A Theory-Driven Investigation of the Association Between Emotion Dysregulation and Suicide Risk in a Clinical Adolescent Sample
Abstract
OBJECTIVE: Emotion dysregulation has been consistently linked to suicide ideation and attempt, but an explanatory model for this relationship has not been adequately investigated in adolescents. This study examined the concurrent relationship among emotion dysregulation, variables from the Interpersonal-Psychological Theory of Suicide (IPTS), and suicide risk (operationalized as a continuous variable that increases in intensity from nonspecific to active suicide ideation to suicide ideation with a plan) in a clinical adolescent sample. METHOD: A total of 151 adolescents (aged 12-17) were recruited from an inpatient psychiatry unit. Cross-sectional analyses were conducted to determine whether the relationship between emotion dysregulation and suicide risk was explained by the variables of perceived burdensomeness (PB), thwarted belongingness, and capability for suicide, as proposed by the IPTS. RESULTS: As hypothesized, the relationship between emotion dysregulation and suicide risk was explained by PB and capability for suicide. Depressive symptoms had an independent relationship with suicide risk after controlling for IPTS variables. CONCLUSIONS: The results from this study suggest that effective treatment strategies that reduce negative cognition tied to PB and depressive symptoms would address the most proximal variables related to suicide risk in adolescents. Enhancing emotion management would serve to maintain low levels of proximal influences on risk.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Studies have shown that emotion dysregulation eases the development of suicidal ideation and behavior.
“Accordingly, studies have shown that emotion dysregulation eases the development of suicidal ideation and behavior [15,16,17,18].”
From The Role of Emotion Dysregulation in Understanding Suicide Risk: A Systematic Review of the Literature (2024) · cites this paper as [17]
Cites
Gratz, K. L., & Roemer, L. (2004) · Journal of Psychopathology and Behavioral Assessment · doi:10.1023/b:joba.0000007455.08539.94 · Cited by 8,942 · see citing works
Introduction to mediation, moderation, and conditional process analysis :
Hayes, A. F., & names (2015) · Cited by 7,004 · see citing works
Cognitive-Behavioral Treatment of Borderline Personality Disorder
Cary, G. L. (1994) · American Journal of Psychotherapy · doi:10.1176/appi.psychotherapy.1994.48.1.155 · Cited by 6,300 · see citing works
The adolescent brain and age-related behavioral manifestations
Spear, L. P. (2000) · Neuroscience & Biobehavioral Reviews · doi:10.1016/s0149-7634(00)00014-2 · Cited by 5,433 · see citing works
The interpersonal theory of suicide.
Van Orden, K. A., Witte, T. K., Cukrowicz, K. C., Braithwaite, S. R., Selby, E. A., & Joiner, T. E. (2010) · Psychological Review · doi:10.1037/a0018697 · Cited by 5,292 · see citing works
Rush, A. J., Trivedi, M. H., Ibrahim, H. M., Carmody, T. J., Arnow, B., Klein, D. N., Markowitz, J. C., Ninan, P. T., Kornstein, S., Manber, R., et al. (2003) · Biological Psychiatry · doi:10.1016/s0006-3223(02)01866-8 · Cited by 3,829 · see citing works
Casey, B. J., Jones, R. M., & Hare, T. A. (2008) · Annals of the New York Academy of Sciences · doi:10.1196/annals.1440.010 · Cited by 3,345 · see citing works
Nock, M. K., Borges, G., Bromet, E. J., Cha, C. B., Kessler, R. C., & Lee, S. (2008) · Epidemiologic Reviews · doi:10.1093/epirev/mxn002 · Cited by 2,897 · see citing works
