The relationship between irritability and suicidal ideation: the chain mediating effects of rumination and distress tolerance

Background Irritability is a core symptom of Major Depressive Disorder (MDD) in children and adolescent. Previous studies have reported a positive association between irritability and suicidal ideation. Based on the cognitive model of suicide and emotion regulation theory, the current study aimed to explore the role of rumination and distress tolerance in the relationship between irritability and suicidal ideation in adolescent patients with MDD. Methods A cross-sectional survey was conducted with 319 adolescent patients with MDD. Patients were clinically interviewed using the Development and Well-Being Assessment (DAWBA). The Children’s Depression Inventory (CDI), Affective Reactivity Index (ARI), Ruminative Response Scale (RRS), Distress Tolerance Scale (DTS) and Positive and Negative Suicide Ideation Inventory (PANSI) were used to measure depressive severity, irritability, rumination, distress tolerance, and suicidal ideation. Descriptive and correlation analysis were conducted to examine the initial relationships among the main variables. Structural Equation Modeling (SEM) was conducted to investigate the mediating effects of rumination and distress tolerance in the relationship between irritability and suicidal ideation. Results 82.76% of adolescent patients with MDD reported experiencing irritability. Both rumination ( β = 0.080, p < 0.001, 95% CI [0.037, 0.136]) and distress tolerance ( β = 0.081, p < 0.001, 95% CI [0.033, 0.145]) independently mediated the relationship between irritability and suicidal ideation. And the chain mediating effects of rumination and distress tolerance in the relationship between irritability and suicidal ideation were significant ( β = 0.048, p < 0.001, 95% CI [0.022, 0.086]). Conclusions Rumination and distress tolerance played a chain mediating roles in the relationship between irritability and suicidal ideation, suggesting that rumination and distress tolerance may serve as important targets for intervention in the prevention and treatment of irritability and suicidal ideation in adolescents with MDD from an emotion regulation perspective. Clinical trial number Not applicable.