Objective To explore the relationship between suicidal ideation and levels of depression, anxiety symptoms, rumination and self-acceptance in adolescents with depressive disorders.

Methods  Adolescents with depressive disorders who attended the Second Hospital of Lanzhou University from March 2023 to January 2024 were selected. Patients were assessed with Self-rating Depression Scale (SDS), Beck Scale for Suicide Ideation-Chinese Version (BSI- CV), Self- rating Anxiety Scale(SAS), Self-Acceptance Questionnaire(SAQ) and Ruminative Responses Scale (RRS). Subjects were classified into suicidal-ideation group and non-suicidal ideation group based on scores on the fourth and fifth items of BSI-CV. The differences between two groups were compared and correlation analyses and mediation effect tests were performed on the scale scores.

Results  A total of 90 adolescents with depressive disorders were included, 68 of whom had suicidal ideation, with a detection rate of 75.56%. Correlation analysis showed that the score of BSI-CV was significantly and positively correlated with SDS, SAS, RRS, and reflection, brooding factor (P<0.05), and was significantly and negatively correlated with SAQ, the self- acceptance and the self-evaluation factor(P<0.05). The mediation effect test showed that depressive symptoms played a complete mediating effect between self-acceptance and suicide ideation [effect value=-0.312, 95%CI (-0.507, -0.133)], while anxious symptoms played a complete mediating effect between rumination and suicide ideation [effect value=0.230, 95%CI (0.037, 0.442)].

Conclusion This study suggests that the incidence of suicidal ideation is high in adolescents with depressive disorder, whose suicidal ideation was positively correlated with depressive symptoms, anxious symptoms and rumination, while negatively correlated with self-acceptance. Depressive symptoms and anxious symptoms respectively play a complete mediating role in the effects of self-acceptance and rumination on suicidal ideation in depressive adolescent patients with suicidal ideation. To reduce suicide risk, clinicians should pay attention to assessing and intervening ruminative thinking. In addition, psychotherapy should be applied to clinical practice to improve self-acceptance and reduce rumination.

1.唐慧琳, 王思怡, 胡永恒. 初中生社会支持与自杀意念的关系: 心理韧性的中介效应[J]. 心理月刊, 2022, 17(2): 33-35, 79. [Tang HL, Wang SY, Hu YH. The relationship between social support and suicidal ideation in junior high school students: The mediating effect of psychological resilience[J]. Psychology Monthly, 2022, 17(2): 33-35, 79.] DOI: 10.19738/j.cnki.psy.2022.02.010.

2.Klonsky ED, Pachkowski MC, Shahnaz A, et al. The three-step theory of suicide: description, evidence, and some useful points of clarification[J]. Prev Med, 2021, 152(Pt 1): 106549. DOI: 10.1016/j.ypmed.2021.106549.

3.Liu J, Wang Y, Wilson A, et al. Anticipating unipolar depression and bipolar depression in young adult with first episode of depression using childhood trauma and personality[J]. Front Public Health, 2023, 10: 1061894. DOI: 10.3389/fpubh.2022.1061894.

4.MacQueen GM, Memedovich KA. Cognitive dysfunction in major depression and bipolar disorder: assessment and treatment options[J]. Psychiatry Clin Neurosci, 2017, 71(1): 18-27. DOI: 10.1111/pcn.12463.

5.Chang Q, Shi Y, Yao S, et al. Prevalence of suicidal ideation, suicide plans, and suicide attempts among children and adolescents under 18 years of age in mainland China: a systematic review and Meta-analysis[J]. Trauma Violence Abuse, 2024, 25(3): 2090-2102. DOI: 10.1177/15248380231205828.

6.刘少华, 刘典英, 邓红冬, 等. 反刍思维对抑郁障碍青少年自杀未遂的影响[J]. 中华行为医学与脑科学杂志, 2022, 31(6): 528-533. [Liu SH, Liu DY, Deng HD, et al. Effect of rumination on suicide attempts in adolescents with depressive disorder[J]. Chinese Journal of Behavioral Medicine and Brain Science, 2022, 31(6): 528-533.] DOI: 10.3760/cma.j.cn371468-20220208-00046.

7.Watkins ER, Roberts H. Reflecting on rumination: consequences, causes, mechanisms and treatment of rumination[J]. Behav Res Ther, 2020, 127: 103573. DOI: 10.1016/j.brat.2020.103573.

8.Tang H, Xiong T, Shi J, et al. Global and reflective rumination are related to suicide attempts among patients experiencing major depressive episodes[J]. BMC Psychiatry, 2021, 21(1): 117. DOI: 10.1186/s12888-021-03119-z.

