Objectives: There is a considerable debate regarding the possible dependence between depression and suicidal ideation treatments. The present study used a novel mediation approach in a randomized comparison of pharmacotherapy and combined therapy to explore whether depressive symptoms mediate the association between treatment and suicidal ideation and whether it depends on the treatment condition.

 

Design: This study is a randomized, controlled, parallel group (۱:۱), clinical trial using a novel mediation approach for longitudinal data. Latent difference score modelling was utilized to investigate whether changes in depressive symptoms drive subsequent changes in suicide ideation.

 

Method: Participants were ۹۴ depressive suicidal outpatients who were assessed regarding depressive symptoms and suicidal ideation over the course of an experiment (۰-۲-۷ months). Direct and indirect associations between (change in) depressive symptoms and (change in) suicidal ideation were explored using Pearson's correlations and latent difference score model.

 

Results: The results showed that depression treatment affects not only suicidal ideation directly but also its influence on suicidal ideation occurs via improvement in depressive symptoms. It was found a more significant effect of combining pharmacotherapy and PPT (in comparison with the pharmacotherapy alone) on the early and late improvements of suicidal ideation (Δ ۰-۲ and Δ ۲-۷) via the early improvement of depressive symptoms (Δ ۰-۲).

 

Conclusions: The findings indicate that changes in depressive symptoms preceded changes in suicidal ideation. Our results highlighted that improving depressive symptoms could be a primary target in treating patients with depression experiencing suicidal thoughts.

 

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