Mentalization and Suicidal Ideation in Women with Suicidal Thoughts: The Mediating Role of Psychological Pain

Document Type : Research Article

Authors

Department of Psychology, Ka.C., Islamic Azad University, Karaj, Iran

Abstract

Background: Suicidal ideation poses a major public health challenge, especially for at-risk groups. This study primarily explored the link between mentalization and suicidal ideation among women reporting prior suicidal thoughts, with a focus on the mediating role of psychological pain.
Methods: This was a cross-sectional correlational study on women with suicidal ideation seeking care at psychology and counseling centers in Karaj, Iran in 2024. From this population, we recruited a convenience sample of 350 participants. For data collection, Mentalization-Based Self-Report Scale (MBSS), Beck Scale for Suicidal Ideation (BSS), and Mental Pain Scale (MPS) were used. For data analysis, we employed structural equation modeling (SEM) in SPSS and AMOS version 27 to evaluate the proposed mediation framework.
Results: Our findings revealed a significant negative direct correlation between mentalization and suicidal ideation (β=−0.28, P<0.001), with a mean mentalization score of 52.34 (SD=8.76) and a mean suicidal ideation score of 15.23 (SD=4.89). Psychological pain (mean=26.87, SD=6.23) was found to have a significant mediating effect, fully explaining the correlation between mentalization and suicidal ideation (β=0.19, P<0.001). The proposed structural model showed good fit to the data and confirmed that diminished mentalization exacerbates psychological pain, which in turn increases suicidal ideation.
Conclusions: The present study highlighted psychological pain as a critical mediator in the pathway from diminished mentalization to suicidal ideation. Interventions aimed at enhancing mentalization and reducing psychological pain should be a cornerstone of therapeutic and preventative strategies for women at risk of suicide.

Highlights

Sahar Malehmir Chegini: (Google Scholar)

Nahid Havasi Soomar: (Google Scholar)

 

How to Cite: Malehmir Chegini S, Havasi Soomar N, Gholami Tooranposhti M. Mentalization and Suicidal Ideation in Women with Suicidal Thoughts: The Mediating Role of Psychological Pain. Women. Health. Bull. 2026;13(2):123-130. doi: 10.30476/whb.2026.108584.1372. 

