From emotional invalidation to suicide risk: the role of depression and sense of coherence in a moderated mediation model

Background: Depression is one of the most common psychiatric disorders associated with suicide risk. Several factors can influence the development of depressive symptoms and the emergence of pre-suicide mental states, including invalidating environments. Specifically, emotional invalidation is associated with both depression and increased suicide risk. However, protective factors, such as high levels of sense of coherence (SOC), may buffer against these negative effects by helping individuals process their experiences. The buffering role of SOC in the emergence of depression and suicide risk has not yet thoroughly investigated. Thus, this study aimed to: a) clarify whether depression could mediate the relationship between perceived emotional invalidation and suicide risk, measured as severity of mental states prodromic of suicide; and b) investigate whether SOC could moderate the pathway linking emotional invalidation, depression, and suicide risk. Methods: 399 adults (73% females; age 33.5±15.7) were recruited from the general Italian population. All participants were administered self-reported questionnaires assessing depression, sense of coherence, perceived invalidation of emotion, the presence of past suicide behaviours, and current pre-suicide mental states. Results: Higher suicide risk was strongly associated with depression (rho = 0.74) and SOC (rho = -0.73), and moderately with emotional invalidation (rho = 0.50) in the bivariate analyses. However, at the multivariate level, emotional invalidation was not significantly associated with suicide risk. The moderatedmediation model indicated that depressive symptoms partially mediated the relationship between perceived emotional invalidation and the severity of mental states prodromic of suicide, after controlling for the presence of past suicidal behaviours, explaining 36% of the common variance. Furthermore, a high level of SOC moderated the impact of emotional invalidation on depression. Conclusions: Invalidating environments may contribute to the development of emerging distress symptoms and increased suicide risk, particularly in individuals with limited coping resources. Promoting a strong sense of coherence could serve as a protective factor, helping individuals find meaning in their life and better cope with everyday stressors, thus limiting depressive states and reducing emerging suicidality.