Suicide, Suicide Attempts, and Suicidal Ideation
Klonsky, E. D., May, A. M., & Saffer, B. Y. (2016) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-021815-093204 · Cited by 1,675 · see citing works
Emotion regulation and mental health
Gross, J. J., & Muñoz, R. F. (1995) · Clinical Psychology: Science and Practice · doi:10.1111/j.1468-2850.1995.tb00036.x · Cited by 1,595 · see citing works
Crowell, S. E., Beauchaine, T. P., & Linehan, M. M. (2009) · Psychological Bulletin · doi:10.1037/a0015616 · Cited by 1,292 · see citing works
Galvan, A., Hare, T. A., Parra, C. E., Penn, J., Voss, H., Glover, G., & Casey, B. J. (2006) · Journal of Neuroscience · doi:10.1523/jneurosci.1062-06.2006 · Cited by 1,282 · see citing works
Van Orden, K. A., Witte, T. K., Gordon, K. H., Bender, T. W., & Joiner, T. E. (2008) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.76.1.72 · Cited by 1,126 · see citing works
Klonsky, E. D., & May, A. M. (2014) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.12068 · Cited by 740 · see citing works
Neurobiology of the Adolescent Brain and Behavior: Implications for Substance Use Disorders
Casey, B. J., & Jones, R. M. (2010) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2010.08.017 · Cited by 692 · see citing works
Adolescent risk taking, impulsivity, and brain development: Implications for prevention
Romer, D. (2010) · Developmental Psychobiology · doi:10.1002/dev.20442 · Cited by 691 · see citing works
Ernst, M., Nelson, E. E., Jazbec, S., McClure, E. B., Monk, C. S., Leibenluft, E., Blair, J., & Pine, D. S. (2005) · NeuroImage · doi:10.1016/j.neuroimage.2004.12.038 · Cited by 635 · see citing works
Emotion-regulation skills as a treatment target in psychotherapy
Berking, M., Wupperman, P., Reichardt, A., Pejic, T., Dippel, A., & Znoj, H. (2008) · Behaviour Research and Therapy · doi:10.1016/j.brat.2008.08.005 · Cited by 532 · see citing works
Components of Emotion Dysregulation in Borderline Personality Disorder: A Review
Carpenter, R. W., & Trull, T. J. (2012) · Current Psychiatry Reports · doi:10.1007/s11920-012-0335-2 · Cited by 446 · see citing works
Ribeiro, J. D., Witte, T. K., Orden, K. A. V., Selby, E. A., Gordon, K. H., Bender, T. W., & Joiner, T. E. (2013) · Psychological Assessment · doi:10.1037/a0034858 · Cited by 408 · see citing works
Rush, A. J., Bernstein, I. H., Trivedi, M. H., Carmody, T. J., Wisniewski, S., Mundt, J. C., Shores-Wilson, K., Biggs, M. M., Woo, A., Nierenberg, A. A., et al. (2006) · Biological Psychiatry · doi:10.1016/j.biopsych.2005.08.022 · Cited by 385 · see citing works
Ma, J., Batterham, P. J., Calear, A. L., & Han, J. (2016) · Clinical Psychology Review · doi:10.1016/j.cpr.2016.04.008 · Cited by 384 · see citing works
Suicide Ideation Among College Students: A Multivariate Analysis
Arria, A. M., O’Grady, K. E., Caldeira, K. M., Vincent, K. B., Wilcox, H. C., & Wish, E. D. (2009) · Archives of Suicide Research · doi:10.1080/13811110903044351 · Cited by 381 · see citing works
Adrian, M., Zeman, J., Erdley, C., Lisa, L., & Sim, L. (2011) · Journal of Abnormal Child Psychology · doi:10.1007/s10802-010-9465-3 · Cited by 301 · see citing works
Anestis, M. D., Bagge, C. L., Tull, M. T., & Joiner, T. E. (2011) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2010.10.013 · Cited by 271 · see citing works
The interpersonal‐psychological theory of suicidal behavior: current status and future directions
