{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T18:26:37Z","timestamp":1791915997949,"version":"4.3.4"},"reference-count":0,"publisher":"Juan Jos\u00e9 L\u00f3pez-Ibor Foundation","issue":"6","license":[{"start":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T00:00:00Z","timestamp":1765929600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Actas Esp Psiquiatr"],"abstract":"<jats:p>Background: Bipolar disorder is associated with a high prevalence of suicidal ideation, and comorbid anxiety may further increase suicide risk. The psychological mechanisms linking anxiety to suicidal ideation, especially the roles of social support and self-esteem, remain unclear. This study constructed a chain mediation model to examine how anxiety, social support and self-esteem relate to suicidal ideation in patients with bipolar disorder.\nMethods: From March 2022 to May 2023, 450 inpatients with bipolar disorder were recruited from six hospitals in Anhui Province. Standardised scales assessed anxiety, social support, self-esteem and suicidal ideation. Pearson correlation examined associations between variables, binary logistic regression identified factors associated with suicidal ideation, and Hayes' PROCESS macro tested the chain mediation model.\nResults: Logistic regression showed that higher anxiety increased the odds of suicidal ideation, whereas higher social support and self-esteem reduced the odds. Suicidal ideation was positively correlated with anxiety and negatively correlated with social support and self-esteem, and mediation analysis demonstrated a significant direct effect of anxiety and significant independent and chain mediating effects of social support and self-esteem (all p &lt; 0.001).\nConclusions: Anxiety is related to suicidal ideation in patients with bipolar disorder both directly and indirectly through reduced social support and self-esteem. The indirect pathway via self-esteem showed the largest effect, underscoring the need to enhance social support and self-esteem in suicide prevention for this population.<\/jats:p>","DOI":"10.62641\/aep.v53i6.2035","type":"journal-article","created":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T06:29:04Z","timestamp":1766039344000},"page":"1354-1365","source":"Crossref","is-referenced-by-count":1,"title":["The Relationship Between Anxiety and Suicidal Ideation in Patients With Bipolar Disorder: Chain Mediation Effects of Social Support and Self-Esteem"],"prefix":"10.62641","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-8036-6877","authenticated-orcid":false,"given":"Yan","family":"Lu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6413-1370","authenticated-orcid":false,"given":"Chenxia","family":"Song","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8612-2054","authenticated-orcid":false,"given":"Juan","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-4103-1782","authenticated-orcid":false,"given":"Long","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-4388-8036","authenticated-orcid":false,"given":"Yang","family":"Du","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinqiong","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"48925","published-online":{"date-parts":[[2025,12,17]]},"container-title":["Actas Espa\u00f1olas de Psiquiatr\u00eda"],"original-title":[],"link":[{"URL":"https:\/\/actaspsiquiatria.es\/index.php\/actas\/article\/download\/2035\/2788","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/actaspsiquiatria.es\/index.php\/actas\/article\/download\/2035\/2788","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T06:29:05Z","timestamp":1766039345000},"score":1,"resource":{"primary":{"URL":"https:\/\/actaspsiquiatria.es\/index.php\/actas\/article\/view\/2035"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,17]]},"references-count":0,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,12,17]]}},"URL":"https:\/\/doi.org\/10.62641\/aep.v53i6.2035","relation":{},"ISSN":["1578-2735","1139-9287"],"issn-type":[{"value":"1578-2735","type":"electronic"},{"value":"1139-9287","type":"print"}],"subject":[],"published":{"date-parts":[[2025,12,17]]}}}