The Interplay Between Depression, Anxiety, Rumination, and Metacognition in Suicidal Ideation: Insights from Major Depressive Disorder Patients

Objective: Suicidal ideation is a critical symptom of major depressive disorder (MDD) and often precedes suicide attempts. This study examines the relationship between depression, anxiety, rumination, metacognitive beliefs, and suicidal ideation in individuals with MDD. Methods: This cross-sectional study included 47 patients (25 men and 22 women) aged 18–65 who had been diagnosed with major depressive disorder (MDD) according to the criteria set out in the DSM-5. Participants completed the following validated assessments: The Beck Depression Inventory (BDI), the Beck Scale for Suicidal Ideation (BSSI), the State-Trait Anxiety Inventory (STAI), the Ruminative Thought Style Questionnaire (RTSQ), and the Metacognitions Questionnaire (MCQ-30). Correlation and regression analyses were then performed. Results: Suicidal ideation was found to be significantly correlated with depression, state anxiety, and rumination. Depression was found to be the strongest predictor (β = 0.527, p = 0.005). Rumination was moderately associated with active suicidal desire, while state anxiety was more related to passive suicidal ideation. Among the metacognitive subscales, only \'Positive Beliefs\' exhibited a weak negative correlation with suicidal ideation, though it was not a significant predictor in the regression analysis. Conclusion: Depression, rumination, and anxiety all significantly contribute to suicidal ideation in people with MDD. Although maladaptive metacognitive beliefs were not predictive, their association with core symptoms suggests a broader cognitive-affective framework of suicide risk. Positive metacognitive beliefs may provide emotional resilience. Integrating metacognitive perspectives into clinical assessments and interventions could improve suicide prevention.