Depressed individuals who feel stigmatized are more likely to contemplate suicide

A longitudinal study of depressed individuals in China found that those experiencing more severe personal stigma were more likely to contemplate suicide. Their suicidal thoughts also tended to be more severe. The research was published in the Journal of Affective Disorders.

Suicide is the act of intentionally taking one’s own life. It typically occurs as a result of overwhelming emotional pain, mental illness, or a sense of hopelessness. Annually, over 700,000 people worldwide die by suicide.

An important precursor to suicide is suicidal ideation. Suicidal ideation refers to thoughts about ending one’s life, which can range from fleeting, distressing thoughts to detailed planning. Not everyone who experiences suicidal ideation will attempt suicide, but it is a serious warning sign that should not be ignored. People experiencing suicidal ideation often feel trapped, worthless, or believe that others would be better off without them.

Risk factors for suicide include depression (major depressive disorder), substance abuse, trauma, social isolation, and access to means such as firearms or toxic substances. Protective factors—such as strong personal relationships, access to mental health care, and a sense of purpose—can help reduce the risk.

Study author Yanzhi Li and her colleagues aimed to explore the longitudinal associations between stigma and suicidal ideation among patients with major depressive disorder (MDD). People suffering from depression often face stigma. Some findings suggest that, for many individuals, stigma can feel worse than the depression itself.

Free daily newsletter

Stigma, in this context, refers to negative attitudes, beliefs, or stereotypes that lead people to judge, dismiss, or avoid individuals with depression. This stigma can prevent people from seeking help, worsen feelings of shame or isolation, and contribute to misunderstanding of the condition.

The researchers analyzed data from patients with major depressive disorder in the Depression Cohort in China (DCC) study. The DCC is an ongoing longitudinal study of patients with MDD and individuals with subthreshold depressive symptoms. It was launched in Shenzhen, China in 2019. While 1,484 patients were enrolled at baseline, only 466 remained in the study by week 72.

This analysis focused on 1,123 patients for whom data on both stigma and suicidal ideation were available. Their average age was 28 years, and 29% were men. Among other measures, participants completed assessments of depression-related stigma (using the Depression Stigma Scale) and suicidal ideation (using the Chinese version of the Beck Scale for Suicide Ideation).

Results showed that 28% of participants had suicidal ideation at the start of the study, but this figure decreased to 7% by week 72. Individuals who reported stronger experiences of depression-related stigma were more likely to have suicidal ideation, and their suicidal thoughts tended to be more severe.

“In this longitudinal study in patients with MDD [major depressive disorder], more severe personal stigma and perceived stigma were associated with a higher likelihood of suicidal ideation and more severe suicidal ideation. These findings suggest that reducing personal stigma and perceived stigma may help prevent suicidal behavior among patients with MDD.”, study authors concluded.

The study contributes to the scientific understanding of the factors associated with suicidal ideation in depression. However, it should be noted that the study data exclusively came from self-reports leaving room for reporting bias to affect the results.

The paper, “Longitudinal association between stigma and suicidal ideation among patients with major depressive disorder,” was authored by Yanzhi Li, Yan Chen, Yifeng Liu, Yingchen Jiang, Hao Zhao, Wanxin Wang, Yuhua Liao, Huimin Zhang, Lan Guo, Beifang Fan, Angela T.H. Kwan, Roger S. McIntyre, Ciyong Lu, and Xue Han.