A cross-sectional study on the role of self-esteem and body image dissatisfaction as mediators in the relationship between perfectionism and suicidality

Background: Suicidality is a major public health concern, particularly among individuals with Major depressive disorder (MDD). While perfectionism, self-esteem, and body image dissatisfaction have each been linked to suicidality, their combined effects remain underexplored. Aim: The study assessed whether self-esteem and body image dissatisfaction mediate the link between perfectionism and suicidality in depressed young adults. Materials and Methods: A cross-sectional study was conducted among 80 young adults (aged 18–35) diagnosed with MDD at a tertiary care center in India. Participants were assessed using validated scales. Correlational analyses, multiple regression, and serial mediation were employed to evaluate direct and indirect relationships. Results: Perfectionism correlated positively with body image concern (r = 0.68) and suicidality (r = 0.69) and negatively with self-esteem (r = –0.69). Self-esteem was negatively associated with body image concern (r = –0.72) and suicidality (r = –0.51). Body image concern positively correlated with suicidality (r = 0.59). Perfectionism (B = 0.5523, P = 0.001) and body image concern (B = 0.2633, P = 0.041) significantly predicted suicidality. Mediation analysis showed a significant total (c = 0.0649) and direct (c’ =0.0333) effect of perfectionism on suicidality. The hypothesized mediation pathway was not significant, but the reverse pathway (perfectionism → self-esteem → body image → suicidality) was statistically significant (effect size = 0.0101). Conclusion: Perfectionism was associated with increased suicidality, with body image dissatisfaction acting as a key mediating factor. While self-esteem did not directly mediate this link, it may influence suicidality indirectly through its impact on body image.