Understanding the Interplay between Somatic Symptoms, Depression, Self-Efficacy, and Suicide Risk among Latinx College Students

Abstract

The current study examined the relations among somatic symptom burden, self-efficacy, depression severity, and suicide risk in a sample of Latinx immigrant college students. It was hypothesized that a greater burden of somatic symptoms would be associated with increased suicide risk, and that self-efficacy would mediate this relation, with depression moderating the link between somatic symptoms and self-efficacy. Data were collected from 493 Latinx immigrant students across seven public universities in Texas via an anonymous survey. Results partially supported the hypotheses. Greater somatic symptom burden was significantly associated with elevated suicide risk. Self-efficacy mediated this relation, but only at higher levels of depression severity. Specifically, at high depression levels, somatic symptoms were positively associated with self-efficacy, which in turn was linked to lower suicide risk. No significant mediation effects were observed at average or low levels of depression. These findings suggest that under conditions of greater depression, some individuals may maintain or strengthen coping beliefs despite physical and psychological distress, and that this may serve a protective function against suicide risk. The study highlights the importance of considering somatic symptoms, self-efficacy, and mental health together when assessing suicide risk in Latinx college students and underscores the need for integrated, culturally responsive interventions. Future research should use longitudinal designs to clarify causal pathways and explore additional contextual factors, such as coping strategies and healthcare engagement, that may influence these processes.

Introduction

Health Care systems have long approached physical health and mental health as separate areas, but the move towards more integrated care is changing the notion of mind-body dualism (Mehta, 2011; Doherty & Gaughran, 2014). The need to consider how mental health and physical health are connected is evident in primary care and emergency department (ED) statistics. In the United States (U.S.), approximately 57.2 million visits to a physician’s office included co-morbid mental health conditions while 5.8 million ED visits were for mental, behavioral, and neurodevelopmental disorders (CDC, 2023).

Latinxs disproportionately rely on EDs for mental health care due to age, race, and socioeconomic factors. Structural barriers and outpatient access often drive reliance on these settings despite their inadequacy (Cabassa et al., 2006). High endorsement of somatic symptoms–intense physical complaints without clear medical causes–also increases medical service use among Latinxs with mental health concerns (Barsky et al., 2005). Prior research notes high levels of somatization in Latinx populations (e.g., Varela et al., 2004; Escovar et al., 2018; Der Sarkissian, Sharkey, & Cerezo, 2022). One primary care study found that Latinx adults reported more somatization and physical functional impairment from mental health conditions compared to White counterparts (Escovar et al., 2018).

The current study aimed to examine links between somatic concerns and mental health issues among Latinx college students–a rapidly growing segment of U.S. higher education and the broader population (Mora, 2022; Pew Research Center, 2022). Specific aims were to test associations between somatic symptoms burden and suicidality and explore whether depression and self-efficacy, both treatment-malleable processes, influence this link.

Somatic Symptoms and Suicide Risk in Latinx Populations

While suicide rates among Latinx populations are lower than non-Latinx whites, they have risen over the past two decades (Silva & Van Orden, 2018; Martínez-Alés et al., 2022). Suicide is now the third leading cause of death among Latinx individuals aged 15 to 24 in the United States. Indeed, gender disparities persist: among Latinx males, suicide dropped from the second to the third leading cause of death between 2018 and 2022, while for Latinx females it has remained the second leading cause (CDC, 2022).

In response to these alarming trends, research on suicidality among Latinx populations has increasingly focused on identifying both risk and protective factors. Most studies have concentrated on interpersonal elements like familismo, perceived burdensomeness, Machismo, thwarted belongingness, and discrimination (Mascayano et al, 2015; Oakey-Frost et al., 2019; Walker et al., 2022; De Luca et al., 2023; Garcia, 2024; Woller et al., 2025). However, there is a gap in understanding how clinical factors, such as somatic symptoms, contribute to suicidal ideation within this group.