Ribeiro, J. D., & Joiner, T. E. (2009) · Journal of Clinical Psychology · doi:10.1002/jclp.20621 · Cited by 238 · see citing works
The Validity of the Interpersonal Theory of Suicide in Adolescence: A Review
Stewart, S. M., Eaddy, M., Horton, S. E., Hughes, J. L., & Kennard, B. D. (2015) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2015.1020542 · Cited by 212 · see citing works
Self-citationPerez, J., Venta, A., Garnaat, S., & Sharp, C. (2012) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-012-9292-7 · Cited by 184 · see citing works
Pope, A. W., & Bierman, K. L. (1999) · Developmental Psychology · doi:10.1037/0012-1649.35.2.335 · Cited by 167 · see citing works
Concise Health Risk Tracking Scale
Trivedi, M. H., Wisniewski, S. R., Morris, D. W., D, M. F. M., Gollan, J. K., Warden, D., Nierenberg, A. A., Gaynes, B. N., Husain, M. M., Luther, J. F., et al. (2011) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.11m06837 · Cited by 165 · see citing works
The role of emotion dysregulation in suicide as considered through the ideation to action framework
Law, K. C., Khazem, L. R., & Anestis, M. D. (2015) · Current Opinion in Psychology · doi:10.1016/j.copsyc.2015.01.014 · Cited by 151 · see citing works
Conceptual and Empirical Scrutiny of Covarying Depression Out of Suicidal Ideation
Rogers, M. L., Stanley, I. H., Hom, M. A., Chiurliza, B., Podlogar, M. C., & Joiner, T. E. (2016) · Assessment · doi:10.1177/1073191116645907 · Cited by 111 · see citing works
Anestis, M. D., Pennings, S. M., Lavender, J. M., Tull, M. T., & Gratz, K. L. (2013) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2013.04.005 · Cited by 100 · see citing works
Horton, S. E., Hughes, J. L., King, J. D., Kennard, B. D., Westers, N. J., Mayes, T. L., & Stewart, S. M. (2016) · Journal of Abnormal Child Psychology · doi:10.1007/s10802-015-0109-5 · Cited by 73 · see citing works
Self-citationvan Lier, P. A. C., & Deater-Deckard, K. D. (2015) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-015-0113-9 · Cited by 73 · see citing works
Anestis, M. D., Kleiman, E. M., Lavender, J. M., Tull, M. T., & Gratz, K. L. (2014) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2014.07.007 · Cited by 64 · see citing works
Kleiman, E. M., Liu, R. T., & Riskind, J. H. (2013) · Behavior Therapy · doi:10.1016/j.beth.2013.10.007 · Cited by 64 · see citing works
King, J. D., Horton, S. E., Hughes, J. L., Eaddy, M., Kennard, B. D., Emslie, G. J., & Stewart, S. M. (2017) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.12352 · Cited by 42 · see citing works
Self-citationMiller, A. B., Esposito-Smythers, C. L., & Leichtweis, R. N. (2015) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.12196 · Cited by 41 · see citing works
Reyes, A. D. L. (2017) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2016.1266649 · Cited by 38 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Colmenero-Navarrete, L., García-Sancho, E., & Salguero, J. M. (2022) · Archives of Suicide Research · doi:10.1080/13811118.2021.1999872 · Cited by 155 · see citing works
Advancing Research in Child Suicide: A Call to Action
Ayer, L. A., Colpe, L. J., Pearson, J. L., Rooney, M. E., & Murphy, E. R. (2020) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2020.02.010 · Cited by 84 · see citing works
Kirshenbaum, J. S., Pagliaccio, D., Bitran, A., Xu, E., & Auerbach, R. P. (2024) · Translational Psychiatry · doi:10.1038/s41398-024-02914-y · Cited by 63 · see citing works
