How Does Deliberate Rumination Influence the Association Between Stigma and Suicide Ideation in Depressed Patients: A Mediation Analysis

This study examined the relationship between stigma, deliberate rumination and suicidal ideation in individuals with depression. A sample of 195 participants aged 18–61 years (39.0% male, 61.0% female) was recruited from a psychiatric hospital in China. Levels of stigma, deliberate rumination and suicidal ideation were assessed using the Depression Stigma Scale (DSS), the Simplified Chinese version of the Event-Related Rumination Inventory (C-ERRI) and the Beck Suicidal Ideation Inventory (BSI), respectively. Mediation analysis and structural equation modelling were employed to test the mediating role of deliberate rumination in the stigma–suicidality association. Among depressed individuals, mean scores were 32.277 (SD = 15.996) for stigma, 17.703 (SD = 11.740) for suicidal ideation and 15.262 (SD = 6.845) for deliberate rumination. Significant correlations were observed between these variables. Mediation analyses indicated that stigma directly influenced suicidal ideation and indirectly affected it through deliberate rumination, which mediated 92% of the total effect. These findings suggest that deliberate rumination acts as a cognitive recalibration mechanism disrupting the stigma–suicidality pathway, consistent with Cognitive Behavioural Theory's focus on restructuring maladaptive schemas. In clinical practice, integrating deliberate rumination training (e.g., through Socratic questioning) into suicide prevention protocols, combined with digital monitoring tools (e.g., wearable sensors or NLP) to assess stigma-related negative thoughts, language and behaviours, could enable early detection of high-risk individuals. This combined intervention may effectively mitigate stigma-induced suicidal ideation.