Depression and Suicidal Ideation Among Adults Diagnosed with Schizophrenia: Moderating Effects of Emotional Social Support

Background and Purpose: Suicide is among the leading causes of death for adults diagnosed with schizophrenia. The general health of individuals is affected by social support, with a lack of support being linked to worsened overall health.  Research indicates that social support plays a large role in prognosis, engagement in treatment, and mental health outcomes. Findings also demonstrate that both positive and negative symptoms of psychosis can weaken social skills, increase avoidance of social contact resulting in social isolation, and negatively impact the development and maintenance of positive relationships.  Social support as a protective factor for suicide is supported in the literature, however, social support is commonly discussed and evaluated for as a global construct while unique domains of social support (emotional and tangible support) may function differently with suicidal outcomes. This study aimed to identify the potential pathways of influence between symptoms of depression, hopelessness, domains of social support, and suicidal ideation among a population of adults diagnosed with schizophrenia. 

 Methods: Data were obtained from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE; n= 1,460).  Suicidal ideation, hopelessness, and symptoms of depression were measured by the Calgary Depression Rating Scale (CDRS), and domains of social support by items of two Quality of Life Scales and a Family Experiences Interview Schedule.  Data were analyzed using Structural Equation Modeling (SEM) with Mplus 7.

 Results: Participants who endorsed having suicidal ideation reported significantly greater levels of hopelessness (t(66) = -4.24, p < .001) and symptoms of depression (t(766) = -12.59, p < .01) as compared to participants who did not report suicidal ideation.  SEM findings indicated: 1) symptoms of depression and hopelessness independently predicted suicidal ideation and symptoms of depression and global social support independently predicted hopelessness; 2) hopelessness mediated the relationship between symptoms of depression and suicidal ideation; and, 3) emotional social support moderated the relationship between symptoms of depression and hopelessness.  Thus, emotional support served as a protective factor in the total effect of depression on suicide, as the relationship between depression and hopelessness fluctuated based upon emotional social support (b = -.031, MOE ± .03, CR = -2.10, p < .05). 

 Conclusions and Implications: The results emphasize the importance of emotional support among adults diagnosed with schizophrenia as a protective factor for suicide.  These findings point towards the implication that emotional support plays a significant role in hopelessness and the subsequent relationship between hopelessness and suicidal ideation cannot be ignored in practice.  As a result, is important that social workers assess for and encourage social support within treatment and intervention efforts.  Some potential ways to focus on social support within treatment are to utilize Social Skills Training Programs (SSTs) and peer support. Future prospective longitudinal study designs are needed to further increase understandings of social support facets as protective factors within this population to ultimately inform evidence-based interventions aiming to reduce premature suicidal death.