The evidence is best understood as a map of candidate psychological processes, not a proven causal model. Fifty-eight of the 68 studies were cross-sectional, and only 10 used longitudinal, prospective or ecological momentary assessment designs. Most participants completed self-report inventories, samples were generally recruited through convenience methods, and psychiatric confounders such as depression were not consistently controlled. The investigators therefore used noncausal language throughout: a correlation, regression coefficient or mediation model can show that variables travel together, but it cannot by itself establish that one process precedes or produces another. The review followed PRISMA 2020 guidelines, used design-specific Joanna Briggs Institute checklists for methodological appraisal and selected narrative synthesis rather than meta-analysis because of substantial differences in populations, measures and statistical estimates.

Hopelessness was the most frequently studied cognitive-affective process in the ideation-specific evidence. It appeared as a direct correlate, an indirect statistical pathway and, in one intensive study, a process that fluctuated alongside momentary suicidal desire. Hopelessness also frequently occupied the middle of multivariable models linking bullying, adverse life events, social anxiety, depression and perfectionistic concerns to suicidal thoughts. Its apparent effect was not always independent. In one model, a correlation of .54 between hopelessness and a continuous ideation score became nonsignificant after depressive symptoms, perceived burdensomeness and their interaction were included. The pattern is consistent with theories in which hopelessness contributes to suicidal desire, but it also shows why a variable can be highly correlated with ideation without being separable from a broader distress pattern.

Repetitive negative thinking and rumination were also prominent, often appearing in statistical chains involving depressive symptoms, perfectionism, loneliness, childhood adversity, entrapment and psychological strain. Their relevance was less consistent after adjustment for concurrent depression: a prospective model found that the independent contribution of rumination was substantially attenuated, while an ecological momentary study likewise found that its association with passive death wishes weakened once depressive symptoms were considered. This does not make repetitive thinking irrelevant, but it raises a question about what exactly is being measured. A student may repeatedly focus on distress for many reasons, and the specific content of that thinking, feelings of entrapment and the presence of depression may determine how closely it covaries with suicidal thoughts. The reviewed evidence therefore supports rumination as a plausible correlate and intermediary, not as an invariant independent predictor.

Perfectionism produced a more differentiated pattern. Socially prescribed perfectionism, which involves standards perceived as imposed by others, and broader maladaptive perfectionistic concerns were repeatedly linked with greater ideation, whereas self-oriented perfectionism showed mixed or nonsignificant relationships. Statistical pathways frequently included self-criticism, loneliness, rejection sensitivity, anti-mattering or depression. A three-wave study found that socially prescribed perfectionism prospectively predicted ideation through anti-mattering and difficulty accepting the past. Another two-wave analysis placed perfectionism before rumination and depression, although the intermediate cognitive variables and ideation were measured concurrently at follow-up. These results support a distinction between externally imposed, socially evaluated perfectionism and the pursuit of high personal standards; they do not establish that any form of ambitious goal-setting is hazardous.

Emotional distress was pervasive in the review, with depressive symptoms appearing as the most common concurrent correlate. Depressive severity was associated with ideation in undergraduate and postgraduate samples, and statistical models often placed it between more distal factors and suicidal thoughts. Yet this evidence requires unusual care because some depression scales contain suicide or self-harm items, creating shared measurement content rather than a fully independent psychological relationship. Negative affect and emotional vulnerability were also associated with ideation in several studies, and one intensive repeated-measures investigation found that momentary negative affect, emotion-regulation difficulties and suicidal ideation covaried over time. General anxiety and stress were less consistent: their independent associations often weakened when hopelessness, depressive symptoms or other cognitive variables were included. The emerging picture is not that one emotion creates suicidal thoughts, but that negative affect may become closely entangled with hopelessness, inflexible appraisal and avoidance.

Behavioral and interpersonal factors generally appeared as parts of larger pathways rather than isolated causes. Impulsivity was directly associated with some outcomes, but more often served as a mediator or moderator involving depression, substance-use problems, trauma or obsessive-compulsive symptoms. Experiential avoidance—attempts to escape unwanted thoughts and emotions—was associated with ideation and also appeared in paths connecting family dysfunction, childhood adversity and depression to suicide-related outcomes. Perceived burdensomeness, the belief that one is a burden to others, showed a relatively consistent positive association with ideation. Thwarted belongingness was more conditional: in one prospective model using the PHQ-9 death/self-harm item, its direct path was nonsignificant, while it operated through hopelessness and interacted with perceived burdensomeness. Because that outcome did not distinguish death thoughts, self-harm thoughts or intent, the result remains complementary evidence rather than a confirmed ideation-specific causal pathway.