Rogante, E., Cifrodelli, M., Sarubbi, S., Costanza, A., Erbuto, D., Berardelli, I., & Pompili, M. (2024) · Healthcare · doi:10.3390/healthcare12020169 · Cited by 39 · see citing works
Lee, C., Chiang, Y., Li, A., Li, X., Wu, Y.-T., Lin, Y.-J., Zhao, Y., & Zhang, X. (2020) · BMC Psychiatry · doi:10.1186/s12888-020-02814-7 · Cited by 29 · see citing works
Gratz, K. L., Kiel, E. J., Mann, A. J., & Tull, M. T. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.06.066 · Cited by 27 · see citing works
Marco, J. H., de Tejada, B. G.-H., Guillén, V., Baños, R., & Pérez, S. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10214867 · Cited by 20 · see citing works
Testing the interpersonal theory of suicide in adolescents: A multi‐wave longitudinal study
Pagliaccio, D., Bitran, A., Kirshenbaum, J. S., Alqueza, K. L., Durham, K., Chernick, L. S., Joyce, K. J., Lan, R., Porta, G., Brent, D. A., et al. (2023) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.13868 · Cited by 18 · see citing works
Emotional dysregulation and its pathways to suicidality in a community-based sample of adolescents
Mittermeier, S., Seidel, A., Scheiner, C., Kleindienst, N., Romanos, M., & Buerger, A. (2024) · Child and Adolescent Psychiatry and Mental Health · doi:10.1186/s13034-023-00699-4 · Cited by 17 · see citing works
The Prospective Association between Emotional Reactivity and Adolescent Suicidal Ideation
Chiang, S., Chen, W., & Chou, L. (2023) · Archives of Suicide Research · doi:10.1080/13811118.2023.2262536 · Cited by 15 · see citing works
Elledge, D. K., Zullo, L., Kennard, B. D., Diederich, A., Emslie, G. J., & Stewart, S. M. (2019) · Archives of Suicide Research · doi:10.1080/13811118.2019.1661896 · Cited by 14 · see citing works
Self-citationAmini‐Tehrani, M., Sadeghi, R., Nasiri, M., Jalali, T., & Zamanian, H. (2020) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2507 · Cited by 12 · see citing works
Zemestani, M., Abdolmaleki, S., McGrew, S. J., & Vujanovic, A. A. (2023) · Archives of Suicide Research · doi:10.1080/13811118.2023.2190366 · Cited by 8 · see citing works
Bonet, C., Palma, C., & Gimeno-Santos, M. (2020) · Revista de Psicología Clínica con Niños y Adolescentes · doi:10.21134/rpcna.2020.07.1.4 · Cited by 8 · see citing works
Borderline personality features influence treatment response to suicide prevention
Balzen, K. M., Goette, W. F., Sachs, R., Dieste, S., Heerschap, J. K., Kennard, B. D., Emslie, G. J., & Stewart, S. M. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.05.083 · Cited by 8 · see citing works
Self-citationPsychometric Properties of the Interpersonal Needs Questionnaire-15 in Spanish Adolescents
Pérez, S., García‐Alandete, J., de Tejada, B. G.-H., Guillén, V., & Marco, J. H. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.833400 · Cited by 8 · see citing works
Chiang, S., Ting, S., & Sung, Y.-H. (2024) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.13146 · Cited by 4 · see citing works
Tian, X., Jiang, L., Liu, S., He, Y., Zheng, G., Liu, X., Wang, X., Xiang, Y., Lü, J., & Xiao, Y. (2025) · BMC Psychiatry · doi:10.1186/s12888-025-07013-w · Cited by 4 · see citing works
Nightmares and Capability for Suicide: Implications in Adolescents at High‐Risk for Suicide
Amadasu, E. E., Valenga, G. L., Dieste, S., Gazor, A., Wolfe, K. L., Brown, W. D., & Stewart, S. M. (2025) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.70061 · Cited by 2 · see citing works
