In addiction treatment, shame predicted suicidal thinking. Depression was the link.

Among 265 people in treatment for substance use disorder in Turkiye, self-stigma predicted suicide-related thinking, and of depression, anxiety and stress, only depression carried the effect. Perceived social support weakened the link at every level tested.

Self-stigma is what happens when a person absorbs society's judgement about their condition and turns it inward, and in addiction it is unusually potent because the public narrative treats the condition as a moral failing. Researchers led by Zehra Ucar Hasanli asked whether that internalised shame connects to suicidal thinking, and if so, through what. They recruited 270 consecutive patients in treatment at an addiction centre affiliated with Ankara Training and Research Hospital, analysing 265, and had them complete measures of substance-use self-stigma, depression, anxiety and stress, perceived social support, and suicide-related cognitions. Self-stigma predicted all three forms of distress. But when depression, anxiety and stress were tested together as competing explanations, only depression predicted suicide cognitions (b = 0.78, p = .012); anxiety and stress both fell away entirely. The indirect path from self-stigma through depression was statistically significant, and the direct path survived too, meaning depression carries part of the effect but not all of it. Social support mattered at every level tested: for people reporting strong support from a partner or significant other, the slope linking self-stigma to suicide cognitions was roughly a third of what it was for those reporting weak support. The design caps what can be claimed. This is a single snapshot in time, so calling depression a "mediator" describes a statistical pattern, not a demonstrated sequence -- shame could follow low mood as easily as cause it. Every measure was self-report, raising the risk that one person's response style colours all of their answers. Depression, anxiety and stress were highly intercorrelated, which the authors flag as a reason the anxiety and stress paths may have been washed out rather than genuinely absent. And the sample was 92% men, drawn from one clinic and excluding alcohol use disorder deliberately, so it describes men in treatment for illicit substance use in one Turkish city.