Keywords

References

  1. Pilkington P, Younan R, Bishop A. Early maladaptive schemas, suicidal ideation, and self-harm: A meta-analytic review. Journal of Affective Disorders Reports. 2021;3:100051. doi: 10.1016/j.jadr.2020.100051. ##
  2. Berardelli I, Rogante E, Sarubbi S, Erbuto D, Cifrodelli M, Concolato C, et al. Is Lethality Different between Males and Females? Clinical and Gender Differences in Inpatient Suicide Attempters. Int J Environ Res Public Health. 2022;19(20):13309. doi: 10.3390/ijerph192013309. PubMed PMID: 36293891; PubMed Central PMCID: PMC9602518. ##
  3. Parvardeh M, Abbasi M, Ghadampour E. The Effectiveness of Self-Compassion Training on Social-Emotional Competence in Girl Students with Suicidal Ideation. Women Health Bull. 2025;12(3):198–205. doi: 10.30476/whb.2025.104846.1326. ##
  4. Devendorf AR, McManimen SL, Jason LA. Suicidal ideation in non-depressed individuals: The effects of a chronic, misunderstood illness. J Health Psychol. 2020;25(13-14):2106–2117. doi: 10.1177/1359105318785450. PubMed PMID: 29992837; PubMed Central PMCID: PMC9185123. ##
  5. Nouraei N, Goodarzi M, Aflakseir A. The Mediating Role of Mentalization and Self-Emotion Regulation in the Relationship between Childhood Trauma and Suicidal Ideation. Journal of Clinical Psychology. 2024;16(2):13–25. doi: 10.22075/jcp.2024.33846.2880. Persian. ##
  6. Bateman A, Fonagy P. Mentalization-Based Treatment. Psychoanal Inq. 2013;33(6):595–613. doi: 10.1080/07351690.2013.835170. PubMed PMID: 26157198; PubMed Central PMCID: PMC4467231. ##
  7. Askari Ashtiani E, Baghdasarians A. The Correlation between Attachment Style, Cognitive Flexibility, and Mentalization with the Social Well-being of Yoginis. Women Health Bull. 2024;11(3):172–179. doi: 10.30476/whb.2024.102161.1284. ##
  8. Hajek Gross C, Oehlke S-M, Prillinger K, Goreis A, Plener PL, Kothgassner OD. Efficacy of mentalization-based therapy in treating self-harm: A systematic review and meta-analysis. Suicide Life Threat Behav. 2024;54(2):317–337. doi: 10.1111/sltb.13044. PubMed PMID: 38279664. ##
  9. Tahmasebiashtiani E, Vatankhah Amjad F, Karimgholipour N, Soleimani H. The effectiveness of mentalization-based therapy on insecure attachment, fear of intimacy and suicidal ideation in people with major depressive disorder. IJPN. 2022;10(2):85-97. doi: 10.22034/IJPN.10.2.85. Persian. ##
  10. Baryshnikov I, Isometsä E. Psychological pain and suicidal behavior: A review. Front Psychiatry. 2022;13:981353. doi: 10.3389/fpsyt.2022.981353. PubMed PMID: 36203837; PubMed Central PMCID: PMC9531162. ##
  11. Shneidman ES, Farberow NL. Clues to Suicide. New York, NY: Blakiston Division; 1957. ##
  12. Uğur K, Polat H. The relationship of suicidal ideation with psychological pain and anger rumination in patients with major depressive disorder. Arch Psychiatr Nurs. 2021;35(5):479–485. doi: 10.1016/j.apnu.2021.06.012. PubMed PMID: 34561062. ##
  13. Pompili M. On mental pain and suicide risk in modern psychiatry. Ann Gen Psychiatry. 2024;23(1):6. doi: 10.1186/s12991-024-00490-5. PubMed PMID: 38229110; PubMed Central PMCID: PMC10790486. ##
  14. Dimitrijević A, Hanak N, Altaras Dimitrijević A, Jolić Marjanović Z. The Mentalization Scale (MentS): A Self-Report Measure for the Assessment of Mentalizing Capacity. J Pers Assess. 2018;100(3):268–280. doi: 10.1080/00223891.2017.1310730. PubMed PMID: 28436689. ##
  15. Asgarizadeh A, Vahidi E, Seyed Mousavi PS, Bagherzanjani A, Ghanbari S. Mentalization Scale (MentS): Validity and reliability of the Iranian version in a sample of nonclinical adults. Brain Behav. 2023;13(8):e3114. doi: 10.1002/brb3.3114. PubMed PMID: 37277991; PubMed Central PMCID: PMC10454271. ##
  16. Beck AT, Kovacs M, Weissman A. Assessment of suicidal intention: the Scale for Suicide Ideation. J Consult Clin Psychol. 1979;47(2):343-52. doi: 10.1037//0022-006x.47.2.343. PubMed PMID: 469082. ##
  17. Esfahani M, Hashemi Y, Alavi K. Psychometric assessment of beck scale for suicidal ideation (BSSI) in general population in Tehran. Med J Islam Repub Iran. 2015;29:268. PubMed PMID: 26793659; PubMed Central PMCID: PMC4715388. ##
  18. Orbach I, Mikulincer M, Sirota P, Gilboa-Schechtman E. Mental pain: a multidimensional operationalization and definition. Suicide Life Threat Behav. 2003;33(3):219–30. doi: 10.1521/suli.33.3.219.23219. PubMed PMID: 14582833. ##
  19. Karami J, Bagian MJ, Momeni K, Elahi A. Measurement of mental pain: Psychometric properties and confirmatory factor analysis of multidimensional mental pain questionnaire. Health Psychology. 2018;7(25):146–72. Persian. ##
  20. Huang M, Hou J. Childhood maltreatment and suicide risk: The mediating role of self-compassion, mentalization, depression. Journal of Affective Disorders. 2023;341:52–61. doi: 10.1016/j.jad.2023.08.112. ##
  21. Arabadzhiev Z, Paunova R. Complexity of mentalization. Front Psychol. 2024;15:1353804. doi: 10.3389/fpsyg.2024.1353804. PubMed PMID: 38487663; PubMed Central PMCID: PMC10937435. ##
  22. Nagy LM, Shanahan ML, Baer RA. An experimental investigation of the effects of self-criticism and self-compassion on implicit associations with non-suicidal self-injury. Behav Res Ther. 2021;139:103819. doi: 10.1016/j.brat.2021.103819. PubMed PMID: 33640591. ##
  23. Ghanbari S, Asgarizadeh A, Vahidi E, Seyed Mousavi PS, Omidghaemi M. Emotion dysregulation as mediator between mentalizing capacity and affective states: An exploratory study. PCN Rep. 2023;2(3):e124. doi: 10.1002/pcn5.124. PubMed PMID: 38867841; PubMed Central PMCID: PMC11114384. ##
  24. Yöyen E, Keleş M. First- and Second-Generation Psychological Theories of Suicidal Behaviour. Behav Sci. 2024;14(8):710. doi: 10.3390/bs14080710. PubMed PMID: 39199106; PubMed Central PMCID: PMC11351948. ##
  25. Kirtley OJ, O'Carroll RE, O'Connor RC. Pain and self-harm: A systematic review. J Affect Disord. 2016;203:347–363. doi: 10.1016/j.jad.2016.05.068. PubMed PMID: 27323296. ##
  26. Landi G, Grossman-Giron A, Bitan DT, Mikulincer M, Grandi S, Tossani E. Mental Pain, Psychological Distress, and Suicidal Ideation During the COVID-19 Emergency: the Moderating Role of Tolerance for Mental Pain. Int J Ment Health Addict. 2023;21(2):1120–1131. doi: 10.1007/s11469-021-00646-4. PubMed PMID: 34744529; PubMed Central PMCID: PMC8560017. ##
  27. Wang T, Yang L, Yang L, Liu B-P, Jia C-X. The relationship between psychological pain and suicidality in patients with major depressive disorder: A meta-analysis. J Affect Disord. 2024;346:115–121. doi: 10.1016/j.jad.2023.10.160. PubMed PMID: 37926158. ##
  28. Amani M, Heidari Z. The Mediating Role of Emotion Regulation, Entrapment, and Depression Between Effortful Control, Rumination, and Suicidal Ideation. PCP. 2025;13(2):129-142. doi: 10.32598/jpcp.13.2.966.1. ##

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