Author's Accepted Manuscript

Emotional intelligence as a mediator between

rumination and suicidal ideation among de-
pressed inpatients: The moderating role of
suicidal history
Abbas Abdollahi, Mansor Abu Talib

www.elsevier.com/locate/psychres

PII: S0165-1781(15)00332-7
DOI: http://dx.doi.org/10.1016/j.psychres.2015.05.046
Reference: PSY8939

To appear in: Psychiatry Research

Received date: 28 July 2014

Revised date: 13 March 2015
Accepted date: 3 May 2015

Cite this article as: Abbas Abdollahi, Mansor Abu Talib, Emotional intelligence
as a mediator between rumination and suicidal ideation among depressed
inpatients: The moderating role of suicidal history, Psychiatry Research, http://dx.
doi.org/10.1016/j.psychres.2015.05.046

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 Rumination, EI, suicidal ideation

Emotional intelligence as a mediator between rumination and suicidal ideation among

depressed inpatients: The moderating role of suicidal history

∗
Abbas Abdollahi , Mansor Abu Talib

Faculty of Human Ecology, Universiti Putra Malaysia, Serdang, 43400, Selangor, Malaysia.

Abbas Abdollahi: Tel: 060105144205, Email: Abdollahi.abbas58@gmail.com

Mansor Abu Talib: Tel: 060129273062, Email: gs31751@mutiara.upm.edu.my

Abstract

Suicide is a substantial public health problem, and it remains a serious cause of death in the

world. Therefore, this study was designed to examine the relationships between brooding,

reflection, emotional intelligence (assessed by performance-based test), and suicidal ideation; the

mediation role of emotional intelligence on the relationships between brooding and reflection

with suicidal ideation; and the moderating role of suicidal history on the relationships between

brooding, reflection, and emotional intelligence with suicidal ideation among Iranian depressed

adolescents. The study consisted of a cross-sectional sample of 202 depressed adolescent

inpatients from five public hospitals in Tehran, Iran completed measures of depression,

rumination, emotional intelligence, and suicide attempt history as indices of suicidal ideation.

Structural Equation Modelling estimated that depressed adolescent inpatients with high levels of

brooding and reflective rumination, and low levels of emotional intelligence were more likely to

report suicidal ideation. Moreover, emotional intelligence partially mediated the relationships

between brooding and reflective rumination with suicidal ideation. Suicidal history moderated

∗
Corresponding author: Tel:+060-01115327203, abdollahi.abbas58@yahoo.com
 Rumination, EI, suicidal ideation

the relationships between brooding, reflection, and emotional intelligence with suicidal ideation.

These findings reinforce the importance of emotional intelligence as an influencing factor against

the deleterious effects of rumination styles and suicidal ideation. The results indicate that

brooding and reflection have detrimental effects on suicidal ideation in depressed inpatients.

Highlights

• We examined whether EI, brooding and reflection correlated with suicidal ideation.

• EI partially mediated the relationship between rumination and suicidal ideation.

• High brooding and reflection were associated with suicidal ideation.

• Suicidal history moderated the relationships between exogenous variables and suicidal
ideation.

Keywords

Rumination, Emotional intelligence, Suicidal ideation, Depressed inpatients

1 Introduction

It is reported that depressed adolescents experience higher rates of suicidal ideation and

attempts (Shahar et al., 2006). The prevalence of suicide and suicidal ideation increased between

ages 12 and 17 years old (Nock et al., 2013), and the transition to adolescence indications a

critical developmental period during which suicidal ideation and behaviors are on the upsurge

(Czyz and King, 2013). This rapidly increase may be related to limitations in cognitive and

emotional abilities, particularly in depressed adolescents (Czyz and King, 2013). Previous

studies have indicated that suicidal ideation is most likely to represent the phase before suicide
 Rumination, EI, suicidal ideation

among depressed individuals (Sokero et al., 2006). Importantly, hospitalized adolescents are at

greater risk for suicide (Czyz and King, 2013). Thus, understanding about suicidal ideation as a

powerful predictor of suicide is a significant factor in preventing suicide among depressed

adolescent inpatients. Accordingly, this study was conducted to understand suicidal ideation and

the variables associated with suicidal ideation among Iranian depressed adolescents.

