| Summary: | Background: Individuals with Alcohol Use Disorder (AUD) exhibit a significantly heightened risk of suicide, yet the contributing explanatory mechanisms remain insufficiently understood. This study aimed to examine a structural model linking perceived social support, emotion regulation, depressive symptoms, psychache, and suicide risk, and to assess whether clinical status (AUD vs. healthy controls, HC) moderated these links. Methods: A cross-sectional sample of 257 participants (AUD: n = 133; HC: n = 124) completed validated self-report measures. Structural Equation Modelling (SEM) was applied and multi-group analysis was used to examine model invariance between groups in terms of regression slopes, and moderated mediation tests whether indirect mechanisms were moderated by clinical status. Results: Two indirect pathways significantly differed between groups. In the AUD group, perceived support from friends reduced psychache via decreased expressive suppression, and expressive suppression increased suicide risk via heightened psychache. These indirect effects were significantly stronger in AUD compared to HC. Invariance testing confirmed group-specific differences in structural path coefficients. Conclusions: The identification of an indirect pathway linking emotional suppression to suicide risk via psychache in individuals with AUD represents a novel finding with important clinical implications. Interventions should prioritise reducing emotional suppression and psychache, and enhancing social support. Longitudinal studies are needed to clarify the temporal and clinical significance of these mechanisms.
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