Self-stigma and suicide cognitions in substance use disorder: the mediating role of psychological distress and the moderating role of social support.

BACKGROUND: Individuals with substance use disorders (SUD) experience substantial psychological and social difficulties. A prominent concern is the internalization of stigmatizing societal attitudes, leading to feelings of guilt and worthlessness. This self-stigma has been linked to depression, anxiety, and stress and may contribute to suicide-related cognitions. This study aimed to examine the relationship between self-stigma and suicide cognitions, and to evaluate the potential mediating roles of psychological distress (depression, anxiety, and stress), as well as the moderating role of perceived social support. METHODS: In this cross-sectional study, 270 adults receiving treatment for SUD at a specialized addiction center were recruited, and analyses were conducted on 265 participants with complete data. Participants completed the Substance Abuse Self-Stigma Scale, Suicide Cognitions Scale-Revised, Depression Anxiety Stress Scale-21, and Multidimensional Scale of Perceived Social Support. Pearson correlations were followed by parallel multiple mediation and moderation analyses using 5000 bootstrap resamples. RESULTS: Self-stigma was positively associated with depression, anxiety, stress, and suicide cognitions, and negatively associated with perceived social support. In the mediation model, only depression significantly mediated the relationship between self-stigma and suicide cognitions, whereas anxiety and stress did not emerge as significant mediators when entered simultaneously. Moderation analyses indicated that perceived support from family, friends, and a significant other each attenuated the association between self-stigma and suicide cognitions, indicating a buffering effect. CONCLUSION: These findings underscore the clinical importance of routinely assessing self-stigma and depression in SUD populations due to their predisposition to suicidal cognitions. Interventions aimed at reducing self-stigma, enhancing self-worth, and increasing perceived social support should be considered integral components of suicide prevention strategies in this high-risk group.