Structural Modeling of Suicidal Ideation Based on Somatic Symptoms: The Mediating Role of Perceived Stress and Psychological Flexibility in Adolescents
Downloads
Objective: This study aimed to test a structural model of suicidal ideation in adolescents based on somatic symptoms, with perceived stress and psychological flexibility as mediators.
Methods and Materials: In a cross-sectional design, 432 students (51.2% girls; Mage = 15.74, SD = 1.42) were selected through multistage cluster sampling. Participants completed validated scales of Patient Health Questionnaire–15 (PHQ-15), Perceived Stress Scale (PSS-10), Connor–Davidson Resilience Scale (CD-RISC-10) and the Suicidal Ideation Questionnaire–Junior (SIQ-JR). Data were analyzed using structural equation modeling with maximum likelihood estimation and 5,000-bootstrap resampling.
Findings: The proposed model showed good fit to the data. Somatic symptoms had a significant direct effect on suicidal ideation (β = .28, p < .001) and a significant indirect effect via perceived stress (β = .19, p< .001). Higher somatic complaints were associated with greater perceived stress (β = .52, p < .001), which, in turn, predicted more severe suicidal ideation (β = .37, p < .001). Psychological flexibility was negatively related to perceived stress (β = −.44, p < .001) and suicidal ideation (β = −.25, p < .001) and partially buffered the impact of somatic symptoms on suicidal ideation (indirect β = −.09, p < .001). Overall, the proposed model explained 63% of the variance in suicidal ideation, indicating substantial explanatory power of the study variables.
Conclusion: Findings underscore somatic symptoms as accessible clinical markers of suicide risk and highlight perceived stress and resilience as key, modifiable mechanisms in adolescent suicide prevention.
Downloads
Abdollahi, A., Carlbring, P., Khanbani, M., & Ghahfarokhi, S. A. (2016). Emotional intelligence moderates perceived stress and suicidal ideation among depressed adolescent inpatients. Personality and Individual Differences, 102, 223-228. https://doi.org/10.1016/j.paid.2016.07.015
Alhassan, M. A., Alarabi, M. A., Albalawi, W. M., Alkhodairi, A., Alghalayini, K. A., Alsomari, A. K., & Al Fiaar, H. A. (2025). Prevalence and risk factors of suicidal ideation and suicide attempts among young people in the MENAT region: a systematic review and meta-analysis. BMC psychiatry, 25(1), 1149. https://doi.org/10.1186/s12888-025-07585-7
Ballabrera, Q., Gómez-Romero, M. J., Chamarro, A., & Limonero, J. T. (2024). The relationship between suicidal behavior and perceived stress: The role of cognitive emotional regulation and problematic alcohol use in Spanish adolescents. Journal of health psychology, 29(9), 950-962. https://doi.org/10.1177/13591053231207295
Bloch, M. H. (2016). Reducing adolescent suicide. In (Vol. 57, pp. 773-774): Wiley Online Library. https://doi.org/10.1111/jcpp.12585
Bohman, H., Jonsson, U., Päären, A., von Knorring, L., Olsson, G., & von Knorring, A.-L. (2012). Prognostic significance of functional somatic symptoms in adolescence: a 15-year community-based follow-up study of adolescents with depression compared with healthy peers. BMC psychiatry, 12(1), 90. https://doi.org/10.1186/1471-244X-12-90
Bohman, H., Jonsson, U., Von Knorring, A. L., Von Knorring, L., Päären, A., & Olsson, G. (2010). Somatic symptoms as a marker for severity in adolescent depression. Acta paediatrica, 99(11), 1724-1730. https://doi.org/10.1111/j.1651-2227.2010.01906.x
Caro-Cañizares, I., Sánchez-Colorado, N., Baca-García, E., & Carballo, J. J. (2024). Perceived stressful life events and suicide risk in adolescence: the mediating role of perceived family functioning. Behavioral Sciences, 14(1), 35. https://doi.org/10.3390/bs14010035
Cepuch, G., Kruszecka-Krówka, A., Liber, P., & Micek, A. (2023). Association between suicidal behaviors in adolescence and negative emotions, the level of stress, stress coping strategies and the quality of sleep. Healthcare, https://doi.org/10.3390/healthcare11030306
Chen, Y.-L., & Kuo, P.-H. (2020). Effects of perceived stress and resilience on suicidal behaviors in early adolescents. European child & adolescent psychiatry, 29(6), 861-870. https://doi.org/10.1007/s00787-019-01401-w
Chen, Y., Xie, R., Tan, D., Wang, X., Fan, R., Li, W., & Ding, W. (2023). Bidirectional longitudinal relationships between victimization, resilience and suicidal ideation of adolescents. Children and Youth Services Review, 154, 107130. https://doi.org/10.1016/j.childyouth.2023.107130
Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of health and social behavior, 385-396. https://doi.org/10.2307/2136404
Connor, K. M., & Davidson, J. R. (2003). Development of a new resilience scale: The Connor‐Davidson resilience scale (CD‐RISC). Depression and anxiety, 18(2), 76-82. https://doi.org/10.1002/da.10113
