Is Anhedonia a Mediating Factor between Depression and Suicidal and Self-Injury Ideation?
Amber T. Pham, Jennifer C. Veilleux, Melissa J. Zielinski, Michael R. Nadorff, & E. Samuel Winer
Department of Psychological Science, The University of Arkansas
Introduction
• Anhedonia is defined as the loss of interest and pleasure in
activities that were once experienced as enjoyable. Changes
in anhedonia refer to the amount of pleasure lost or gained
over time.1
• High levels of anhedonia are often associated with additional
depressive symptoms, and depressed mood and/or anhedonia
is required for a clinical diagnosis of Major Depressive
Disorder.2
• Suicide attempts, ideation, and self-injury are behaviors often
associated with depressive symptoms.2
• Research suggests that different components of depression
may differentially influence outcomes.3 Consistent with past
research3 , we believed that anhedonia might account for the
relation between depressive symptoms and suicide and selfinjury outcomes.
• Therefore, we hypothesized that anhedonia may be a
mediator in the relationship between depression and
behaviors often associated with depression. Specifically, we
investigated self-injury ideation and behaviors and suicide
behaviors as outcome variables.
Method
Recruitment Strategy and Procedure
• Recruited through Amazon’s Mechanical Turk
• Pre-screened to select participants who endorsed either a
previous suicide attempt or a previous instance of
nonsuicidal self-injury (i.e., cutting, carving, burning, or
punching oneself without the intent to die).
• Restricted to workers in the United States.
• 1128 participants completed pre-screening surveys
• 369 were determined to be eligible for this study and were
invited to participate.
•
219 participants (66.2% women) completed the second round
of data collection and are included in the present analyses:
• Mage = 32.33, SDage = 9.57, (Range = 18-64)
• 79% White, 5.9% African American, 5.9% Hispanic, 4.1%
Asian American, 5% Others.
• 31.1% Employed, 41.6% Employed full time, 27.4%
Employed part time.
Measures
• Depression Anxiety Stress Scale (DASS)4
• Specific Loss of Interest and Pleasure Scale (SLIPS)1
• Suicide Behaviors Questionnaire-Revised (SBQ-R)5
• Ottawa Self-Injury Inventory-Clinical (OSI)6
Analytic Strategy
• We ran four mediational analyses using PROCESS.7
• Depressive symptoms were the focal predictor, changes in
anhedonia as the mediator, with self-injury and suicide
variables as outcomes.
• Confidence intervals not including zero are considered
statistically significant.
Results
Discussion
Figure 2. Mediated Model with Self-Injury Ideation
as Outcome
Figure 1. Mediated Model with Suicide Ideation as
Outcome
Anhedonia
Anhedonia
.59 (.05)**
Depressive
Symptoms
.59 (.05)**
.08 (.02)**
Suicide
Ideation
.11 (.02)**
Depressive
Symptoms
R2 = .31, F(2, 216) = 49.22, p < .001
• Interestingly, anhedonia did mediate the relation between
depression and the belief that self-injury is helpful, and
partially mediated the relation between depression and
suicidal ideation.
.03 (.02)
Self-Injury
Ideation
.07(.02)**
X2 (1, N = 218) = 49.00, Nagelkerke R2 = .30
Table 1. Direct and Indirect Effects for Model 1
Table 2. Direct and Indirect Effects for Model 2
Effect
SE
LLCI
ULCI
Direct Effect
.11
.02
.06
.15
Indirect Effect
.05
.01
.02
.08
Figure 3. Mediated Model with Self-Injury Behavior
as Outcome
Effect
SE
LLCI
ULCI
Direct Effect
.07
.02
.04
.11
Indirect Effect
.02
.01
-.002
.04
Figure 4. Mediated Model with Self-Injury Helpfulness
as Outcome
Anhedonia
Anhedonia
.02
.59 (.05)**
Depressive
Symptoms
• The analyses revealed that the effect of depression on selfinjury ideation and self-injury behavior was not mediated by
changes in anhedonia.
(.02)
Self-Injury
Behavior
.05 (.02)
.03 (.01)*
.57 (.06)**
Depressive
Symptoms
X2 (1, N = 218) = 11.27, Nagelkerke R2 = .28
Self-Injury
Helpfulness
.01 (.01)
R2 = .12, F(2, 194) = 12.93, p < .000
Table 3. Direct and Indirect Effects for Model 3
SE
LLCI
ULCI
Direct Effect
.05
.02
-.002
.09
Indirect Effect
.01
.01
-.02
.04
Effect
SE
LLCI
ULCI
Direct Effect
.01
.01
-.01
.02
Indirect Effect
.02
.01
.01
.03
Table 5. Pearson Correlations for Study Variables
Depressive
Symptoms
Anhedonia
Self-Injury
Ideation
Self-Injury
Behaviors
Depressive
Symptoms
--
Anhedonia
.65**
--
Self-Injury Ideation
.45**
.38**
--
Self-Injury Behaviors
.22**
.19**
.35**
--
Suicide Ideation
.52**
.48**
.54**
.25**
Note: * Significant at the 0.05 level, ** Significant at the 0.01 level
• Individuals who engage in nonsuicidal self-injury may do so for
a “feeling.” Changes in anhedonia may cause individuals to
lose feelings of positive emotions, so instead they prefer to
feel anything, even pain, to simply feel something.8
• These results indicate a possible direction for treatment in
individuals who engage in self-injury behavior. Future
treatments could examine changes in anhedonia and way of
thinking to prevent individuals from thinking self-harm is
helpful. Through the use of treatment, individuals can find
other ways to release pain and emotions and still decrease the
amount of self-injury. Future studies could also examine
anhedonia mediating depressive symptoms and suicide risk
with at-risk samples (e.g., adolescents, inpatients at hospital
release) to replicate and extend results found here.
References
Table 4. Direct and Indirect Effects for Model 4
Effect
• Previous research has indicated that anhedonia accounted for
significant variance in suicidal ideation even after accounting
for other depressive symptoms in clinical samples.3 mTurk was
not a clinical sample, therefore the sample could be the factor
that makes anhedonia not a full mediator for suicide risk.
Changes in anhedonia may anger or upset individuals, leading
them to have a need to release pain and anger, thus making
them think self-injury is helpful.8
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