The mediating roles of depression, anxiety, and psychological pain in the relationship between chronotype and suicide in patients with depressive disorder

The evening chronotype has been associated with depressive symptoms and suicidality; however, the underlying mechanisms are still under investigation. Research has shown that psychological pain, or feelings of suffering, is closely related to suicidality. Therefore, the aim of the study is to determine whether psychological pain, anxiety, and depressive symptoms mediate the association between chronotype and depressive symptoms in patients with depression and in healthy controls. A total of 118 patients with depressive disorder and 85 healthy controls completed the Morningness-Eveningness Questionnaire, the Hospital Anxiety and Depression Scale, the Suicide Probability Scale, and the Mee-Bunney Psychological Pain Assessment Scale. Mediation analysis revealed that the relationship between eveningness and suicidality was fully mediated by depression and psychological pain and not by anxiety. These findings highlight that psychological pain is an important psychological dimension in the relationship between eveningness and suicidality.