Fergusson, D. M., Woodward, L. J., & Horwood, L. J. (2000). Risk factors and life processes associated with the onset of suicidal behaviour during adolescence and early adulthood. Psychological medicine, 30(1), 23-39. https://doi.org/10.1017/S003329179900135X
Franklin, J. C., Ribeiro, J. D., Fox, K. R., Bentley, K. H., Kleiman, E. M., Huang, X., Musacchio, K. M., Jaroszewski, A. C., Chang, B. P., & Nock, M. K. (2017). Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research. Psychological bulletin, 143(2), 187. https://doi.org/10.1037/bul0000084
Gmuca, S., Sonagra, M., Xiao, R., Miller, K. S., Thomas, N. H., Young, J. F., Weiss, P. F., Sherry, D. D., & Gerber, J. S. (2021). Suicidal risk and resilience in juvenile fibromyalgia syndrome: a cross-sectional cohort study. Pediatric Rheumatology, 19(1), 3. https://doi.org/10.1186/s12969-020-00487-w
Hink, A. B., Killings, X., Bhatt, A., Ridings, L. E., & Andrews, A. L. (2022). Adolescent suicide—Understanding unique risks and opportunities for trauma centers to recognize, intervene, and prevent a leading cause of death. Current trauma reports, 8(2), 41-53. https://doi.org/10.1007/s40719-022-00223-7
Ji, Y., Liu, Z.-Z., Jia, C.-X., & Liu, X. (2025). Associations between somatic symptoms and suicidal behavior: a cohort study in Chinese adolescents. BMC psychology, 13(1), 788. https://doi.org/10.1186/s40359-025-03113-0
Johnson, J., Wood, A. M., Gooding, P., Taylor, P. J., & Tarrier, N. (2011). Resilience to suicidality: The buffering hypothesis. Clinical psychology review, 31(4), 563-591. https://doi.org/10.1016/j.cpr.2010.12.007
Kim, J., & Cho, M. (2024). Path to suicidality in Korean adolescents: Mediating role of self-esteem, somatic symptoms, and self-harm amid depressive symptoms. Healthcare, https://doi.org/10.3390/healthcare12161662
Kirmayer, L. J., & Sartorius, N. (2007). Cultural models and somatic syndromes. Biopsychosocial Science and Medicine, 69(9), 832-840. https://doi.org/10.1097/PSY.0b013e31815b002c
Kroenke, K., Spitzer, R. L., & Williams, J. B. (2002). The PHQ-15: validity of a new measure for evaluating the severity of somatic symptoms. Psychosomatic medicine, 64(2), 258-266. https://doi.org/10.1097/00006842-200203000-00008
Lewis, C. P., Klimes-Dougan, B., Croarkin, P. E., & Cullen, K. R. (2026). Understanding the emergence of suicidal thoughts and behaviors in adolescence from a brain and behavioral developmental perspective. Neuropsychopharmacology, 51(1), 259-272. https://doi.org/10.1038/s41386-025-02168-2
Luo, S., Hu, J., Zhang, J., Mei, Z., Tang, Z., & Luo, S. (2025). The correlation between resilience and mental health of adolescents and young adults: a systematic review and meta-analysis. Frontiers in psychiatry, 16, 1536553. https://doi.org/10.3389/fpsyt.2025.1536553
Nock, M. K., Green, J. G., Hwang, I., McLaughlin, K. A., Sampson, N. A., Zaslavsky, A. M., & Kessler, R. C. (2013). Prevalence, correlates, and treatment of lifetime suicidal behavior among adolescents: results from the National Comorbidity Survey Replication Adolescent Supplement. JAMA psychiatry, 70(3), 300-310. https://doi.org/10.1001/2013.jamapsychiatry.55
Organization, W. H. (2017). More than 1.2 million adolescents die every year, nearly all preventable. World Health Organization. https://www.who.int/news/item/16-05-2017-more-than-1-2-million-adolescents-die-every-year-nearly-all-preventable
Reynolds, W. M. (1991). Psychometric characteristics of the Adult Suicidal Ideation Questionnaire in college students. Journal of personality assessment, 56(2), 289-307. https://doi.org/10.1207/s15327752jpa5602_9
Sun, G., Liu, Z., Ma, Z., Lew, B., & Jia, C. (2022). The relationship between negative focused disposition and suicidal ideation among college students: The mediating effects of somatic anxiety, general distress, and depression. Frontiers in psychiatry, 13, 928666. https://doi.org/10.3389/fpsyt.2022.928666
Tang, F., Xue, F., & Qin, P. (2015). The interplay of stressful life events and coping skills on risk for suicidal behavior among youth students in contemporary China: a large scale cross-sectional study. BMC psychiatry, 15(1), 182. https://doi.org/10.1186/s12888-015-0575-x
Torres, M. E., Löwe, B., Schmitz, S., Pienta, J. N., Van Der Feltz-Cornelis, C., & Fiedorowicz, J. G. (2021). Suicide and suicidality in somatic symptom and related disorders: A systematic review. Journal of psychosomatic research, 140, 110290. https://doi.org/10.1016/j.jpsychores.2020.110290
Uno, A., Nagaoka, D., Usami, S., Yamaguchi, S., Minami, R., Tanaka, R., Sawai, Y., Okuma, A., Yamasaki, S., & Miyashita, M. (2024). Suicidal thoughts and trajectories of psychopathological and behavioral symptoms in adolescence. JAMA network Open, 7(1), e2353166. https://doi.org/10.1001/jamanetworkopen.2023.53166
Wang, X., Lu, Z., & Dong, C. (2022). Suicide resilience: A concept analysis. Frontiers in psychiatry, 13, 984922. https://doi.org/10.3389/fpsyt.2022.984922
Copyright (c) 2026 International Journal of Body, Mind and Culture
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
