Preventive Care in Nursing and Midwifery Journal
Volume 15, Issue 2 (10-2025)
Prev Care Nurs Midwifery J 2025, 15(2): 32-41 |
Back to browse issues page
Ethics code: IR.IAU.K.REC.1404.068
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Malehmir Chegini S, Havasi Soomar N, Gholami Tooran Poshti M. The relationship between defense mechanisms and suicidal ideation in women: The mediating role of psychological pain and difficulties in emotion regulation. Prev Care Nurs Midwifery J 2025; 15 (2) :32-41
URL: http://nmcjournal.zums.ac.ir/article-1-983-en.html
URL: http://nmcjournal.zums.ac.ir/article-1-983-en.html
Department of Psychology, Ka.C., Islamic Azad University, Karaj, Iran , havasin2020@gmail.com
Abstract: (254 Views)
Background: Suicidal ideation persists as a pressing public health concern, especially in women. Dysfunctional defense mechanisms and their complex interplay with emotional and cognitive processes warrant further scholarly investigation.
Objectives: This study investigates the mediating roles of psychological pain and difficulties in emotion regulation in the relationship between defense mechanisms and suicidal ideation in women.
Method: This descriptive-correlational study used structural equation modeling to examine direct and indirect pathways in women with suicidal ideation from Karaj counseling centers (2024). A convenience sample of 350 participants (mean age = 32.0 years, SD = 7.8) completed the Defense Style Questionnaire-40 (immature/dysfunctional subscale), Beck Scale for Suicide Ideation, Mental Pain Scale, and Difficulties in Emotion Regulation Scale. Data analysis used SPSS-27 and AMOS-27. The study received ethics approval, included informed consent, and high-risk participants (BSSI ≥17) were referred to crisis services.
Results: Findings indicated a significant direct effect of dysfunctional defense mechanisms on suicidal ideation (β=0.22, p<0.001). Psychological pain (β=0.15, 95% CI [0.10, 0.20], p<0.001) and difficulties in emotion regulation (β=0.10, 95% CI [0.05, 0.15], p<0.001) partially mediated this relationship, with the direct effect remaining significant, confirmed through 5,000 bootstrap resamples. The model exhibited strong fit (CFI=0.92, TLI=0.91, RMSEA=0.06), underscoring the mediators’ salience in suicidal ideation.
Conclusion: This study highlights the need for multidimensional interventions targeting dysfunctional defenses, psychological pain, and emotion regulation to prevent and treat suicidal ideation in women.
Objectives: This study investigates the mediating roles of psychological pain and difficulties in emotion regulation in the relationship between defense mechanisms and suicidal ideation in women.
Method: This descriptive-correlational study used structural equation modeling to examine direct and indirect pathways in women with suicidal ideation from Karaj counseling centers (2024). A convenience sample of 350 participants (mean age = 32.0 years, SD = 7.8) completed the Defense Style Questionnaire-40 (immature/dysfunctional subscale), Beck Scale for Suicide Ideation, Mental Pain Scale, and Difficulties in Emotion Regulation Scale. Data analysis used SPSS-27 and AMOS-27. The study received ethics approval, included informed consent, and high-risk participants (BSSI ≥17) were referred to crisis services.
Results: Findings indicated a significant direct effect of dysfunctional defense mechanisms on suicidal ideation (β=0.22, p<0.001). Psychological pain (β=0.15, 95% CI [0.10, 0.20], p<0.001) and difficulties in emotion regulation (β=0.10, 95% CI [0.05, 0.15], p<0.001) partially mediated this relationship, with the direct effect remaining significant, confirmed through 5,000 bootstrap resamples. The model exhibited strong fit (CFI=0.92, TLI=0.91, RMSEA=0.06), underscoring the mediators’ salience in suicidal ideation.
Conclusion: This study highlights the need for multidimensional interventions targeting dysfunctional defenses, psychological pain, and emotion regulation to prevent and treat suicidal ideation in women.
Type of Study: Orginal research |
Subject:
other
References
1. 1. Harmer B, Lee S, Rizvi A, Saadabadi A. Suicidal Ideation. Treasure Island (FL): StatPearls Publishing; 2025. [https://www.ncbi.nlm.nih.gov/books/NBK565877/]
2. Bommersbach TJ, Rosenheck RA, Petrakis IL, Rhee TG. Why are women more likely to attempt suicide than men? Analysis of lifetime suicide attempts among US adults in a nationally representative sample. J Affect Disord. 2022;311:157-64. [https://doi.org/10.1016/j.jad.2022.05.096] [PMID]
3. Weiss SJ, Simeonova DI, Koleva H, Muzik M, Clark KD, Ozerdem A, et al. Potential paths to suicidal ideation and suicide attempts among high-risk women. J Psychiatr Res. 2022;155:493-500. [https://doi.org/10.1016/j.jpsychires.2022.09.033] [PMID]
4. Carretta RF, McKee SA, Rhee TG. Gender differences in risks of suicide and suicidal behaviors in the USA: A narrative review. Curr Psychiatry Rep. 2023;25(12):809-24. [https://doi.org/10.1007/s11920-023-01473-1] [PMID]
5. Di Giuseppe M, Perry JC. The hierarchy of defense mechanisms: Assessing defensive functioning with the Defense mechanisms rating scales Q-sort. Front Psychol. 2021;12:718440. [https://doi.org/10.3389/fpsyg.2021.718440] [PMID]
