Predicting Suicidal Behaviors in Patients With Bipolar Disorder Based on Stressful Life Events, Emotion Regulation, and Coping Strategies
Keywords:
suicide, stressful life events, emotion regulation, patients with bipolar disorderAbstract
Bipolar disorder is one of the most important psychiatric disorders and is associated with a high prevalence of suicide. Irregular social rhythms may play an important role in the development of suicidal thoughts and behaviors among these patients. Therefore, the present study aimed to investigate the role of social rhythm in predicting suicidal behaviors among patients with bipolar disorder and the mediating roles of emotion regulation and coping strategies. This study employed a descriptive-correlational design using regression analysis. The statistical population consisted of patients with bipolar disorder in Tehran during 2025–2026. A total of 193 patients were selected through convenience sampling from Iran Psychiatric Hospital and Rasoul Akram Hospital. The participants completed the Stressful Life Events Questionnaire (1985), Emotion Regulation Questionnaire (Gross, 2003), Ways of Coping Questionnaire (1984), and Suicidal Behaviors Questionnaire (2002). The data were analyzed using regression analysis in SPSS version 25. The results indicated that stressful life events (β = −0.23, p = .001), cognitive reappraisal (β = −0.13, p = .036), suppression (β = −0.23, p = .001), escape–avoidance (β = 0.21, p = .001), and planful problem-solving strategies (β = −0.13, p = .040) significantly predicted suicidal behaviors among patients with bipolar disorder. Based on the findings, it is recommended that clinicians pay particular attention to reducing stressful factors and improving emotion regulation and coping strategies in treatment programs designed to prevent and ameliorate suicidal behaviors among patients with bipolar disorder.
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References
Amini-Tehrani, M., Nasiri, M., Jalali, T., Sadeghi, R., Ghotbi, A., & Zamanian, H. (2020). Validation and Psychometric Properties of Suicide Behaviors Questionnaire-Revised (SBQ-R) in Iran. Asian Journal of Psychiatry, 47, 101856. https://doi.org/10.1016/j.ajp.2019.101856
Bazrafshan, M. R., Jahangir, F., Mansouri, A., & Kashfi, S. H. (2014). Coping Strategies in People Attempting Suicide. International Journal of High Risk Behaviors & Addiction, 3(1), e16265. https://doi.org/10.5812/ijhrba.16265
Colmenero-Navarrete, L., García-Sancho, E., & Salguero, J. M. (2022). Relationship between Emotion Regulation and Suicide Ideation and Attempt in Adults and Adolescents: A Systematic Review. Archives of Suicide Research, 26(4), 1702-1735. https://doi.org/10.1080/13811118.2021.1999872
Fletcher, K., Parker, G., & Manicavasagar, V. (2014). The Role of Psychological Factors in Bipolar Disorder: Prospective Relationships between Cognitive Style, Coping Style and Symptom Expression. Acta Neuropsychiatrica, 26(2), 81-95. https://doi.org/10.1017/neu.2013.41
Foroughi, A. A., Parvizifard, A., Sadeghi, K., & Parsa Moghadam, A. (2021). Psychometric Properties of the Persian Version of the Emotion Regulation Questionnaire. Trends in Psychiatry and Psychotherapy, 43(2), 101-107. https://doi.org/10.47626/2237-6089-2020-0106
He, Y., Liu, X., Yang, T., Xu, X., Liu, W., Sun, K., & Wu, S. (2025). The Relationships among the Meaning of Life, Coping Styles, and Suicidal Ideation: A Network Analysis. BMC public health, 25(1), 2587. https://doi.org/10.1186/s12889-025-23877-9
Horwitz, A. G., Czyz, E. K., Berona, J., & King, C. A. (2018). Prospective Associations of Coping Styles with Depression and Suicide Risk among Psychiatric Emergency Patients. Behavior therapy, 49(2), 225-236. https://doi.org/10.1016/j.beth.2017.07.010
Lew, B., Huen, J., Yu, P., Yuan, L., Wang, D. F., Ping, F., Abu Talib, M., Lester, D., & Jia, C. X. (2019). Associations between Depression, Anxiety, Stress, Hopelessness, Subjective Well-Being, Coping Styles and Suicide in Chinese University Students. PLoS One, 14(7), e0217372. https://doi.org/10.1371/journal.pone.0217372
Liu, R. T., & Miller, I. (2014). Life Events and Suicidal Ideation and Behavior: A Systematic Review. Clinical psychology review, 34(3), 181-192. https://doi.org/10.1016/j.cpr.2014.01.006
Malhi, G. S., Bargh, D. M., Kuiper, S., Coulston, C. M., & Das, P. (2013). Modeling Bipolar Disorder Suicidality. Bipolar Disorders, 15(5), 559-574. https://doi.org/10.1111/bdi.12093
Mazaheri, M., Pirmoradi, M., Gharraee, B., Farahani, H., & Malakouti, K. (2026). Examining the Effectiveness of Group-Based Interpersonal and Social Rhythm Therapy (IPSRT) as an Adjunctive Treatment for Patients with Bipolar Disorder: A Quasi-Experimental Study. Journal of education and health promotion, 15, 97. https://doi.org/10.4103/jehp.jehp_1330_24
Miller, J. N., & Black, D. W. (2020). Bipolar Disorder and Suicide: A Review. Current psychiatry reports, 22(2), 6. https://doi.org/10.1007/s11920-020-1130-0
Neacsiu, A. D., Fang, C. M., Rodriguez, M., & Rosenthal, M. Z. (2018). Suicidal Behavior and Problems with Emotion Regulation. Suicide and Life-Threatening Behavior, 48(1), 52-74. https://doi.org/10.1111/sltb.12335
Poyraz, C. A., Özdemir, A., Şen, C. Ç., Sağlam, N. G. U., Enginkaya, S., & Tomruk, N. (2021). The Impact of Coping Strategies on Suicide Attempts and Suicidal Ideation in Bipolar Disorder. The Journal of Nervous and Mental Disease, 209(8), 564-570. https://doi.org/10.1097/NMD.0000000000001347
Sher, L., & Oquendo, M. A. (2023). Suicide: An Overview for Clinicians. Medical Clinics, 107(1), 119-130. https://doi.org/10.1016/j.mcna.2022.03.008
Stewart, M. (2022). The Interpersonal Theory of Suicide: Military Populations.