Researchers have indicated rumination as a predictor of suicidality (McLean et al., 2008). It

is probably that suicidal ideation may be supported by a ruminative thought that stretches

negative mood and hinders faster declines in suicidal ideation. Consequently, ruminative thought

is associated with increased suicidal ideation and longer and more depressive symptoms (Smith

and Alloy, 2009). Rumination has been defined as repetitive and recurrent thinking regarding

one's personal distress, including the causes and the consequences of unresolved goals (Nolen-

Hoeksema, 1991). Rumination is associated with depressive symptoms, loss of motivation,

ineffective problem-solving skills, and suicidal ideation (Tucker et al., 2013). In addition,

ruminative thought is experienced as intrusive, disruptive, and time consuming (Tucker et al.,

2013). For these reasons, rumination has been considered as a dysfunctional coping strategy.

Two subtypes of rumination were revealed in a factor analysis performed by Treynor et al.,

(2003): (1) brooding was defined as moody pondering on negative consequences of distress, and

(2) reflection was defined as actively looking for information so that you can understand one’s

distress (Lyubomirsky and Nolen-Hoeksema, 1995). Therefore, in this study, the relationship

between subtypes of rumination and suicidal ideation was studied separately.

The relationships between brooding, reflection, and suicidal ideation has been extensively

studied during the last decade. Interestingly, the findings were not consistent for the particular

styles of brooding and reflection. One study showed that reflective subtype of rumination led to
 Rumination, EI, suicidal ideation

reduced depressive symptoms, whereas brooding subtype of rumination led to increased

depressive symptoms (Treynor et al., 2003; Tucker et al., 2013). Morrison and O’Connor (2008)

reconsidered the existing studies and concluded that rumination positively predicted suicidal

ideation in 10 of the 11 reviewed studies. Some studies found that brooding and reflective

subtypes of rumination were associated with suicidal ideation (Crane et al., 2007; Miranda and

Nolen-Hoeksema, 2007; Surrence et al., 2009; Tucker et al., 2013); however, in other studies,

reflection was not associated with suicidal ideation, they argued that reflection may be a

problem-solving orientation that protects against suicidal ideation (O’Connor and Noyce, 2008;

Surrence et al., 2009). A recent study has indicated that psychiatric inpatients with a history of

suicide attempts were more likely to engage in brooding subtype of rumination more than

inpatients without a history of attempts, but no difference was found for reflective subtype of

rumination between two groups (Grassia and Gibb, 2009). Based on the suicide literature, both

rumination styles contribute to the work on rumination and depression, and show the importance

of investigating brooding and ruminative styles. According to response styles theory (Nolen-

Hoeksema, 1991), ruminating on unpleasant events increases negative cognitive thought of the

one's depressive state, by reinforcing the negative aspects and increased emotional reactivity.

Results from previous studies have shown that rumination maintains and exacerbates depressive

symptoms in adolescences (Verstraeten et al., 2010). With incompatibilities in the literature

concerning the perniciousness of brooding and reflection, further study is necessary to

investigate brooding and reflection in relation to suicidal ideation. Also, the nature of the

relationships between rumination, brooding, and suicidal ideation remains a topic of debate.

Thus, the first aim of the present study was to develop the body of literature concerning the links

between reflection, brooding, and suicidal ideation.

 Rumination, EI, suicidal ideation

Given the incompatible findings on the relationships between reflection, brooding, and

suicidal ideation, no study has investigated emotional intelligence as a possible mediator of the

relations. Emotional intelligence has been shown to mediate the relationship between stress and

depression (Davis and Humphrey, 2012), but has not been investigated in relation to the link

between rumination and suicidal ideation. It may be that rumination associated with suicidal

ideation, if emotional intelligence is not present. Ruminative thought is related to more abstract,

high-level construals that lead to deficits such as impaired emotional and cognitive coping skills,

impaired emotional regulation, and increased emotional reactivity (Watkins et al., 2008). This

idea suggests that limitations in self-regulation of emotions and cognitions may increase the risk

of suicidal ideation and behavior (Czyz and King, 2013). Emotional regulation, emotional

control, and emotional competence are constructs that comprise emotional intelligence. The

abilities to withstand negative thoughts and adaptive response to aversive emotions are more

likely to decrease vulnerability toward suicidal ideation. Therefore, the evidence supports a

mediating model in which ruminative individuals with emotion dysregulation are more likely to

think about suicide. Accordingly, the second aim of this study was to examine the mediating role

of emotional intelligence on the link between rumination and suicidal ideation.

