Stress Tolerance Influences Suicide Risk and Can Be Modified

Sherrie R. Webb, PA-C, for Medscape

January 12, 2023

The study covered in this summary was published on ResearchSquare as a preprint and has not yet been peer reviewed.

Key Takeaways

  • In people with depression, the relationship between stressful life events and suicide risk is completely mediated by distress tolerance, defined as an individual's actual or perceived ability to experience, accept, and persist in the context of negative psychological states, according to researchers.

  • The study highlights the importance of distress tolerance in mitigating suicide risk.

  • Clinicians should assess levels of distress tolerance in patients with depression.

  • Improving distress tolerance may bolster suicide prevention efforts.

Why This Matters

  • Major depressive disorder is the leading cause of disability in the world and an important risk factor for suicide. The rate of mortality by suicide for patients with depression is 15%.

  • Prior studies have demonstrated a strong link between stressful life events and suicide risk in people with depression. However, knowledge is limited regarding the underlying mechanisms of this relationship.

  • This study clearly establishes distress tolerance as the mediating factor between stressful life events and suicide risk.

Study Design

  • This cross-sectional study evaluated 125 patients with major depressive disorder recruited between December 2021 and September 2022 from Guangdong Mental Health Center in Guangzhou, China.

  • An investigator collected sociodemographic and clinical information from each patient. Patients were assessed for severity of depression, suicide risk, life events, and distress tolerance using the 17-item Hamilton Depression Rating scale, the Chinese version of the Mini International Neuropsychiatric Interview, the Life Events Scale, and Distress Tolerance Scale.

Key Results

  • Patients were categorized as either at risk or not at risk for suicide. The proportion of patients categorized as at risk for suicide was 75.2%.

  • An initial statistical analysis revealed that stressful life events, greater severity of depression, and lower levels of distress tolerance were all significantly associated with suicide risk. No association was found between sociodemographic or clinical information and suicide risk.

  • A subsequent analysis revealed that depressive symptoms and stressful life events were independent predictors of suicide risk in these patients. Distress tolerance was an independent protective factor for suicide risk.

  • The correlation with suicide risk was strongest for severity of depression (r = 0.522, P < .01), but was also positive for stressful life events (r = 0.182, P < .05). Suicide risk was negatively correlated with distress tolerance (r = -0.406, P < .01).

  • A mathematical model demonstrated that the link between stressful life events and suicide risk was not direct. Rather, stressful life events affected suicide risk indirectly through distress tolerance. Distress tolerance was an intermediary factor regulating the impact of stressful life events on suicide risk. Distress tolerance accounted for 60% of the total effect of stressful life events on suicide risk.


  • The study may be limited by patient recall bias.

  • Because the study was conducted in patients with depression, results cannot be generalized to the healthy population.

  • The study sample was relatively small and drawn from a single center in China.

  • The study did not assess other factors which may affect the risk for suicide, such as level of social support or personality characteristics.


  • The Guangdong Science and Technology Project (project NO: 2017A020215095) provided funding for the study.

  • Authors declare no conflicts of interest.

This is a summary of a preprint research study, "The mediating effect of distress tolerance on the relationship between stressful life events and suicide risk in patients with major depressive disorder," written by Jing Zhong from Southern Medical University in Guangzhou, Guangdong Province, China, and colleagues on, provided to you by Medscape. This study has not yet been peer reviewed. The full text of the study can be found on

For more news, follow Medscape on Facebook, Twitter, Instagram, YouTube, and LinkedIn


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.