9.Cordaro DT, Bai Y, Bradley CM, et al. Contentment and self-acceptance: wellbeing beyond happiness[J/OL]. Journal of Happiness Studies, 2024, 25(1): 15. DOI: 10.1007/s10902-024-00729-8.

10.Ruan QN, Shen GH, Yang JS, et al. The interplay of self-acceptance, social comparison and attributional style in adolescent mental health: cross-sectional study[J]. BJPsych Open, 2023, 9(6): e202. DOI: 10.1192/bjo.2023.594.

11.金炬. 首发抑郁青少年自杀意念形成的影响因素[J]. 浙江实用医学, 2024, 29(6): 501-502, 525. [Jin J. Influencing factors of suicidal ideation in adolescents with first-episode depression[J]. Zhejiang Practical Medicine, 2024, 29(6): 501-502, 525.] DOI: 10.16794/j.cnki.cn33-1207/r.2024.06.014.

12.李献云, 费立鹏, 童永胜, 等. Beck自杀意念量表中文版在社区成年人群中应用的信效度[J]. 中国心理卫生杂志, 2010, 24(4): 250-255. [Li XY, Fei LP, Tong YS, et al. Reliability and validity of the Chinese version of the Beck Suicide Ideation Scale(BSI-CV) in adult community residents[J]. Chinese Mental Health Journal, 2010, 24(4): 250-255.] DOI: 10.3969/j.issn.1000-6729.2010.04.002.

13.袁刚, 赵晋, 郑冬, 等. 抑郁自评量表和贝克抑郁量表区分抑郁症严重程度的准确度[J]. 神经疾病与精神卫生, 2021, 21(12): 868-873. [Yuan G, Zhao J, Zheng D, et al. Study on distinguishing the severity of depression with self-rating depression scale and Beck depression inventory[J]. Journal of Neuroscience and Mental Health, 2021, 21(12): 868-873.] DOI: 10.3969/j.issn.1009-6574.2021.12.002.

14.Zung WW. A rating instrument for anxiety disorders[J]. Psychosomatics, 1971, 12(6): 371-379. DOI: 10.1016/S0033-3182(71)71479-0.

15.He J, Liu Y, Cheng C, et al. Psychometric properties of the Chinese version of the 10-item ruminative response scale among undergraduates and depressive patients[J]. Front Psychiatry, 2021, 12: 626859. DOI: 10.3389/fpsyt.2021.626859.

16.丛中, 高文凤. 自我接纳问卷的编制与信度效度检验[J]. 中华行为医学与脑科学杂志, 1999, 8(1): 20-22. [Cong Z, Gao  WF. The development of self-acceptance questionnaire and the test of its reliability and validity[J]. Chinese Journal of Behavioral Medicine and Brain Science, 1999, 8(1): 20-22.] DOI: 10.3760/cma.j.issn.1674-6554.1999.01.007.

17.Cicchetti DV, Sparrow SA. Developing criteria for establishing interrater reliability of specific items: applications to assessment of adaptive behavior[J]. Am J Ment Defic, 1981, 86(2): 127-137. https://pubmed.ncbi.nlm.nih.gov/7315877/

18.杜洋, 吴贝贝, 张东梅, 等. 青少年快感缺失、童年期虐待和抑郁症状对自杀意念的影响: 有调节的中介模型[J]. 中华精神科杂志, 2023, 56(3): 176-183. [Du Y, Wu BB, Zhang DM, et al. The effect of anhedonia, childhood abuse and depression on suicidal ideation of adolescents: a moderated mediating model[J]. Chinese Journal of Psychiatry, 2023, 56(3): 176-183.] DOI: 10.3760/cma.j.cn113661-20220902-00248.

19.Liu D, Liu S, Deng H, et al. Depression and suicide attempts in Chinese adolescents with mood disorders: the mediating role of rumination[J]. Eur Arch Psychiatry Clin Neurosci, 2023, 273(4): 931-940. DOI: 10.1007/s00406-022-01444-2.

20.Li F, Cui Y, Li Y, et al. Prevalence of mental disorders in school children and adolescents in China: diagnostic data from detailed clinical assessments of 17,524 individuals[J]. J Child Psychol Psychiatry, 2022, 63(1): 34-46. DOI: 10.1111/jcpp.13445.