According to the model of Mayer et al., (2004) emotional intelligence was defined as

perceiving, understanding, managing, and harnessing emotions in self and others, and utilizing

suitable emotions in adaptive ways. Perceiving of emotion includes identifying emotional cues.

Understanding emotion involves applying knowledge of the complexities of emotional

experience. Managing emotions includes being clever to regulate emotions efficiently and

properly. Harnessing emotions entails of applying emotion towards other ends such as drawing

on positive mood to help creativity (Schutte and Malouff, 2011). Attention to emotions refers to
 Rumination, EI, suicidal ideation

an individual's tendency to awareness and ponders on his/her feelings and emotions. Emotional

intelligence refers to the ability to be discriminate between positive and negative emotions. In

addition, emotional intelligence can repair emotional hurts even in a mood state (Aradilla-

Herrero et al., 2013). Mayer et al. (2004) postulated that emotional intelligence is best conceived

as an ability; however, other theorists argued that emotional intelligence can be considered as

trait functioning. Although the emotional intelligence literature has sometimes presented ability

and trait functioning conceptualization of emotional intelligence as mutually exclusive

alternatives, they may be complementary dimension of adaptive emotional functioning (Schutte

and Malouff, 2011). Thus, emotional intelligence as a trait or as an ability prepared individuals to

regulate their emotions, and deal with suicidal ideation (Cha and Nock, 2009). Individuals with

greater emotional intelligence reported better emotion regulation, and low levels of suicidal

ideation (Aradilla-Herrero et al., 2013; Law et al., 2015). Therefore, with regard to emotional

regulation, there is a consecutive process whereby a particular level of attention to feelings is

needed in order to understand emotional states and a certain level of clarity of feelings is needed

in order to regulate those. It is conceivable that ruminative individuals who struggle with

understanding, managing, and expressing their emotions are more likely to be at an increased

risk of suicidal ideation. Therefore, it is expected that emotional intelligence would mediate the

relationship between rumination (brooding and reflection) and suicidal ideation in depressed

individuals. Much of the study up to now have mostly conducted on the linear relationship

between rumination and suicidal ideation (Treynor et al., 2003; Tucker et al., 2013) without

considering mediating role of emotional intelligence. Although the rumination literature and

emotional intelligence literature have related to suicidal ideation, these literatures have remained

independent from each other. Clarifying these relationships can provide competent treatment and
 Rumination, EI, suicidal ideation

prevention programs about the reduction of suicidal ideation and ruminative thoughts by

fostering emotional intelligence in clients.

The present study sought to examine the relationships between emotional intelligence,

brooding, reflection, and suicidal ideation. It was hypothesized that emotional intelligence would

be associated with lower levels of brooding, and reflection, hence displaying a protective

relationship. This study also examined whether emotional intelligence can mediate the

relationships between brooding and reflection with suicidal ideation. Additionally, in the current

study, we endeavored to develop the literature on the subtypes of rumination and suicidal

ideation and attempts by examining how a history of suicidal behavior moderates the relationship

between emotional intelligence, brooding and reflective styles with suicidal ideation.

2 Methods

2.1 Ethical considerations

The ethics committee of Iranian Ministry of Health (Tehran, Iran) approved this study. The

participants were informed about the aims of the research. The participation in this study was

voluntary and anonymous, and that they could withdraw from the study at any time. Written

permission were obtained from each participant. Furthermore, parental consent was obtained.

The consent procedure was approved by the ethics committee.

 Rumination, EI, suicidal ideation

2.2 Participants

A total of 202 depressed adolescents who had been psychiatrically hospitalized due to

depression disorder from five public hospitals in Tehran, Iran participated in this study

(male=48%, n=97, and female= 52%, n=105, aged from 13 to 18 years, Mean age= 16.28,

SD=2.58). Based on the total score on Patient Health Questionnaire (PHQ) (Spitzer et al., 1999);

participants were categorized as minimal depression (1-4, n= 10), mild depression (5-9, n=12),

moderate depression (10-14, n=78), moderately severe depression (15-19, n=122), and severe

depression (20- 27, n=18). Moderate depressed individuals and moderately severe depressed

individuals were selected for this study. The average length of hospitalization for participants

was 6.5 months (range from 2 to 14 months). In terms of marital status, (90%, n=182) were

single, (8%, n=16) were married, and (2%, n= 4) were separated or widowed. Thirty-five percent

of participants were college students; forty-three percent were high-school students; twelve

percent of participants were guidance-school, and ten percent of participants obtained an

elementary degree. Seventy-two percent of participants reported that they lived with both their

parents. The rest of participants reported they lived with their mother (14%), father (8%), and

others (6%). In terms of religion, 91% of participants considered themselves Muslim, 3%

Christian, 2% Zoroastrian, and 4% other religious affiliation. Ninety-five of participants (47%)

reported a suicide attempt history (46 of them also reported suicidal ideation), eighty-one of

participants (40%) reported suicidal ideation (only), and twenty-six of participants (13%)

reported neither suicidal ideation nor history of an attempt. Thus, there were ninety five

participants with previous suicide attempters and one hundred and seven participants with non-

suicide-attempters in the present sample.

