The association between entrapment and suicidality in adolescents with depressive disorders: a moderated mediation analysis involving depressive symptoms and gender

Preventing suicide among adolescents with depression remains a global health priority. Entrapment has been shown to be associated with suicidality, with depressive symptoms potentially accounting for part of this association, and these associations may vary by gender. To clarify these relationships, this study examined the statistical associations among entrapment, depressive symptoms, and suicidality, with particular attention to the statistical mediating role of depressive symptoms and the moderating role of gender. This study utilized a cross-sectional design, recruiting 406 adolescents with depressive disorders (79.6% female). Entrapment (Entrapment Scale), depressive symptoms (PHQ-9), and suicidality (SBQ-R) were assessed. Mediation and moderated mediation models (PROCESS macro, Models 4 and 8) were tested with age as a control variable, and bootstrapping procedures (5,000 resamples) were used to evaluate the robustness of the effects. Results indicated that (1): female participants reported significantly higher levels of entrapment, depressive symptoms, and suicidality than males (2); entrapment was positively associated with both depressive symptoms and suicidality (3); depressive symptoms statistically mediated the relationship between entrapment and suicidality; and (4) gender moderated the direct association, while the indirect (statistical mediation) association showed no significant gender differences. These findings suggest that the observed pattern of associations is consistent with theoretical models of suicidality, while also highlighting the importance of gender-sensitive clinical considerations: for males, clinical care should prioritize identifying and alleviating entrapment, whereas for females, comprehensive management addressing both entrapment and depressive symptoms may be more effective.