Academic and social environments appeared in combination with psychological processes. Test anxiety, digital stress, academic burnout and demanding educational expectations were associated with ideation through factors such as psychological pain, perfectionism, emotion-regulation difficulty and reduced meaning. Bullying and childhood adversity were linked to ideation in several samples, sometimes with dose-response patterns or indirect associations involving rumination and psychiatric prodromal experiences. Family conflict, low cohesion and poor communication also covaried with ideation or composite suicide-risk outcomes. The geographical reach of the literature was broad, with 24 studies from China, 10 from the United States and five from Spain, alongside studies from numerous other countries. Differences among countries cannot demonstrate cultural moderation, however, because recruitment, instruments, sample composition and statistical adjustment also varied.

Resources appeared in the studies as inverse or conditional associations rather than guaranteed safeguards. Meaning in life, purpose and reasons for living were generally linked to less ideation and, in some models, to lower composite risk trajectories. Resilience, coping competence, gratitude, self-acceptance, self-esteem, positive affect and perceived social support also showed inverse associations with ideation or attenuation of pathways involving adversity, entrapment and depressive symptoms. Self-compassion and mindfulness produced mixed results: compassion was inversely associated with suicidal thoughts in one continuous-scale study, mindfulness weakened the association between entrapment and ideation in another, and a proposed buffering effect of self-compassion was not formally demonstrated. Global mindfulness was not uniformly protective, because its moderating association with hopelessness in one analysis was attributable specifically to its compassion facet. These are promising correlates, but the review found no evidence that changing them reduces suicidal ideation.

The central limitation is measurement. Thirty-four studies contributed only to the primary ideation synthesis, 29 only to complementary outcomes and five to both. The primary synthesis included dedicated multi-item scales, structured interview modules, explicit ideation items and ecological momentary ratings. The complementary group included 12 broad death or self-harm indicators, 17 multidimensional composite risk measures and five analyses of proximal suicide cognitions, suicidal rumination or mixed positive-negative inventories, with additional behavioral-history comparisons. Composite instruments often combine thoughts with attempts or other behavior, and some total scores contain the same hopelessness or coping elements being tested as predictors, creating partial circularity. That difference matters: the apparent agreement across studies cannot be counted as clean replication when some measure suicidal thoughts and others measure a broader mixture of ideation and behavior.

For university mental-health services, the review suggests that assessment could look beyond diagnostic labels to examine hopelessness, repetitive thinking, perfectionistic concerns, perceived burdensomeness, loneliness and available coping resources. It does not validate a screening algorithm, establish which combination best identifies students at risk or justify relying on network centrality or composite scores as if they represented pure ideation. The authors also call for prospective, preregistered and intensive repeated-measures studies that separate passive death wishes, active suicidal ideation and behavioral outcomes, adjust for baseline risk and psychiatric confounders, and test whether changing a candidate process affects later thoughts. Until such evidence exists, the most defensible conclusion is that these mechanisms identify recurring patterns in the lives of suicidal students—and plausible targets for future experiments—not a demonstrated pathway from distress to suicide or from thoughts to action.

Subject of Research: Transdiagnostic psychological correlates of suicidal ideation among university students

Article Title: Beyond diagnostic categories: transdiagnostic psychological mechanisms associated with suicidal ideation among university students: a systematic review (2021–2025)

Article References: Onofre Ancco, D. N., Talavera-Mendoza, F. M., & Rojas Zegarra, M. E. (2026). Beyond diagnostic categories: transdiagnostic psychological mechanisms associated with suicidal ideation among university students: a systematic review (2021–2025). Frontiers in Psychiatry, 17, Article 1972940. https://doi.org/10.3389/fpsyt.2026.1972940

Image Credits: AI Generated

DOI: 10.3389/fpsyt.2026.1972940

Keywords: suicidal ideation, university students, systematic review, hopelessness, rumination, perfectionism, emotion regulation, perceived burdensomeness, social support, mental health, Beyond, diagnostic