 Rumination, EI, suicidal ideation

2.3 Procedure

The Iranian Ministry of Health, obtained permission for gathering data from five psychiatric

hospitals, located in Tehran city. The head of each hospital agreed to data collection from his or

her hospital. Then, the head of each psychiatric department obtained permission for the authors

to collect data from depressed inpatients. At the first stage, participants were introduced by a

psychiatrist or a psychologist as depressed inpatients, and subsequently, in order to evaluate of

the depressive symptoms, they were evaluated by the Patient Health Questionnaire. Inclusion

criteria were participants under age 13, and over age 18 were excluded from our sample.

According to the UNICEF, childhood is below 18 years old (UNICEF, 2012). Another exclusion

criterion was inability to read or comprehend the questionnaires. Each package contained an

introductory letter about the aims of the study and six questionnaires (one of them was a

demographic questionnaire). The packages of questionnaires were distributed among depressed

inpatients, and filled out by them during one session without help of researchers.

2.4 Measures

2.4.1 Suicide attempted history

Suicide attempt history was assessed by two questions: ‘‘have you ever, in your whole

life tried to kill yourself or made a suicide attempt?’’, and “have you ever, in your whole-life

wish to die yourself?

 Rumination, EI, suicidal ideation

2.4.2 Patient Health Questionnaire

The Patient Health Questionnaire (Spitzer et al., 1999) comprises of nine items that

measure symptoms of depression. All the questions are based on a 4-point Likert scale from 0

(Not at all) to 3 (Nearly every day). The total score is from 0 to 36, with a higher score indicating

higher levels of depression. In the current study, the average score was 16.0 (SD: 6.0), with a

range of 4–27. The PHQ had a good reliability (α: 0.81), when used with adolescent psychiatric

inpatients (Surrence et al., 2009). In the current study, the convergent validity (Average Variance

Extracted) was 0.66, and the construct reliability (CR) was 0.72.

2.4.3 Suicidal Ideation Questionnaire

This questionnaire (Reynolds, 1991) comprises of 30 items that measure the frequency of

suicidal ideation. All the questions are based on a 7-point Likert scale from 0 (never had the

thought) to 6 (had the thought almost every day). The total score is from 0 to 180, with a higher

score indicating higher levels of suicidal ideation. The SIQ had an excellent internal consistency

and good test-retest stability, when used with adolescent psychiatric inpatients (Pinto et al., 1997;

Reynolds, 1986). In the present study, the average score was 87.14 (SD: 15.12), with a range of

23–152. In addition, the convergent validity (Average Variance Extracted) was 0.69, and the

construct reliability (CR) was 0.71.

 Rumination, EI, suicidal ideation

2.4.4 Assessing Emotions Scale

The Assessing Emotional Scale (Schutte et al., 1998) is a 33-item that measures emotional

intelligence. All questions are in 5-point Likert's scales from 1 (strongly disagree) to 5 (strongly

agree). Whole scores can be calculated by reverse coding items 5, 28 and 33, and then summing

all items. The total score is from 33 to 165. A high score indicates greater ability of emotional

intelligence. The scale assesses how effectively respondents typically identify, understand,

regulate, and harness emotions in self and others. In earlier studies the scale had a good internal

consistency from 0.87 to 0.90, and reliability (a two-week test–retest reliability) was 0.78, and

evidence of construct validity through association with related constructs (Schutte and Malouff,

2011; Schutte et al., 1998), including associations with other measures of trait emotional

intelligence (Kirk et al., 2008) and ability emotional intelligence (Schutte and Malouff, 2011). In

the current study, the average score was 74.33 (SD: 12.21), with a range of 23-145. In addition,

in the present study, the convergent validity (AVE) was 0.60, and the construct reliability (CR)

was 0.73.