Somatic symptoms refer to physical complaints (e.g., fatigue, pain, gastrointestinal issues) that may not have an identifiable medical cause but are often manifestations of psychological distress. Latinxs are more likely to perceive and express stress through physical symptoms due to culturally familiar frameworks for understanding distress (Canino, 1992). For instance, nervios–a culturally recognized idiom of distress–is commonly associated with symptoms such as headaches, chest pain, abdominal discomfort, and fluctuations in blood pressure (Baer et al., 2003). A systematic review by Torres et al. (2021), along with several studies (e.g., Fang et al., 2019; Jeon et al., 2016; Bohman et al., 2010), found that somatic symptom and related disorders are positively associated with suicidal ideation and behaviors. However, most of the research focused on European, Asian, or non-Latinx U.S. samples, with few studies including Latinx participants. These studies highlight the need to identify possible protective and cultural factors that can buffer the negative effects of somatic symptoms.

The Mediating Role of Self-Efficacy

Rooted in Bandura’s Social Cognitive Theory (SCT), self-efficacy plays a central role in shaping our understanding of social learning, self-concept, and motivation (Bandura, 1997; Choi, 2005; McCoy, 2010). In the existing literature, self-efficacy is commonly viewed as a mediator linking pain and health outcomes (e.g., depression, health quality of life; Arnstein et al., 1999; Mikkelsen et al., 2021). Research further underscores the impact of self-efficacy on mental health outcomes. For instance, Martin et al. (1996) observed in a study of college students that lower self-efficacy was associated with higher depression and increased somatic symptoms. Similarly, a Finnish study by Grigaitytė and Söderberg (2021) revealed that lower emotional self-efficacy correlated with more somatic complaints in both boys and girls.

Self-efficacy has been widely recognized as a protective factor against the development of mental health challenges in Latinx college student populations (Torres & Taknint, 2015; Vazquez & Cortina, 2024). Specifically, it has been identified as a moderating variable in the relationship between ethnic microaggressions, traumatic stress, and psychological outcomes (Torres & Taknint, 2015). Research also highlights the role of social self-efficacy in promoting higher levels of life satisfaction and a stronger sense of belonging among Latinx college students (Zamudio et al., 2020; Gutierrez, 2020). Furthermore, self-efficacy served as a buffer against anxiety during atypical stressors such as the COVID-19 pandemic, demonstrating its relevance in both every day and crisis contexts (Vazquez & Cortina, 2023). Importantly, self-efficacy may also be shaped by cultural values such as familismo and personalismo, which emphasize family loyalty and social harmony (Thomas Hebdon et al., 2023). These cultural norms may support coping despite distress and influence how Latinx students maintain a sense of control in the face of emotional or somatic symptoms.

Depression Severity as a Moderator

A meta-analysis focusing on Latinx coping resources by Lee and Ahn (2012) demonstrated that higher self-efficacy levels are associated with lower levels of depression and anxiety. To our knowledge, the current study is the first to consider depression as a moderator of the relation between somatic concerns and self-efficacy. Previous studies have touched on related themes; for instance, observational studies have found a connection between depressive symptoms and reduced self-efficacy in managing chronic health conditions (Dilorio et al., 2006; Kennard et al., 2006). Individuals who display symptoms of depression tend to have lower confidence in their ability to handle the daily challenges and management of chronic illnesses. Further, there is a significant correlation between self-efficacy and depression, where lower levels of self-efficacy are associated with higher levels of depression (Ali & Nair, 2021; Sharma & Kumra, 2022). Additionally, recent findings support the positive association between somatic symptoms and depression among adolescents (Bohman et al., 2010) and Latinx adults (Hollenbaugh et al., 2024). Despite these insights, existing models have yet to explore how somatization in individuals with varying severity in depressive symptoms may impact self-efficacy beliefs.