Self-citationPsychopathology and risk factors for suicide in the young
Barak, M. I., & Orbach, I. (2021) · doi:10.1093/med/9780198834441.003.0066 · Cited by 2 · see citing works
Stecher, S., Batejan, K. L., Baker, R. R., Sanchez-Sarmiento, A. M., Worden, P. M., & Tung, E. S. (2025) · Adolescent Psychiatry · doi:10.2174/0122106766337495250203064209 · Cited by 1 · see citing works
Espinosa-Salido, P., Nieto, M. Á. P., Baca‐García, E., & Provencio, M. (2025) · Journal of Social and Clinical Psychology · doi:10.1521/jscp.2025.44.2.111 · Cited by 1 · see citing works
Investigating the lived experience of adolescents with a history of self-mutilation
Asgharzadeh, A., Ardakan, A. M., & Aryanpour, H. R. (2022) · journal of Adolescent and Youth Psychological Studies · doi:10.52547/jspnay.3.2.417 · Cited by 1 · see citing works
Investigating the lived experience of adolescents with a history of self-mutilation
Asgharzadeh, A., Ardakan, A. M., & Aryanpour, H. R. (2022) · doi:10.61838/kman.jayps.3.2.32
Acquired Capability for Suicide: An Evolutionary Concept Analysis
Keefner, T. P., & Minton, M. E. (2024) · Issues in Mental Health Nursing · doi:10.1080/01612840.2024.2346594
Trauma-Informed, Equity-Focused, and Community-Led Suicide Prevention and Healing
Busby, D. R., Tunno, A. M., Brownlow, B. N., Hargrove, S., & Maxie-Cole, R. (2026) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/j.chc.2025.11.015
Testing within-person correlates of daily fearlessness about death in young adults
Sherifi, E., Dixon, A., Filion, A., & Stewart, J. G. (2026) · Journal of Affective Disorders · doi:10.1016/j.jad.2026.122002
Apicella, M., Pontillo, M., Maglio, G., Minutolo, A., Serra, G., Santa, G. D., Andracchio, E., D’Amario, G., Labonia, M., Averna, R., et al. (2026) · Scientific Reports · doi:10.1038/s41598-026-57386-5
Fındık, H., & Çimen, İ. D. (2026) · Acta Medica Nicomedia · doi:10.53446/actamednicomedia.1784235
Adolescent emotional dysregulation and suicide
Xu, F., & Xu, S. (2026) · Medicine · doi:10.1097/md.0000000000043127
Yin, T., Peng, Y., Chen, L., Lin, X., & Liang, F. (2026) · Frontiers in Public Health · doi:10.3389/fpubh.2026.1934268
- Authors
- Eaddy, M., Zullo, L., Horton, S. E., Hughes, J. L., Kennard, B., Diederich, A., Emslie, G. J., Schuster, L., & Stewart, S. M.
- Affiliations
- Children's Medical Center (US)
- The University of Texas Southwestern Medical Center (US)
- Corresponding author
- Stewart, Sunita M.
- ORCID
- Venue
- Suicide and Life-Threatening Behavior
- Publisher
- Wiley
- Published
- 2018-05-10
- Volume
- 49
- Issue
- 4
- Pages
- 928-940
- ISSN
- 0363-0234 (ISSN-L)
- 1943-278X
- OpenAlex
- W2800099026
- Cited by
- 32
- References
- 40
- Citations by year
- 2026: 6 · 2025: 4 · 2024: 5 · 2023: 3 · 2022: 5 · 2021: 3 · 2020: 4 · 2019: 2
- FWCI
- 2.64
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Suicide and Life-Threatening Behavior (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Keywords
- emotional dysregulation, suicide risk, adolescents, interpersonal theory of suicide, perceived burdensomeness, thwarted belongingness, suicidal ideation, suicide planning, depressive symptoms, emotional management
- MeSH terms
- Emotional Regulation, Adolescent, Adolescent Behavior, Psychology, Adolescent, Affective Symptoms, Cross-Sectional Studies, Depression, Female, Humans, Inpatients, Interpersonal Relations, Male, Psychological Theory, Suicide, Attempted, Suicidal Ideation
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review