Early maladaptive schema domains and suicide risk in major depressive disorder: the mediating role of patients’ illness-related self-regulation processes and symptom severity

Early maladaptive schemas (EMS), illness representations, and coping are associated with clinical outcomes of patients with major depressive disorder (MDD). However, the pathways that link these factors are largely unknown. The present prospective study aimed at investigating the possible mediating role of illness representations and coping in the associations among schema domains, symptom severity, and suicide risk in MDD. Participants were 135 patients diagnosed with MDD, aged 48.13 ± 14.12 (84.4% females). The Young Schema Questionnaire-Short Form 3 was used to measure schema domains at baseline. Illness representations and coping were measured at approximately five months later (mean = 5.04 ± 1.16 months) with the Illness Perception Questionnaire-Mental Health and the Brief COPE Inventory, respectively. MDD outcomes were measured about 10 months after the baseline assessment (mean = 9.44 ± 2.36 months) with the Beck Depression Inventory and the Risk Assessment Suicidality Scale. SPSS AMOS 27 was used to conduct path analysis. Serial mediation Structural Equation Modelling, controlling for age, education, marital status, working status, MDD duration, pharmacotherapy, and psychotherapy, revealed that Impaired Autonomy and Performance was positively linked to suicide risk. Negative MDD impact representations and symptom severity serially mediated the aforementioned association. Finally, problem-focused coping was negatively related to symptom severity and suicide risk. This study’s main limitation was modest sample size. Representations regarding the impact and severity of MDD mediate the effects of Impaired Autonomy and Performance on future suicide risk in MDD. Healing Impaired Autonomy and Performance domain of EMS, restructuring patients’ representations of high MDD impact, and enhancing problem-focused coping could significantly reduce symptom severity and suicide risk in Schema Therapy with MDD individuals.