler RC, Lee S. Suicide and suicidal behavior. Epidemiol Rev. 2008;30(1):133-54. Doi:10.1093/epirev/mxn002
    80. Nolen-Hoeksema S, Larson J, Grayson C. Explaining the gender difference in depressive symptoms. J Pers Soc Psychol. 1999;77(5):1061-72. Doi:10.1037//0022-3514.77.5.1061
    81. Wenzel A, Beck AT. A cognitive model of suicidal behavior: Theory and treatment. Appli and prevent psych. 2008;12(4):189-201. https://doi.org/10.1016/j.appsy.2008.05.001
    82. Polanco-Roman L, Gomez J, Miranda R, Jeglic E. Stress-Related Symptoms and Suicidal Ideation: The Roles of Rumination and Depressive Symptoms Vary by Gender. Cognit Ther Res. 2016;40(5):606-16. Doi:10.1007/s10608-016-9782-0
    83. Chiang YH, Ma YC, Lin YC, Jiang JL, Wu MH, Chiang KC. The Relationship between Depressive Symptoms, Rumination, and Suicide Ideation in Patients with Depression. Int. J. Environ. Res. Public Health. 2022, 19(21), 14492; https://doi.org/10.3390/ijerph192114492
    84. Tucker RP, O’Connor RC, Wingate LR. An investigation of the relationship between rumination styles, hope, and suicide ideation through the lens of the integrated motivational-volitional model of suicidal behavior. Arch Suicide Res. 2016; 20(4):553-66. Doi:10.1080/13811118.2016.115868