The role of perfectionism and stress in the suicidal behaviour of depressed adolescents

The present study aimed to investigate the role of self-oriented and socially prescribed perfectionism in conjunction with stressful life experiences in suicidal ideation, potential, and prior attempts among depressed adolescents. Self-oriented perfectionism involves striving to meet one's own unrealistically high standards and evaluating one's performance stringently. Socially prescribed perfectionism involves the perception that significant others have very high expectations for oneself, which the perfectionist strives to meet. This study examined correlations between these perfectionism dimensions and suicidal ideation, potential or risk, and prior attempts in addition to investigating whether either perfectionism dimension accounted for additional variance in suicide outcomes beyond the established risk factors depression and hopelessness. Also examined was a moderational model whereby dimensions of perfectionism were hypothesized to interact with stress to predict suicide outcomes. A sample of 55 adolescents (41 females, 14 males) who met the Diagnostic and Statistical Manual of Mental Disorders---Fourth Edition (DSM-IV; APA, 1994) criteria for Major Depression (65.5%), Dysthymia (16.4%), or Depressive Disorder NOS (18.2%) completed self-report measures of perfectionism, daily hassles, depression, hopelessness, suicidal ideation, suicide potential, and prior suicidal attempts. Additionally, adolescents and one of their parents completed a diagnostic interview and a stress interview measuring major stressful experiences. Results revealed that self-oriented perfectionism was not correlated with any aspect of suicide; however, socially prescribed perfectionism was associated with suicide potential. Hierarchical regression analyses indicated that self-oriented perfectionism did not account for unique variance in suicide outcomes, whereas, socially prescribed perfectionism predicted additional variance in suicide potential once depression and hopelessness were controlled. Regarding the moderational model, both self-oriented and socially prescribed perfectionism were found to interact with aspects of stress to predict suicidality. More specifically, self-oriented perfectionism interacted with daily hassles to predict suicide potential/risk. Socially prescribed perfectionism interacted with subjective and objective ratings of major stressful experiences and with daily hassles to predict suicide potential/risk. Neither perfectionism dimension interacted with stress to predict suicidal ideation or prior suicide attempts. Taken together, these findings suggest that among depressed adolescents, socially prescribed perfectionism is correlated with suicide risk and predicts unique variance in this suicide outcome beyond other established risk factors. Additionally, both self-oriented and socially prescribed perfectionism act as vulnerability factors that are predictive of suicide potential when adolescents experience elevated levels of stress. As these relationships were apparent even after controlling for the contributions of depression and hopelessness to suicide, the results of this study highlight the importance of considering perfectionistic tendencies when evaluating suicide risk among youth.