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Depression and suicide attempts in Chinese adolescents with mood disorders: the mediating role of rumination

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Abstract

Mood disorders (MD) are often associated with a higher incidence of suicidal behavior, especially in adolescent patients. However, the mechanisms by which depression affects suicide attempts in adolescents with MD remain poorly elucidated. Therefore, the purpose of this study was to determine the incidence, risk factors, and clinical correlates of suicide attempts in Chinese adolescent patients with MD, as well as the inter-relationship between depressive symptoms, rumination, and suicide attempts, and the role of rumination in mediating depression and suicide attempts. A total of 331 MD adolescent patients aged 11 ~ 18 years were recruited from a psychiatric hospital. Suicide attempts were assessed with the MINI Suicide Scale. Depressed symptoms were measured with the Patient Health Questionnaire-9 (PHQ-9). To assess rumination, we used the 21-item Chinese version of the Ruminative Responses Scale (RRS). Overall, the percentage of suicide attempts among MD adolescents was 51.96%, with a higher percentage of females (58.62%) than males (36.36%). Compared to non-suicide attempters, suicide attempters had higher scores on PHQ-9, RRS, depression-related, brooding, and reflective pondering. Gender and RRS were independently associated with suicide attempts. Rumination played a fully mediating role between depression and suicide attempts. In addition, the mediating effect of depression between rumination and suicide attempts was not significant. The incidence of suicide attempts was higher in MD adolescents than in general adolescents. Gender and rumination were associated with suicide attempts in MD adolescents. Moreover, rumination mediated the correlation between depressive symptoms and suicide attempts, suggesting that rumination may be an important intervention component for clinical staff to prevent suicidal behavior in adolescents with MD.

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Data availability

The datasets that support the findings of this study are not publically available due to ongoing analyses for further publications but are available from the corresponding author XZ upon reasonable request.

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Acknowledgements

We want to express special gratitude to the participants for their cooperation and patience across this study. We also thank the medical staff of the Third People’s Hospital of Ganzhou City for their help in data collection.

Funding

This study was supported by the Planning Program of Health Committee of Ganzhou (2022–1-5); Key R&D Program of Jiangxi Province (20202BBGL73106); Key R&D Program of Science and Technology in Ganzhou (201926); the Planning Program of Health Committee of Jiangxi Province (20202089) and grants 81771139 and 81371477 from the CAS Pioneer Hundred Talents Program and the National Natural Science Foundation of China. All funding had no role in study design, data analysis, paper submission and publication.

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  1. Dianying Liu, Shaohua Liu and Hongdong Deng contributed equally.

Authors and Affiliations

  1. Ganzhou City Key Laboratory of Mental Health, The Third People’s Hospital of Ganzhou City, Ganzhou, China

    Dianying Liu, Shaohua Liu, Hongdong Deng, Lijuan Qiu, Baiyun Xia, Wanglin Liu, Delong Zhang, Dan Huang & Huiyun Guo

  2. Institute of Psychology, Chinese Academy of Sciences, Beijing, China

    Xiangyang Zhang

  3. Department of Psychology, University of Chinese Academy of Sciences, Beijing, China

    Xiangyang Zhang

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Contributions

DL, SL and XZ were designed the study. LQ, BX, WL, DZ, DH and HG collected literatures and cleaned data. DL did statistical analysis. DL and HD wrote the manuscript. XZ reviewed and revised the manuscript.

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Correspondence to Dianying Liu or Xiangyang Zhang.

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The authors declare no conflicts of interest.

Ethical approval

This research project was approved by the ethics committee, Ganzhou Third People's Hospital.

Informed consent

All adolescent participants and their guardians signed a written informed consent form. All methods described in this study were performed in accordance with the Declaration of Helsinki issued by the National Institutes of Health.

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Liu, D., Liu, S., Deng, H. et al. Depression and suicide attempts in Chinese adolescents with mood disorders: the mediating role of rumination. Eur Arch Psychiatry Clin Neurosci 273, 931–940 (2023). https://doi.org/10.1007/s00406-022-01444-2

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