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Purpose <p>Suicidal ideation is a robust predictor of suicidal behavior and is prevalent in mood disorders. Childhood maltreatment, including abuse and neglect, is a well-established risk factor for suicidal ideation, but underlying mechanisms remain unclear. Early maladaptive schemas (EMSs) are plausible mediators; four EMSs – defectiveness/shame, social isolation/alienation, failure, and dependence/incompetence – have been linked to suicidal ideation. This study examined these mediating pathways in mood disorders and explored differences across major depressive disorder (MDD), bipolar II disorder (BD-II), and bipolar I disorder (BD-I).</p> Methods <p>A total of 932 Korean psychiatric outpatients aged 18–49 years with MDD, BD-II, or BD-I were included. Childhood maltreatment, EMSs, suicidal ideation, and depressive symptoms were assessed. Four structural equation models tested EMS mediation, controlling for age, sex, and depressive symptoms. Multi-group analyses evaluated measurement and structural invariance across diagnostic groups.</p> Results <p>Indirect pathways from childhood neglect to suicidal ideation were observed through three EMSs: defectiveness/shame (B = 0.28, 95% confidence interval [CI], 0.15–0.45), social isolation/alienation (B = 0.14, 95% CI, 0.05–0.27), and failure (B = 0.10, 95% CI, 0.03–0.20). Dependence/incompetence did not mediate this association but showed a significant direct path to suicidal ideation. Measurement invariance was upheld across MDD, BD-II, and BD-I, with no significant group differences in structural pathways (Δχ² [10] = 4.48–7.98, all <i>p</i>s &gt; 0.63).</p> Conclusions <p>Maladaptive schemas reflecting unworthiness, isolation, and failure appear to shape enduring pathways across mood disorders. Addressing these EMSs could inform personalized and transdiagnostic approaches for suicide prevention.</p>

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Early Maladaptive Schemas as Mediators between Childhood Maltreatment and Suicidal Ideation in Major Depressive Disorder, Bipolar II Disorder, and Bipolar I Disorder

  • 期刊论文

  • 发表日期：

    2026年5月6日

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  • Eunbyeol Lee,
  • Myeongkeun Cho,
  • Chanhee Park,
  • C. Hyung Keun Park

摘要

Purpose

Suicidal ideation is a robust predictor of suicidal behavior and is prevalent in mood disorders. Childhood maltreatment, including abuse and neglect, is a well-established risk factor for suicidal ideation, but underlying mechanisms remain unclear. Early maladaptive schemas (EMSs) are plausible mediators; four EMSs – defectiveness/shame, social isolation/alienation, failure, and dependence/incompetence – have been linked to suicidal ideation. This study examined these mediating pathways in mood disorders and explored differences across major depressive disorder (MDD), bipolar II disorder (BD-II), and bipolar I disorder (BD-I).

Methods

A total of 932 Korean psychiatric outpatients aged 18–49 years with MDD, BD-II, or BD-I were included. Childhood maltreatment, EMSs, suicidal ideation, and depressive symptoms were assessed. Four structural equation models tested EMS mediation, controlling for age, sex, and depressive symptoms. Multi-group analyses evaluated measurement and structural invariance across diagnostic groups.

Results

Indirect pathways from childhood neglect to suicidal ideation were observed through three EMSs: defectiveness/shame (B = 0.28, 95% confidence interval [CI], 0.15–0.45), social isolation/alienation (B = 0.14, 95% CI, 0.05–0.27), and failure (B = 0.10, 95% CI, 0.03–0.20). Dependence/incompetence did not mediate this association but showed a significant direct path to suicidal ideation. Measurement invariance was upheld across MDD, BD-II, and BD-I, with no significant group differences in structural pathways (Δχ² [10] = 4.48–7.98, all ps > 0.63).

Conclusions

Maladaptive schemas reflecting unworthiness, isolation, and failure appear to shape enduring pathways across mood disorders. Addressing these EMSs could inform personalized and transdiagnostic approaches for suicide prevention.