21.Magson NR, Freeman JYA, Rapee RM, et al. Risk and protective factors for prospective changes in adolescent mental health during the COVID-19 pandemic[J]. J Youth Adolesc, 2021, 50(1): 44-57. DOI: 10.1007/s10964-020-01332-9.

22.Ho TC, Gifuni AJ, Gotlib IH. Psychobiological risk factors for suicidal thoughts and behaviors in adolescence: a consideration of the role of puberty[J]. Mol Psychiatry, 2022, 27(1): 606-623. DOI: 10.1038/s41380-021-01171-5.

23.王薇, 刘忠纯. 性激素对青春期抑郁症的影响研究进展[J]. 临床精神医学杂志, 2021, 31(5): 419-421. [Wang W, Liu ZC. Research progress on the effects of sex hormones on adolescent depression[J]. Journal of Clinical Psychiatry, 2021, 31(5): 419-421.] DOI: 10.3969/j.issn.1005-3220.2021.05.001.

24.Casey BJ, Jones RM, Hare TA. The adolescent brain[J]. Ann N Y Acad Sci, 2008, 1124: 111-126. DOI: 10.1196/annals.1440.010.

25.Korczak DJ, Westwell-Roper C, Sassi R. Diagnosis and management of depression in adolescents[J]. CMAJ, 2023, 195(21): E739-E746. DOI: 10.1503/cmaj.220966.

26.Li X, Wang M, Zhang X, et al. The role of parental conflict in predicting adolescent depression symptoms during the COVID-19 pandemic: a longitudinal study[J]. Curr Psychol, 2022: 1-9. DOI: 10.1007/s12144-022-03696-6.

27.范力夫, 张燕, 田浩. 父母冲突对青少年抑郁症状的影响: 亲子三角关系及认知重评的作用[J]. 心理技术与应用, 2023, 11(12): 736-746. [Fan LF, Zhang Y, Tian H. The effect of interparental conflict on adolescents' depressive symptoms: the role of parent-child triangulations and cognitive reappraisal[J]. Psychology: Techniques and Applications, 2023, 11(12): 736-746.] DOI: 10.16842/j.cnki.issn2095-5588.2023.12.005.

28.胡义秋, 曾子豪, 彭丽仪, 等. 亲子关系和父母教育卷入对青少年抑郁、自伤和自杀意念的影响: 挫败感和人生意义感的作用[J]. 心理学报, 2023, 55(1): 129-141. [Hu YQ, Zeng  ZH, Peng LY, et al. The effects of the parent-child relationship and parental educational involvement on adolescent depression, self-injury and suicidal ideation: the roles of defeat and meaning in life[J]. Acta Psychologica Sinica, 2023, 55(1): 129-141.] DOI: 10.3724/SP.J.1041.2023.00129.

29.刘慧瀛, 吉思思, 孔德荣, 等. 期待性快感缺失与自杀风险的关系：抑郁与反刍思维的作用[J]. 中国临床心理学杂志, 2022, 30(3): 669-673, 652. [Liu HY, Ji SS, Kong DR, et al. The relationship between anticipatory anhedonia and suicide risk: the role of depression and rumination[J]. Chinese Journal of Clinical Psychology, 2022, 30(3): 669-673, 652.] DOI: 10.16128/j.cnki.1005-3611.2022.03.034.

30.郭伟, 许晓静, 袁贤明, 等. 伴自杀意念的高中生失眠与非自杀性自伤行为的关系: 焦虑情绪的作用路径[J]. 四川精神卫生, 2024, 37(4): 354-359. [Guo W, Xu XJ, Yuan XM, et  al. Relationship between insomnia and non-suicidal self-injury behavior among senior high school students with suicidal ideation: the path way of anxiety[J]. Sichuan Mental Health, 2024, 37(4): 354-359.] DOI: 10.11886/j.issn.1007-3256.2024.04.008.

31.Fang L, Tong Y, Li M, et al. Anxiety in adolescents and subsequent risk of suicidal behavior: a systematic review and Meta-analysis[J]. J Affect Disord, 2024, 358: 97-104. DOI: 10.1016/j.jad.2024.05.005.

32.谭清宇, 刘平, 吕桃, 等. 青少年抑郁障碍患者失眠与自杀意念的关系: 反刍思维的中介作用[J]. 四川精神卫生, 2023, 36(2): 118-122. [Tan QY, Liu P, Lyu T, et al. Relationship between insomnia and suicidal ideation in adolescents with depressive disorder: the mediating role of rumination[J]. Sichuan Mental Health, 2023, 36(2): 118-122.] DOI: 10.11886/j.issn.1007-3256.2023.02.008.

