Stopping suffering: An exploration of suicidal ideation and its clinical, cognitive and relational correlates among women with a diagnosis of endometriosis

Background

Women with endometriosis are at risk for poor mental health and suicidal ideation and behaviour. This manuscript includes two studies aimed to: (i) investigate the differences in suicidal ideation (SI) frequencies between women with (EN) and without (CG) endometriosis; and (ii) identify clinical, cognitive and relational factors associated with SI in the EN group.

Methods

Study 1 included 171 EN and 62 CG participants, while Study 2 included 38 EN and 71 CG participants. Participants completed self-reported instruments to assess SI, pain, cognitive emotion regulation strategies, and attachment styles. Both studies included sociodemographic and clinical forms. Statistical analyses included the chi-square test and logistic hierarchical regressions.

Results

In both studies, about 20 % of the EN group reported SI, with a frequency of occurrence significantly higher than CG (respectively p = 0.03 and p = 0.002). EN with SI, when compared to EN without SI, showed lower health (respectively p = 0.018; p = 0.006), and higher occurrence of backache (p = 0.031), surgeries for endometriosis (p = 0.040), and lifetime abortion (p = 0.043). Moreover, among the EN group, higher levels of self-blame (OR = 1.36) and avoidant attachment (OR = 18.95) and lower levels of acceptance (OR = 0.68) were associated with a higher likelihood of having SI, over and above clinical variables.

Discussion

SI among the EN group is significantly linked to attachment insecurity and cognitive emotional regulation strategies (i.e. self-blame, acceptance), in addition to disease-related factors (i.e. pain, surgical treatments). These findings highlight the complex interplay between clinical symptoms, cognitive emotion regulation, and relational functioning and underscore the need for integrated psychological assessment and care.