The Effect of Anxiety Sensitivity on Repeated Suicide Attempts: The Serial Mediation Effects of Rumination and Hopelessness and the Moderated Mediation Effect of Gender

Repeated suicide attempts are a significant risk factor for suicide, and anxiety sensitivity has been proposed as one of the individual characteristics that increase such attempts. However, there is a lack of research that explores the underlying mechanism of how anxiety sensitivity is associated with suicide attempts. The present study examined the mediating effect of rumination and hopelessness in the relationship between anxiety sensitivity and repeated suicide attempts among psychiatric patients. The moderating effect of gender in this mediating relationship was also investigated. Two hundred twenty-nine patients who visited the psychiatric department at a university hospital in Seoul completed self-report measures and structured clinical interview. Data on demographic characteristics as well as anxiety sensitivity (ASI-3), rumination (RRS), and hopelessness (BHS) were collected. Structured interviews (SCID-5-CV) were also administered to identify their history and frequency of suicide attempts. The results indicated a significant mediating effect of rumination and hopelessness in the relationship between anxiety sensitivity and repeated suicide attempts. This association differed by gender, demonstrating a moderated mediation effect. More specifically, the mediation effect was not significant among men. In the case of women, the simple mediation effect of hopelessness was significant (indirect effect = 0.008, Boot SE = 0.003, 95% CI [0.003, 0.016]), and the serial mediation effect of rumination and hopelessness was also significant (indirect effect = 0.006, Boot SE = 0.003, 95% CI [0.003, 0.012]). The results imply a significant link between hopelessness and suicide attempts, specifically observed in women (interaction effect = 0.081, SE = 0.033, 95% CI [0.015, 0.146]). The present study highlights the prominent role of anxiety sensitivity regarding suicidal risks among patients with mental disorders. Moreover, it is vital to consider both rumination, a maladaptive emotion regulation strategy, and feelings of hopelessness to understand their repeated suicide attempts better. In addition, this study provides evidence of the importance of gender-specific interventions in suicide prevention measures.