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. 2023 Nov 3;9(11):e21986.
doi: 10.1016/j.heliyon.2023.e21986. eCollection 2023 Nov.

Perceived stress and severity of depression mediate the association between alexithymia and suicidal ideation in patients with major depressive disorder

Dan Li  1 , Ying Gao  1 , Shuhua Li  1   2 , Chi Zhou  1 , Yuting Wang  1 , Meijuan Li  1 , Nanage Guobule  1 , Huan Mao  1 , Xiangyang Zhang  3 , Jie Li  1
Affiliations

Perceived stress and severity of depression mediate the association between alexithymia and suicidal ideation in patients with major depressive disorder

Dan Li et al. Heliyon. .

Abstract

Introduction: Alexithymia and perceived stress have been recognized as risk factors for suicide in patients with major depressive disorder (MDD). However, few studies have been conducted to examine the relationship between these factors.

Methods: A cross-sectional study was conducted on 105 MDD patients. Alexithymia was assessed by the 20-Item Toronto Alexithymia Scale (TAS), perceived stress was assessed by the Perceived Stress Scale (PSS), severity of depression was assessed by the 17-item Hamilton Depression Rating Scale (HAMD), and suicidal ideation was assessed by the self-report Beck Scale for Suicide Ideation (SSI). A sequential mediation model was established to test the mediating effects of perceived stress and severity of depression on the association between alexithymia and suicidal ideation.

Results: 81 of the 105 participants (77.14 %) had suicidal ideation. Patients with suicidal ideation had greater difficulty in identifying feelings (DIF) (p = 0.046), higher severity of depression (p = 0.005) and perceived stress (p = 0.003). DIF subscale score of TAS was associated with perceived stress (r = 0.292, p = 0.003), severity of depression (r = 0.349, p < 0.001) and suicidal ideation (r = 0.229, p = 0.012). Sequential mediation model showed that perceived stress and severity of depression mediated the effect of DIF on suicidal ideation.

Conclusions: This study suggests that perceived stress and severity of depression fully mediate the relationship between difficulty in identifying feelings and suicidal ideation in MDD patients.

Keywords: Alexithymia; Major depressive disorder; Perceived stress; Suicidal ideation.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Examined sequential mediation model perceived stress and severity of depression on alexithymia and suicidal ideation. *p < 0.05, **p < 0.01, ***P < 0.001. Solid lines represent significant pathways, the dashed line represents a non-significant pathway. Unstandardized coefficients are presented. DIF: Difficulty in Identifying Feelings; PSS: Perceived stress scale; HAMD: Hamilton Depression Rating Scale; SSI: Beck scale for suicide ideation.
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