2.4.5 Ruminative Responses Scale

The Ruminative Response Scale comprises of 22-items that measuring rumination.

Treynor et al. (2003) removed 12 items with content of depression. Therefore, the remaining

items are comprised of two five question subscales, brooding and reflection. The breading is

defined as moody pondering on the negative consequences of distress. The reflection is defined

as a tendency to attempt to understand one’s distress. All the questions are based on a 4-point
 Rumination, EI, suicidal ideation

Likert scale from 1 (never to) to 4 (always). The RRS had an excellent internal consistency (α:

0.95); moreover, internal consistency for brooding (α: 0.85) and reflection (α: 0.78) were

acceptable. In the current study, the average scores for brooding and reflection were (Mean: 9.3

and 7.8, SD: 2.1 and 1.88, respectively), with a range of 5-14 for brooding sub scale and 5-12 for

reflective subscale. In the present study, the convergent validity (AVE) for brooding and

reflection were 0.53 and 0.62, and the construct reliability (CR) for brooding and reflection were

0.73 and 0.71, respectively.

2.4.6 Demographics

A self- report questionnaire was provided to obtain demographic information, such as

gender, age, educational levels, religious affiliation, and marital status.

2.5 Translation of the questionnaires

The questionnaires were translated into the Persian language. In order to ensure that the

Persian translation correctly reflected the meaning of the English version, back-translation was

conducted with the assist of three experts in English language, and needed changes were

performed accordingly. Two health academics (English speakers) compared the original English

version and the Persian version, and checked for equivalence in the meaning of scales, questions

and the answer options. They identified discrepancies between the original and the back-

translated versions. In addition, the test–retest reliability was assessed by the intra-class

correlation coefficient.
 Rumination, EI, suicidal ideation

2.6 Pilot study

The test–retest reliability (interval between two weeks) was conducted on thirty

depressed inpatients to determine the reliability of the tools. The Cronbach’s Alpha coefficients

for the questionnaires in the pilot study were as follows: (1) Patient Health Questionnaire α: 0.80

- 0.82, (2) Suicidal Ideation Questionnaire α: 0.72 - 0.74; (3) Assessing Emotional Scale α: 0.77 -

0.79; and (4) Rumination Responses Scale α: 0.78 - 0.80. After reading a survey letter of consent

and completing the questionnaires, the respondents were asked to indicate any difficulties or

ambiguities in the questionnaires. In general, the respondents of the pilot study indicated a

positive feedback towards the general structure and presentation of the questionnaire. Those

depressed inpatients, who participated in the pilot study were excluded from the main study

sample.

2.7 Analysis

We employed Structural Equation Modeling (SEM) analysis. According to the advantages

of employing SEM are that it (a) improves statistical estimation by taking into account

measurement error in the estimation process, (b) enables the testing of multiple relationships

simultaneously, (c) tests much more complex models, such as testing mediation, moderation, and

provides goodness of fit indices for model testing, and (d) provides better identification of the

validity and reliability of the instruments. Therefore, the Average Variance Extracted (AVE),

and Construct Reliability (CR) was performed for measuring the validity and reliability of the

instruments.
 Rumination, EI, suicidal ideation

2.8 Data Preparation

The missing range of items were from 0.21% to 1.71%; therefore, for addressing missing

data a multiple imputation method in AMOS 20 software was applied. The data were distributed

normally, because the skewness values were from -0.91 to 1.11, and the Kurtosis values were

from -2.60 to 2.11 for all variables. Byrne (2010) argued that, if the skewness value is between -

2 to +2, and the kurtosis value is between -7 to +7; data were appropriate to assume multivariate

normality. For model fit, Kline (2010) suggested using model fit indexes, including the chi

square/degree of freedom ratio (CMIN/DF), the comparative-fit index (CFI), the goodness-of-fit

index (GFI), and the Tucker-Lewis Index (TLI). A rule of thumb for the fit indices is that values

equal or greater than 0.90 have acceptable fit (Kline, 2010). Furthermore, the model may be

classified as acceptable, if the root mean squared error of approximation (RMSEA) is between

0.03 and 0.08. AMOS 20 software was utilized for analyzing the data.

