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.