Depression and suicidality of college students in Hong Kong : a path-analysis of mediating/moderating roles of depressive thoughts, ruminative style, and psychological inflexibility

Abstract

Introduction: Suicide is a grave and universal concern in every society, and there is a rising trend in the number of suicides among college students in Hong Kong. The current study aimed to investigate the contributing factors to suicidal ideation, a proxy for suicide, with a hope to shed light on strategies to reduce and prevent further student suicides. To achieve this goal, the current study sought to (1) identify the life stressors that Hong Kong college students are experiencing, and (2) investigate the processes of how the cognitive vulnerability variables derived from traditional and “new wave” cognitive theories affect students’ depressive symptoms and suicidal ideation. Specifically, the complex psychometric relationships among depressive thoughts, ruminative tendency, and psychological inflexibility were systematically examined to delineate the mediating/moderating roles of these cognitive variables in the process of influences from stress to depression and suicidal ideation. Method: Eight hundred and seventeen students, aged 17 to 46, receiving tertiary education from 11 local colleges were recruited. Six well-validated or empirically supported self-report measures assessing exposure to life stress, negative cognition, rumination, psychological inflexibility, depression, and suicidal ideation were administered to the participants. All measures showed good internal consistency and temporal stability. Path-analyses of these measures were examined by a newly developed advanced analytic approach, Variable System (VS), for complex analyses of mediated moderation and moderated mediation effects. Results: Nearly one-quarter of the participating students reported different degrees of severity in suicidal ideation. The top life stressors endorsed by the students were found to be mostly related to academic achievement and study stress. Consistent with the study’s hypotheses, negative cognitions were shown to be a significant mediator of life stressors’ impacts on depression and suicidal ideation, whereas both ruminative tendency and psychological inflexibility were found to be significant moderators in the process of influences. Path-analysis by VS provided empirical support for an integrative model with significant moderated mediation and mediated moderation effects. The mediation effects of negative cognitions on the relations of life stress with depression and suicidal ideation were moderated by rumination and psychological inflexibility in different pathways (moderated mediation effects). On the other hand, the moderation effect of psychological inflexibility on the relation between life stress and negative cognitions was fully mediated by rumination (mediated moderation effect). Furthermore, this integrative model was demonstrated to be applicable to the students regardless of their gender and degree types. Discussion: Based on the newly proposed integrated model, the complex interplay among the cognitive vulnerability variables was discussed. By delineating the mechanisms underlying depression and suicidal ideation, this integrated model provided a preliminary theoretical framework for conceptualizing and tailoring effective strategies to prevent and ameliorate depression/suicidal ideation among college students. Implications on research methodology were also discussed in light of limitations and recommendations for future research.