Expressed Emotion in Adolescent Suicidal Ideation: The Mediating Role of Thwarted Belongingness and Perceived Burdensomeness.

Introduction
Suicidal ideation (SI) is a major public health concern among adolescents. Although parental criticism within the Expressed Emotion (EE) framework has been linked to SI, the impact of a balance between positive and negative interaction remains understudied. This study introduces the Positivity-Negativity Difference of EE (PND-EE), investigates its relationship with SI, and examines whether dimensions of the Interpersonal Theory of Suicide (IPTS) mediate this relationship.Methods
The study included a combined clinical and population-based sample of 46 adolescents (Mage = 15.37, SDage = 1.37) and their mothers. Participants completed questionnaires assessing SI and the IPTS dimensions Thwarted Belongingness (TB) and Perceived Burdensomeness (PB). Mothers completed the Preschool Five Minute Speech Sample, which has proven suitable for assessing EE in adolescence. Simple and parallel mediation analyses were conducted using Hayes' PROCESS macro.Results
Higher PND-EE was directly associated with lower SI in all analyses. Both TB and PB significantly mediated the effect of PND-EE on SI in simple mediation analyses, but only PB remained statistically significant in the parallel mediation analysis.Conclusions
Our findings highlight the potential of PND-EE as a promising measure of EE in adolescents. Enhancing positive parent-adolescent interactions and addressing TB and PB in clinical interventions may help reduce adolescent SI.