Examination of the moderating role of internalizing symptoms in the direct and indirect relationships between alcohol use severity, rumination, and suicidal ideation.

OBJECTIVE

Alcohol use is associated with suicidal ideation (SI). Rumination, an established suicide risk factor, is elevated following alcohol use, suggesting its potential relevancy in the relationship between alcohol use and SI. The nature of this relationship is understudied, and more work is necessary to understand the dynamic interaction between alcohol use and SI. The current study aimed to examine this relationship indirectly through rumination, as well as examining the moderating roles of depression and anxiety symptoms on these paths.

METHODS

Participants were 278 community-based adults with current SI and/or a lifetime suicide attempt (Mage = 28.05, 65.5 % cisgender man, 56.5 % White), who completed a series of self-report measures. A moderated mediation model was conducted in PROCESS (Model 59) to examine mediating and moderating relationships.

RESULTS

Rumination did not account for the relationship between alcohol use severity and SI (B = 0.02, SE = 0.02, 95 % CI [-0.02, 0.07]). Depression and anxiety symptoms significantly moderated (1) the relationship between alcohol use severity and rumination; (2) the relationship between rumination and SI; and (3) the relationship between alcohol use severity and SI. The nature of simple slopes differed across paths.

CONCLUSION

The indirect relationship between alcohol use severity and SI through rumination was non-significant, yet internalizing symptoms of depression and anxiety significantly moderated the relationships between alcohol use severity, rumination, and SI. Varying levels of these symptoms influenced these associations differently, which may reveal how internalizing symptoms impact risk factors for suicide differentially, suggesting notable clinical and research implications.