3 Results

3.1 Measurement Model

The measurement model includes brooding, reflection, emotional intelligence, and

suicidal ideation as latent variables. This model depicts good fit indices: CMIN/DF (Chi-square)

= 2.4, p<0. 01, CFI= 0.93, GFI= 0.94, TLI= 0.92, RMSEA= 0.06 CFI= 0.99, TLI= 0.98, NFI=

0.99, TLI= 0.98, RMSEA= 0.07 with 90% confidence interval of 0.03 to 0.09. According to

Kline (2010), the model provides an acceptable fit for the model.
 Rumination, EI, suicidal ideation

3.2 Structural model

This model includes brooding, reflection, and emotional intelligence as exogenous

variables, and suicidal ideation as an endogenous variable. As it can be seen from Fig 1,

brooding, reflection, and emotional intelligence have a significant relationship with suicidal

ideation. It can be seen from the data in Fig 1 that brooding, and reflection are positively

associated with suicidal ideation in depressed inpatients, whereas emotional intelligence is

negatively associated with suicidal ideation in depressed patients. These variables explained

46.0% of the variance in suicidal ideation. The findings of this study indicate that brooding,

reflection, and emotional intelligence are valuable predictors of suicidal ideation.

3.3 Mediation test of Emotional Intelligence

The model included brooding and reflection as exogenous variables; and emotional

intelligence and suicidal ideation as endogenous variables. Hair et al., (2010) indicated that, “a

mediate effect is created when a third variable/construct intervenes between two other related

constructs” (p. 866). The multi-model analysis was utilized for testing mediation effects (Baron

and Kenny, 1986). Hair et al. (2010) indicated that: if the relationship between exogenous

variable and endogenous variable was zero when the mediator was included, full mediation was

established. However, if the relationship between exogenous variable and endogenous variable

was reduced when the mediator was included, partial mediation was established.

In order to establish a mediation effect in the overall model, it must be shown that full

mediation model is better than an indirect model (Baron & Kenny, 1986). The level of goodness-
 Rumination, EI, suicidal ideation

of-fit for full mediation and the indirect model could be compared based on Nested Model

Comparisons (Kline, 2010). The full mediation model showed (Chi-square: 2.96. p >0.01, GFI:

0.90, CFI: 0.95, TLI: 0.94, and RMSEA: 0.06 CFI= 0.99, TLI= 0.98, NFI= 0.99, TLI= 0.98,

RMSEA= 0.07 with 90% confidence interval of 0.03 to 0.09), and the indirect model showed

(Chi-square: 3.27, p> 0.01, GFI: 0.91, CFI: 0.94, TLI: 0.93, and RMSEA: 0.07 with 90%

confidence interval of 0.03 to 0.09). Although both models fit the data according to the Nested

Model comparison, the full mediation model showed a significantly better fit than the indirect

model, because the full mediation model showed smaller AIC (Akaike Information Correction):

348.56, to compare the indirect model (Akaike Information Correction): 410.69, and the PNFI

(Parsimony Normed Fit Index) of the full mediation model was (0.74) bigger than the PNFI

(Parsimony Normed Fit Index: 0.74) of the indirect model.

According to the above-mentioned condition indicated by Hair et al. (2010), emotional

intelligence mediates the relationships between brooding and reflection with suicidal ideation. As

demonstrated in Table 1, the results show that in the direct model, the relationships between

brooding and reflection with suicidal ideation were significant (β= 0.41, and 0.35, respectively),

whereas, in the mediation model, the relationships between brooding and reflection with suicidal

ideation were significant; however, the size of standard regression weights were decreased (β=

0.31, and 0.30, respectively). Therefore, the partial mediation of emotional intelligence on the

relationships between brooding and reflection with suicidal ideation were supported.
 Rumination, EI, suicidal ideation

3.4 Moderation test of history of suicidal behaviour

The first step to test the moderation effect is to compare “the unconstrained model” against

“the measurement residuals model”. If “the unconstrained model” is better than “the

measurement residuals model”, then we can conclude that there is moderation effect of history of

suicidal behaviour on the overall model. The second step to test the moderation effect is to check

for the significance of individual paths. The path is moderated by moderator (History of suicidal

behaviour) if: (1) beta for group 1 is significant, while beta for group 2 is not significant. (2) beta

for both groups are significant. However, one is positive, while the other negative (Hair et al.,

2006).

