The Relationship Between Anxiety and Suicidal Ideation in Patients With Bipolar Disorder: Chain Mediation Effects of Social Support and Self-Esteem.

BACKGROUND

Bipolar disorder is associated with a high prevalence of suicidal ideation, and comorbid anxiety may further increase suicide risk. The psychological mechanisms linking anxiety to suicidal ideation, especially the roles of social support and self-esteem, remain unclear. This study constructed a chain mediation model to examine how anxiety, social support and self-esteem relate to suicidal ideation in patients with bipolar disorder.

METHODS

From March 2022 to May 2023, 450 inpatients with bipolar disorder were recruited from six hospitals in Anhui Province. Standardised scales assessed anxiety, social support, self-esteem and suicidal ideation. Pearson correlation examined associations between variables, binary logistic regression identified factors associated with suicidal ideation, and Hayes' PROCESS macro tested the chain mediation model.

RESULTS

Logistic regression showed that higher anxiety increased the odds of suicidal ideation, whereas higher social support and self-esteem reduced the odds. Suicidal ideation was positively correlated with anxiety and negatively correlated with social support and self-esteem, and mediation analysis demonstrated a significant direct effect of anxiety and significant independent and chain mediating effects of social support and self-esteem (all p < 0.001).

CONCLUSIONS

Anxiety is related to suicidal ideation in patients with bipolar disorder both directly and indirectly through reduced social support and self-esteem. The indirect pathway via self-esteem showed the largest effect, underscoring the need to enhance social support and self-esteem in suicide prevention for this population.