6. Turiaco F, Iannuzzo F, Lombardo C, Clementi V, Mento C, Drago A, et al. Role of early trauma on defense mechanisms and coping strategies in personality disorders. Medicina (Kaunas). 2025;61(7):1162. [https://doi.org/10.3390/medicina61071162] [PMID]
7. Mozafari S, Bahadivand AH, Khodarahimi S, Mazraeh N, Rahimianbougar M. The role of adverse childhood experiences and defense mechanisms on suicidal ideation and social dysfunction. Curr Psychol. 2024;43(6):5462-71. [https://doi.org/10.1007/s12144-023-04742-7]
8. Şahin AB, Giousouf Chousein M, Uludağ D, Saydam MB. Immature defense mechanisms and suicide attempts in borderline personality organization: A clinical sample study. Front Psychol. 2025;16:1632246. [https://doi.org/10.3389/fpsyg.2025.1632246] [PMID]
9. Sadeghi Nia K, Asmaee Majd S. Comparing defensive mechanisms and suicidal thoughts in addicted men and women. Health Nexus. 2023;1(4):115-24. [https://doi.org/10.61838/kman.hn.1.4.14]
10. Baryshnikov I, Isometsä E. Psychological pain and suicidal behavior: A review. Front Psychiatry. 2022;13:981353. [https://doi.org/10.3389/fpsyt.2022.981353] [PMID]
11. Pompili M. On mental pain and suicide risk in modern psychiatry. Ann Gen Psychiatry. 2024;23(1):6. [https://doi.org/10.1186/s12991-024-00490-5] [PMID]
12. Morales S, Barros J. Mental pain surrounding suicidal behaviour: A review of what has been described and clinical recommendations for help. Front Psychiatry. 2022;12:750651. [https://doi.org/10.3389/fpsyt.2021.750651] [PMID]
13. Verrocchio MC, Carrozzino D, Marchetti D, Andreasson K, Fulcheri M, Bech P. Mental pain and suicide: A systematic review of the literature. Front Psychiatry. 2016;7:108. [https://doi.org/10.3389/fpsyt.2016.00108] [PMID]
14. Tahmasebi zadeh B, Kooshki S, Nemat Tavousi M, Oraki M. The effectiveness of acceptance-commitment therapy and emotion regulation training on impulsivity and distress tolerance in people with a history of drug addiction. Prev Care Nurs Midwifery J. 2021;11(2):65-76. [https://doi.org/10.52547/pcnm.11.2.65]
15. Aslan IH, Dorey L, Grant JE, Chamberlain SR. Emotion regulation across psychiatric disorders. CNS Spectr. 2024;29(3):215-20. [https://doi.org/10.1017/s1092852924000270] [PMID]
16. Givi F, Meschi F, Zhian Bagheri M, Farhood D. Structural equation modeling of pain management based on rumination and positive and negative emotional regulation mediating vitality in women with breast cancer. Prev Care Nurs Midwifery J. 2022;12(2):62-73. [https://doi.org/10.52547/pcnm.12.2.62]
17. Amani M, Heidari Z. The mediating role of emotion regulation, entrapment, and depression between effortful control, rumination, and suicidal ideation. Pract Clin Psychol. 2025;13(2):129-42. [https://doi.org/10.32598/jpcp.13.2.966.1]
18. Turton H, Berry K, Danquah A, Pratt D. The relationship between emotion dysregulation and suicide ideation and behaviour: A systematic review. J Affect Disord Rep. 2021;5:100136. [https://doi.org/10.1016/j.jadr.2021.100136]
19. Beck AT, Kovacs M, Weissman A. Assessment of suicidal intention: The scale for suicide ideation. J Consult Clin Psychol. 1979;47(2):343-52. [https://doi.org/10.1037/0022-006X.47.2.343] [PMID]
20. 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. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4715388/]
21. 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. [https://doi.org/10.1521/suli.33.3.219.23219] [PMID]
22. Kulehmarzi M, Lewis K, Marzban M, Rajabi M, Moghadam M, Rajeh Y. Psychometric evaluation of the Persian 8-item Orbach Mikulincer mental pain scale and psychic pain scale in suicidal adolescents. Res Square. 2025. [https://doi.org/10.21203/rs.3.rs-7012909/v1]
23. Garnefski N, Kraaij V, Spinhoven P. Negative life events, cognitive emotion regulation and emotional problems. Pers Individ Dif. 2001;30(8):1311-27. [https://doi.org/10.1016/S0191-8869(00)00113-6]
24. Abdi S, Taban S, Ghaemian A. Cognitive emotion regulation questionnaire: Validity and reliability of Persian translation of CERQ-36 item. Procedia Soc Behav Sci. 2012;32:2-7. [https://doi.org/10.1016/j.sbspro.2012.01.001]
25. Andrews G, Singh M, Bond M. The defense style questionnaire. J Nerv Ment Dis. 1993;181(4):246-56. [https://doi.org/10.1097/00005053-199304000-00006] [PMID]
26. Heidari Nasab L, Mansouri M, Azadfallah P, Shaieeri M. Validity and reliability of defense style questionnaire (DSQ-40) in Iranian samples. Clin Psychol Pers. 2007;5(1):11-27. [https://cpap.shahed.ac.ir/article_2594.html?lang=en]
27. Ma D, Cao J, Wei J, Jiang J. Immature defense mechanisms mediate the relationship between negative life events and depressive symptoms. Front Psychiatry. 2023;14:1341288. [https://doi.org/10.3389/fpsyt.2023.1341288] [PMID]
28. Hatkevich C, Penner F, Sharp C. Difficulties in emotion regulation and suicide ideation and attempt in adolescent inpatients. Psychiatry Res. 2019;271:230-8. [https://doi.org/10.1016/j.psychres.2018.11.038] [PMID]
Send email to the article author
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |