The relationship between defense mechanisms and suicidal ideation in women: The mediating role of psychological pain and difficulties in emotion regulation

Background: Suicidal ideation persists as a pressing public health concern, especially in women.Dysfunctional defense mechanisms and their complex interplay with emotional and cognitive processes warrant further scholarly investigation.Objectives: This study investigates the mediating roles of psychological pain and difficulties in emotion regulation in the relationship between defense mechanisms and suicidal ideation in women.Methods: This descriptive-correlational study used structural equation modeling to examine direct and indirect pathways in women with suicidal ideation from Karaj counseling centers (2024).A convenience sample of 350 participants (mean age = 32.0 years, SD = 7.8) completed the Defense Style Questionnaire-40 (immature/dysfunctional subscale), Beck Scale for Suicide Ideation, Mental Pain Scale, and Difficulties in Emotion Regulation Scale.Data analysis used SPSS-27 and AMOS-27.The study received ethics approval, included informed consent, and high-risk participants (BSSI 17) were referred to crisis services.Results: Findings indicated a significant direct effect of dysfunctional defense mechanisms on suicidal ideation (=0.22,p<0.001).Psychological pain (=0.15,95% CI [0.10, 0.20], p<0.001) and difficulties in emotion regulation (=0.10,95% CI [0.05, 0.15], p<0.001) partially mediated this relationship, with the direct effect remaining significant, confirmed through 5,000 bootstrap resamples.The model exhibited strong fit (CFI=0.92,TLI=0.91,RMSEA=0.06),underscoring the mediators' salience in suicidal ideation.Conclusion: This study highlights the need for multidimensional interventions targeting dysfunctional defenses, psychological pain, and emotion regulation to prevent and treat suicidal ideation in women. Implications for Nursing and Midwifery Preventive Care Empowers nurses to identify dysfunctional defenses, psychological pain, and emotional dysregulation for early suicide risk detection in women. Supports coping and resilience training for high-risk women in clinical settings. Promotes education and timely referral to reduce suicidal ideation.