title: Role of depression severity and impulsivity in the relationship between hopelessness and suicidal ideation in patients with major depressive disorder.
abstract: BACKGROUND
  Hopelessness, depression and impulsivity all contribute to the development of suicidal ideation in patients with major depressive disorder, but the pathway of these factors to suicidal ideation is not clear. This study examined the meditating effect of depression severity on the relationship between hopelessness and suicidal ideation and explored how this mediating effect was moderated by impulsivity.
  
  
  METHODS
  A total of 162 patients with major depressive disorder (MDD) completed a structured clinical diagnostic interview and a battery of scales assessing depression severity, hopelessness, suicidal ideation, and impulsivity. Regression analyses with bootstrapping methods were used to examine the mediating and moderating effects of various risk factors.
  
  
  RESULTS
  Mediation analysis revealed a significant indirect effect of hopelessness on suicidal ideation, and the effect was fully mediated through depression severity. On moderation analysis, the moderating effects of the relationship between depression severity and suicidal ideation were significant in both the medium and high impulsivity groups.
  
  
  CONCLUSIONS
  The present study was limited by the assessment of trait impulsivity and observer-rated depression severity, which might not fully reflect momentary impulsivity and feeling of depression when suicidal ideation occurs.
  
  
  CONCLUSIONS
  Depression severity plays a mediator role in the relationship between hopelessness and suicidal ideation and this mechanism is contingent on the levels of impulsivity. MDD patients with higher impulsivity appear to be more likely to have suicidal ideations even when they are less depressed. These findings highlight the importance of impulsivity assessment and alleviation of depressive symptoms to prevent suicidality in patients with MDD.
authors.affiliation: Department of Psychology, Weifang Medical University, Weifang, Shandong Province, China; Neuropsychology and Applied Cognitive Neuroscience Laboratory, Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.
authors.forename: Yan-yu
authors.initials: YY
authors.lastname: Wang
authors.affiliation: Department of Psychology, Weifang Medical University, Weifang, Shandong Province, China.
authors.forename: Neng-zhi
authors.initials: NZ
authors.lastname: Jiang
authors.affiliation: Castle Peak Hospital, Hong Kong Special Administrative Region, Hong Kong, China.
authors.forename: Eric F C
authors.initials: EF
authors.lastname: Cheung
authors.affiliation: Department of Psychology, Weifang Medical University, Weifang, Shandong Province, China. Electronic address: sunhongwei@wfmc.edu.cn.
authors.forename: Hong-wei
authors.initials: HW
authors.lastname: Sun
authors.affiliation: Neuropsychology and Applied Cognitive Neuroscience Laboratory, Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.
authors.forename: Raymond C K
authors.initials: RC
authors.lastname: Chan
mesh_terms: D000328:Adult; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000523:psychology*; D005260:Female; D006801:Humans; D007175:Impulsive Behavior; D008297:Male; D008875:Middle Aged; D011788:Quality of Life / Q000523:psychology; D012044:Regression Analysis; D012307:Risk Factors; D012649:Self Concept; D012720:Severity of Illness Index; D059020:Suicidal Ideation; D013406:Suicide, Attempted / Q000523:psychology
keywords: Hopelessness; Impulsivity; Major depressive disorder; Suicidal ideation