The mediating role of hopelessness in the relationship between self-esteem, social anxiety, and suicidal ideation among Japanese university students who visited a university health care center

Abstract

• In Japan, suicide is a major mental problem, especially among early adulthood. • Self-esteem and social anxiety were associated with suicidal ideation. • Hopelessness mediated the effects of self-esteem and social anxiety on suicidal ideation. • Targeting self-esteem, social anxiety and hopelessness may help prevent suicide. : Suicide is a serious social health problem, especially among young adults. This study aimed to investigate the link between self-esteem, social anxiety, hopelessness, and suicidal ideation among Japanese university students. : Data were collected from 322 university students (Mage = 21; 61.8% male) who visited the Hokkaido University Health Care Center in Japan for psychiatric consultation. Participants completed questionnaires including the Rosenberg Selfesteem Scale, Liebowitz Social Anxiety Scale, Beck Hopelessness Scale, and Patient Health Questionnaire 9, to measure the severity of depression and suicidal ideation. Structural equation models were created to examine the direct and indirect effects of self-esteem and social anxiety on suicidal ideation through hopelessness. : Multiple regression analysis showed that self-esteem and social anxiety were significant predictors of suicidal ideation. Results from structural equation modeling indicated that the effects of self-esteem and social anxiety on suicidal ideation were partially mediated by hopelessness. Bootstrap results indicated that the direct and indirect effects were significant. In a sub-analysis, hopelessness also partially mediated the relationship between self-esteem, social anxiety and depression. : The cross-sectional nature and sample collecting method of the study may prevent the results from being generalized to the overall populations. Additionally, the reliability of the ninth item of PHQ-9 in evaluating suicidal ideation remains conflicted. : This study demonstrated the mediating role of hopelessness in suicidal university students with low self-esteem and high social anxiety. Our results suggest that future suicide prevention programs may be more effective when targeting subjects' self-esteem, social anxiety, and hopelessness levels.