Perceived stressfulness mediates the effects of subjective social support and negative coping style on suicide risk in Chinese patients with major depressive disorder

Background: Risk factors for suicide have been widely investigated in patients with major depressive disorder (MDD); However, far less research has been conducted on protective factors for suicide. Methods: The diagnosis of MDD and suicide risk were evaluated by the Mini-International Neuropsychiatric Interview (MINI). Social support and coping behaviors were assessed by the Social Support Rate Scale (SSRS) and Simplified Coping Style Questionnaire (SCSQ), respectively. Life stressors were captured by the Life Events Scale (LES). Severity of depression was assessed by 17-item Hamilton Depression Rating Scale (HAMD-17). Logistic regression analysis and path analyses were used to test the association of protective factors, risk factors, life stress and suicide risk. Results: Patients with suicide risk showed a significantly lower level of subjective social support (adjusted P < 0.012), a higher level of perceived stressfulness (P < 0.001) and negative coping style (P = 0.008) compared with patients without suicide risk. Path analysis showed that perceived stressfulness can mediate the protective effect of subjective social support and deleterious effect of negative coping style on suicide risk. Limitations: Cross-sectional design, and retrospective recall of stressful life events. Conclusions: This study suggests that subjective social support and negative coping style may be regarded as a protective factor and a risk factor for suicide risk in MDD patients, respectively, and perceived stressfulness mediates their roles in suicide. Further suicide prevention and intervention strategies should focus on increasing individual subjective social support and improving coping strategies to enhance their resilience.