Perfectionism and Suicidal Ideation in Outpatient Depressed Adults: The Moderating Role of Self-Esteem, Loneliness and Rumination

Introduction: Identifying factors that contribute to the development of suicidal ideation (SI) is crucial for prevention and treatment. Perfectionistic Concerns (PC) represent the experience of external pressure to be perfect and have been consistently linked to SI, but it is unclear how PC and SI are associated in depressed adults. This study examined the association between PC and SI and whether self-esteem, loneliness and rumination (brooding, reflection and depression-related rumination) moderated this association in a clinical sample. Methods: This cross-sectional study used a psychiatric outpatient sample of depressed adults, selected for the presence of SI. In total 110 adults (mean age 33.54 (SD = 12.03) and 60% female) participated in this study. Associations were estimated by regression analyses. Results: PC was not associated with SI in the sample (r =.16, p =.087). However, high levels of PC in combination with low self-esteem (β = -.29, p =.007) or with high levels of depression-related rumination (β =.22, p =.017) were positively associated with SI. Loneliness, brooding and reflection did not moderate the PC-SI relationship. Discussion: These findings underline the importance of taking into account the individual characteristics in depressed, perfectionistic individuals when estimating SI severity and selecting the focus of intervention. Due to the cross-sectional design no causal inferences can be made.