Stressors and suicidal ideation in low-income adults in Malaysia: A serial mediation analysis of social support and mental health symptoms

Background: Studies have documented a heightened risk of suicidal ideation in response to stressors, especially among people from socioeconomically disadvantaged backgrounds. However, the mechanisms of this association remain elusive. Aims: Drawing on the social deterioration and counteractive models, this study aims to elucidate the pathways linking stressors to suicidal ideation through serial mediation of social support and mental health symptoms in Malaysia. Method: Data were collected from 404 low-income adults (33.2% male and 66.8% female) receiving monthly financial assistance from Malaysia's social welfare department. We employed stressor measures (i.e. financial, family and work), the Oslo Social Support Scale, the Patient Health Questionnaire and the Suicidal Behaviour Questionnaire-Revised. Results: A total of 46.8% of participants reported mild-to-severe anxiety and depressive symptoms, with 11.1% classified as high risk for suicide. Direct and indirect effects were found. After controlling for age and gender, social support and mental health symptoms mediated the link between stressors and suicidal ideation. The serial mediation analysis indicates that stressors are connected to heightened suicidal ideation through a sequence involving insufficient social support, followed by elevated levels of mental health symptoms. Conclusion: Understanding the multifaceted relationships among stressors, social support, mental health symptoms and suicide ideation expands the potential for developing targeted interventions and preventive strategies tailored for vulnerable populations. Clinical work with low-income individuals may include implementing early systematic efforts to develop accessible mental health and integrated care services.