33.高华, 黄涛, 彭新波. 反刍思维影响自杀意念: 理论支撑及作用机制[J]. 宁波大学学报(教育科学版), 2022, 44(1): 116-124. [Gao H, Huang T, Peng XB. Rumination influences on suicidal ideation: theoretical support and mechanism[J]. Journal of Ningbo University (Educational Science Edition), 2022, 44(1): 116-124.] DOI: 10.3969/j.issn.1008-0627.2022.01.016.

34.任艳萍, 吴涵, 王雯, 等. 抑郁症自杀行为发生机制及预测研究新进展[J]. 首都医科大学学报, 2024, 45(1): 88-96. [Ren  YP, Wu H, Wang W, et al. Research progress in the mechanism and prediction of suicide attempt in patients with depression[J]. Journal of Capital Medical University, 2024, 45(1): 88-96.] DOI: 10.3969/j.issn.1006-7795.2024.01.012.

35.Martin EI, Ressler KJ, Binder E, et al. The neurobiology of anxiety disorders: brain imaging, genetics, and psychoneuroendocrinology[J]. Psychiatr Clin North Am, 2009, 32(3): 549-575. DOI: 10.1016/j.psc.2009.05.004.

36.Nolen-Hoeksema S, Wisco BE, Lyubomirsky S. Rethinking rumination[J]. Perspect Psychol Sci, 2008, 3(5): 400-424. DOI: 10.1111/j.1745-6924.2008.00088.x.

37.Nolen-Hoeksema S. The role of rumination in depressive disorders and mixed anxiety/depressive symptoms[J]. J Abnorm Psychol, 2000, 109(3): 504-511. DOI: 10.1037/0021-843X.109.3.504.

38.李青燕, 贾斯然, 孙造诣. 反刍思维对大学生自我效能感的影响: 状态与特质焦虑的中介作用[J]. 心理学进展, 2022, 12(11): 3848-3857. [Li QY, Jia SR, Sun ZY. The influence of rumination on self-efficacy of college students: the mediating role of state and trait anxiety[J]. Advances in Psychology, 2022, 12(11): 3848-3857.] DOI: 10.12677/AP.2022.1211466.

39.Zhu L, Lan J. The influence of negative emotion and self-acceptance on suicidal ideation of disabled college students: the mediating effect of hopelessness[J]. Iran J Public Health, 2024, 53(12): 2759-2767. DOI: 10.18502/ijph.v53i12.14345.

40.陈冲, 洪月慧, 杨思. 应激性生活事件、自尊和抑郁在自杀意念形成中的作用[J]. 中国临床心理学杂志, 2010, 18(2): 190-191, 164. [Chen C, Hong YH, Yang S. Relationships among adolescents' life events, self-esteem, depression and suicide ideation[J]. Chinese Journal of Clinical Psychology, 2010, 18(2): 190-191, 164.] DOI: 10.16128/j.cnki.1005-3611.2010.02.026.

41.陈秀珍, 贾珍荣, 杨晓娟. 生活事件、自尊和抑郁对大学生自杀意念的影响[J]. 中国健康心理学杂志, 2020, 28(10): 1557-1561. [Chen XZ, Jia ZR, Yang XJ. Effects of life events, self-esteem and depression on suicidal ideation of college students[J]. China Journal of Health Psychology, 2020, 28(10): 1557-1561.] DOI: 10.13342/j.cnki.cjhp.2020.10.027.

42.艾婷. 高中生负性生活事件与心理健康的关系: 自我接纳的中介作用及其干预[D]. 武汉: 华中师范大学, 2021. [Ai T. The relationship between negative life events and mental health in high school students: the mediating effect of self-acceptance and its intervention[D]. Wuhan: Central China Normal University, 2021.] DOI: 10.27159/d.cnki.ghzsu.2020.002339.

43.Brown GW, Harris T. Social origins of depression: a study of psychiatric disorder in women[M]. London: Routledge, 2001.

44.Abela JRZ. Depressive mood reactions to failure in the achievement domain: a test of the integration of the hopelessness and self-esteem theories of depression[J]. Cognit Ther Res, 2002, 26(4): 531-552. DOI: 10.1023/A:1016236018858.

45.Pedrola-Pons A, Sanchez-Carro Y, Pemau A, et al. Efficiency of psychological interventions in the prevention of suicidal behavior and self-injury in penitentiary population: a systematic review[J]. Int J Law Psychiatry, 2024, 92: 101948. DOI: 10.1016/j.ijlp.2023.101948.