Independent contribution of emotion dysregulation to suicide attempts in adolescents beyond the role of depressive symptoms.

Emotion dysregulation (ED) is increasingly recognized as a transdiagnostic factor in adolescent psychopathology and suicidal ideation and behavior. This study examined the association between ED and recent suicide attempts (SAs) in a clinically referred adolescent sample (n = 182; mean age = 15.70 ± 1.44 years; 80.8% female). We compared adolescents with recent SAs (n = 41) to psychiatric controls (n = 141) on diagnostic and dimensional variables, including the RIPoSt-Y, a novel measure of ED. Adolescents with SAs had higher rates of major depressive episodes (MDEs), depressive symptoms, and significantly elevated RIPoSt-Y interpersonal sensitivity and affective instability. Sequential logistic regressions revealed that both MDE diagnosis and interpersonal sensitivity independently predicted recent SAs, with the latter showing incremental predictive value beyond depressive symptoms. Mediation analysis using structural equation modeling indicated that interpersonal sensitivity had both a significant direct effect and a smaller indirect effect mediated by MDE and depressive symptoms. The total model explained 32.7% of the variance. Findings support the role of interpersonal sensitivity as a dispositional vulnerability of adolescent suicidal behavior, partially mediated by depression. This is the first study to demonstrate the predictive value of RIPoSt-Y dimensions for SAs in youth, underscoring the clinical importance of ED assessment in suicide risk evaluation.