Exploring the mediating roles of emotion regulation difficulties and mental pain tolerance in the association between physical pain sensitivity and suicidal ideation among undergraduate students.

backgroundAlthough mental pain is widely regarded as a central catalyst for suicidal behavior, the relationship between physical pain sensitivity and suicidal ideation remains poorly characterized. This study examines whether mental pain tolerance and difficulties in emotion regulation serve as independent or sequential mediators in the association between physical pain sensitivity and suicidal ideation, accounting for potential suppression effects.

methodsA cross-sectional survey was administered to 457 university students, yielding 388 valid responses for analysis. Standardized, validated self-report measures assessed physical pain sensitivity, mental pain tolerance, difficulties in emotion regulation, depressive symptoms, and suicidal ideation. Structural equation modeling (SEM) was used to test a parallel mediation model in which mental pain tolerance and difficulties in emotion regulation were entered as simultaneous mediators. Two alternative sequences-a serial model and a reversed serial model-were also examined.

resultsParticipants exhibiting suicidal ideation demonstrated significantly heightened physical pain sensitivity, diminished mental pain tolerance, heightened emotion regulation difficulties, and more severe depressive symptomatology compared to non-suicidal ideation. Parallel mediation analysis revealed that difficulties in emotion regulation independently mediated the association between physical pain sensitivity and suicidal ideation (standardized indirect effect = 0.066, 95% CI [0.036, 0.133], p = 0.002), whereas the indirect effect via mental pain tolerance was not significant (β = 0.015, p = 0.179). The hypothesized serial mediation pathway (physical pain sensitivity → mental pain tolerance → difficulties of emotion regulation → suicidal ideation) was not supported (β = 0.008, p = 0.150).

conclusionsDifficulties in emotion regulation, rather than mental pain tolerance, were found to mediate the association between physical pain sensitivity and suicidal ideation, although the indirect effect was modest in magnitude. The observed mediating effects underscore the complex, multi directional nature of pain-related influences on suicidality. These findings suggest that integrating perceptual and emotional dimensions may be of value within suicide risk assessment and intervention frameworks, with potential implications for targeting emotion regulation skills. CLINICAL TRIAL NUMBER: Not applicable.