The comparison between the unconstrained model and the measurement residual model

showed that the unconstrained model with (Chi-square: 2.91, p < 0.01, RMSEA = 0.06 with 90%

confidence interval of 0.02 to 0.09, CFI = 0.91, GFI= 0.90, NFI = 0.91), and the measurement

residuals model with (Chi-square: 3.41, p < 0.01, RMSEA = 0.88 with 90% confidence interval

of 0.04 to 0.09, CFI = 0.76, GFI= 0.72, NFI = 0.71) were significant; however, the unconstrained

model was better than the measurement residual model, because chi-square was smaller (Kline,

2010). According to the measurement residual model (CMIN= 318.77, df= 36, and p< 0.01) in

“the assuming model unconstrained to be correct", the findings indicated that the impact of likely

differences between suicide attempters and non-attempters.

The results indicate that the relationships between reflection and brooding with suicidal

ideation for both groups were significant (See Table 2). Thus, suicide attempt history cannot

moderate the relationships between reflection and brooding with suicidal ideation. Our finding
 Rumination, EI, suicidal ideation

supports previous study representing that participants with the histories of suicidal attempts

experience higher levels of reflective rumination than participants without histories of suicidal

attempts (Surrence et al., 2009). Although the direction of the correlation coefficients was

consistent with previous findings that brooding is more strongly related to suicidal ideation

(Morrison and O’Connor, 2008; Surrence et al., 2009). Moreover, the results reveal that there

was a significant relationship between emotional intelligence and suicidal ideation for

participants without suicidal attempts, while there was not a significant between emotional

intelligence and suicidal ideation for participants with suicidal attempts (Table 2). Therefore,

suicide attempt history moderates the relationship between emotional intelligence and suicidal

ideation. This finding is consistent with prior studies indicated that emotional intelligence was

higher in participants without suicidal attempts than participants with suicidal attempts (Cha and

Nock, 2009; Ciarrochi et al., 2002).

4 Discussion

The first goal of this study was to examine the relationships between brooding, reflection,

emotional intelligence, and suicidal ideation among depressed adolescents. Contrary to our first

hypothesis, the finding showed that brooding and reflective rumination were positively

associated with suicidal ideation. These findings are consistent with previous studies (Aradilla-

Herrero et al., 2013; Miranda and Nolen-Hoeksema, 2007; O’Connor and Noyce, 2008), and take

those results one step further by providing support for emotional intelligence as an influencing

factor against the most serious of ruminative symptoms and suicidal ideation. In addition, the

findings revealed that higher levels of suicidal ideation for those who had high levels of
 Rumination, EI, suicidal ideation

brooding and reflection, and low levels of emotional intelligence, as opposed to individuals with

high levels of emotional intelligence. Therefore, emotional intelligence helps individuals by

managing their emotions and cognitions to prevent them from suicidal ideation and behavior.

This adds support to Cha and Nock (2009), further signifying that emotional intelligence

decreases likelihood of suicidal ideation. In addition, the findings showed that brooding was the

strongest predictor of suicidal ideation. It may be because brooding exacerbates an existing

problem-solving deficits (Surrence et al., 2009). The deleterious effects of brooding may stem

not only from an excessively abstract level of cognition, but also from rumination’s influence on

executive processing and cognitive flexibility (Surrence et al., 2009). Additionally, reflective

rumination was positively associated with suicidal ideation. This finding supports previous

finding that reflective rumination is not an adaptive cognitive response style, particularly in the

context of suicidal ideation (Surrence et al., 2009).

The second aim of this study was to examine the mediating role of emotional intelligence

on the link between rumination and suicidal ideation. Contrary to our first hypothesis, emotional

intelligence mediates the relationships between brooding and reflective styles with suicidal

ideation in depressed adolescents. It means that, brooding and reflective rumination may be

harmful when an absence of emotional intelligence is present. A key finding in our study was

that emotional intelligence provided a useful influencing effect against the detrimental effects of

brooding, reflection, and suicidal ideation. The findings also show that depressed inpatients who

have high levels of emotional intelligence, are better able to regulate their emotions and

cognitions to guide their thinking and actions, and are more apply effective and appropriate

emotional coping strategies; therefore, they may be less likely to ruminate about their problems,

and they in turn may less likely to experience suicidal ideation (Law et al., 2015). Indeed,
 Rumination, EI, suicidal ideation

emotional dysregulation is associated with both ruminative thoughts and increased suicidal

ideation, while emotional intelligence serves as an obstacle for both ruminative thoughts and

suicidal ideation.

The last aim of this study was to determine whether suicide attempters differed from non-

suicide-attempters in the relationships between brooding, reflection, and emotional intelligence

with suicidal ideation. Both brooding and reflection were significantly related to suicidal ideation

for both groups. While the correlation coefficient value between reflection and suicidal ideation

for suicide attempters were greater than non-attempters, and correlation coefficient value

between brooding and suicidal ideation for non-attempters were greater than suicide attempters.

