Interpersonal distress and depression pathways to suicidality among women in alcohol addiction care

Purpose Women with alcohol use disorders are at increased risk for suicidal ideation and behaviors, yet the psychological pathways underlying this risk remain poorly understood. This study investigates the role of depression, interpersonal distress, and alcohol use in explaining suicidal risk among women receiving outpatient treatment for alcohol dependence.Methods A total of 74 women recruited from addiction treatment centers (CSAPA) completed validated self-report measures assessing depressive symptoms (BDI-II), suicidal risk (SBQ-R), interpersonal distress (INQ), and alcohol use (AUDIT). Logistic regressions, mediation models (SEM), receiver operating characteristic (ROC) analyses, and hierarchical clustering were used to identify risk profiles and psychological mechanisms.Results Eighty percent of participants reported moderate to severe depressive symptoms, and nearly half scored above the clinical threshold for suicidal risk. Depression was the strongest predictor of suicidal risk (OR = 1.10, p < .01), mediating both the effects of interpersonal distress (β = 0.38, p < .001) and alcohol use (β = 0.26, p < .001) on suicidal risk. Interestingly, having children was associated with a suppression effect: it predicted lower depression but higher suicidal risk, suggesting conflicting mechanisms (e.g., emotional overload, contextual stress). Cluster analysis identified three psychological profiles, one of which combined severe depression, high interpersonal distress, and heavy alcohol use – associated with the highest suicidal risk.Conclusion Depression is a central mechanism linking interpersonal and behavioral vulnerabilities to suicidal risk in women with alcohol dependence. The ambivalent role of parenthood highlights the importance of integrating clinical and contextual interpretations into suicide risk assessment. A multidimensional and gender-sensitive approach is critical for improving screening and prevention strategies in this vulnerable population.