While researchers have inclined to depict reflection as an adaptive mode of rumination (Crane et

al., 2007), the results support prior findings that reflection is not a uniformly adaptive cognitive

response style, especially in the context of suicidal ideation (Surrence et al., 2009). In addition,

the findings showed that emotional intelligence was significantly related to suicidal ideation for

non-attempters, whereas this association was not significant for suicide attempters. That is,

depressed adolescents without suicide attempts and greater emotional intelligence was less likely

to involve suicidal ideation than those with suicide attempts. The findings support previous study

suggesting that increased emotional dysregulation is associated with a greater number of suicide

attempts (Law et al., 2015). It appears that the lack of emotional clarity and access to emotion

regulation strategies are significant factors leading to an elevated risk for suicide attempts.
 Rumination, EI, suicidal ideation

4.1 Implications

The mediating role of emotional intelligence on the relationship between rumination and

suicidal ideation in depressed adolescents have implications for practitioners. Firstly, when

assessing the risk of suicide in individuals. It is important to account for the presence of

emotional intelligence in addition to other risk factors, such as rumination. Secondly, the results

suggest that preventions and interventions for depressed adolescents with ruminative thoughts

may be more effective at preventing or reducing suicidal ideation if they focus more on

promoting emotional intelligence. Additionally, such programs could provide benefits by

targeting adolescents without ruminative thoughts or suicidal ideation, because the improvement

of emotional intelligence might protect them from suicidal ideation and enhance the strengths.

Taken together, it appears that teaching of emotion intelligence is likely an important target for

treatment to reduce suicidal ideation.

4.2 Limitations

One important limitation of this study is its reliance on self-report questionnaires, which

can be affected by situational factors and mood of participants when assessments are taken.

Although the measures used in the study are psychometrically adequate, multi-method approach,

such as objective or interview-based assessments of the constructs of interest would be superior

and lend incremental validity to the current study. In addition, the study was cross-sectional

nature; therefore, statements about causality is not possible from the present study. The focus of

our study was on depressed sample, future studies could examine the relationships between
 Rumination, EI, suicidal ideation

rumination, emotional intelligence, and suicidal ideation on different psychiatric samples. While

the present findings are preliminary in nature, they fit with previous studies that have suggested

emotional intelligence provides a protective effect against suicidal ideation (Aradilla-Herrero et

al., 2013; Cha and Nock, 2009; Ciarrochi et al., 2002).

As a whole, the present study suggests that emotional intelligence plays an important role

in understanding suicidal ideation in depressed inpatients and provides a potential area to draw

from to ameliorate suicidal ideation and rumination.

Acknowledgement

We would like to show our great appreciation to the clinical staff and participants at the

hospitals for their support and assistance in data collection. There was no external funding for

this study.

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Tables:

Table 1
Results from mediation testing of emotional intelligence between brooding and reflection with
suicidal ideation.
Mediation Direct Indirect
DV IV
Model Model Model
Emotional Intelligence <--- Brooding -0.38** -0.67**

Emotional Intelligence <--- Reflection -0.48** -0.20*

Suicidal Ideation <--- Emotional Intelligence -0.56*** -0.62***

Suicidal Ideation <--- Brooding 0.31** 0.41**

Suicidal Ideation <--- Reflection 0.30* 0.35**

Note: *p<. 05, **p<. 01, ***p < .001

Table 2

Results from moderation testing of suicidal history between exogenous and endogenous variables (Suicide

Attempters versus Non-attempters)

Hypothesis S.E.a C.Rb. Standard Estimate

Suicidal Ideation <--- Reflection 0.79(0.97) 1.04 (1.50) 0.39**(0.36**)

Suicidal Ideation <--- Brooding 0.44 (0.89) 0.31 (.51) 0.25*(0.29**)

Suicidal Ideation <--- Emotional intelligence -.08 (-0.21) -3.43 (-2.57) -0.20 (-0.25*)

Note: *p<.05, **p<. 01, ***p < .001, without*= Not significant. a: Standard Error, b: Critical Ratio.

Results for Suicide Attempters are presented first, and results for Non-attempters are presented in parenthesis.
 Rumination, EI
EI, suicidal ideation

Figures

Fig 1. Structural model for the suicidal ideation