Taken together, the existing literature underscores the importance of culturally responsive research that examines the interconnected roles of somatic symptoms, suicidality, depression, and self-efficacy, particularly within the Latinx college student population who experience high rates of somatization and rising suicide risk (Oakey-Frost et al., 2019; Zvolensky et al., 2019). Moreover, the protective influence of self-efficacy and its complex relationship with depression further highlight the relevance of exploring these variables as potential mechanisms linking somatic distress to suicidal ideation. Although prior studies have identified links between these constructs individually, none have tested an integrated, theory-driven model in a Latinx sample. The current study aims to fill this gap by investigating these relationships within a rapidly expanding and understudied segment of the U.S. higher education population.

Current Study

This study was guided by SCT, which identifies self-efficacy as central to how individuals manage stress and regulate behavior (Bandura, 1997). Specifically, this study tested a model in which self-efficacy mediates the association between somatic symptom burden and suicide risk, moderated by depression severity (Figure 1). Although cultural variables were not directly measured, the focus on Latinx college students reflects an effort to explore these relations in a culturally relevant population.

Figure 1.

Hypothesized Moderated Mediation Model

Prior research suggests that Latinx individuals may express distress somatically to avoid mental health stigma (Canino et al., 1992), which may impact perceived coping ability. As such, the following hypotheses were made: (1) Somatic symptom burden would be positively associated with suicide risk; (2) Self-efficacy would mediate this relation, such that higher somatic symptom burden would be associated with lower self-efficacy, which in turn would be linked to greater suicide risk; and (3) Depression severity would moderate the association between somatic symptoms and self-efficacy, such that the negative association between somatic symptom burden and self-efficacy would be stronger at higher levels of depression. While this model is not culturally comprehensive, it offers an initial step toward understanding these processes in a Latinx sample and highlights the need for future work incorporating direct measures of culture.

Method

Procedure

This sample of Latinx immigrant college students was part of a larger study on undergraduate students’ mental health and campus experiences across seven Texas universities, which varied in demographics, population densities, and geographical settings. Ethical approval was obtained from each Institutional Review Board (IRB). Data were collected via an anonymous Qualtrics survey in English, taking about 90 minutes. Participants were recruited through online channels like SONA and incentivized with extra credit in psychology courses. Verbal consent was obtained, and data were collected from July 2017 to May 2020.

Sample

The present study included a final analytic sample of 493 college students who self-identified as Latinx. Participants were drawn from a larger initial dataset of 3,158 respondents. Participants were excluded if they failed three attention-check items embedded throughout the battery (e.g., “Choose ‘Somewhat agree’ as your answer”) or if their data were incomplete due to listwise deletion, resulting in the final sample.

Participants ranged in age from 18 to 55 years (M = 22.17; SD = 5.63), and roughly 74% of the sample fell within the traditional college age range of 18–22 years. Most respondents identified as female (80%), hailed from Mexico (75%), and were not a U.S. citizen (52%). In terms of racial identification, 47% identified as White, 45% as some other race, 3% as American Indian/Alaska Native, 2% as Black or African American, and 3% did not report their race.

Measures

Demographics

Demographic information (e.g., age, sex, race, country of origin, immigration status) were collected through a questionnaire created for the larger study. While a variety of immigration statuses were initially collected, the present study simplified them into two categories: U.S. citizen and non-U.S. citizen.

Suicide Risk

Suicide risk was measured using the Suicide Behaviors Questionnaire-Revised (SBQ-R; Osman et al., 2001). The SBQ-R consists of 4 items that assess different aspects of suicidality including lifetime suicide ideation/attempt, frequency of suicidal ideation in the past 12 months, threat of suicide attempt, and self-reported likelihood of suicidal behavior in the future. Each item uses a different Likert-type scale tailored to the specific domain being assessed. Despite the varying scale lengths, responses are summed to produce a total score ranging from 3 to 18, with higher scores indicating greater suicide risk. A total score of ≥7 indicates elevated suicide risk in the general population, including non-clinical undergraduate samples, while a score of ≥8 is recommended for identifying high risk in psychiatric populations (Osman et al., 2001). The SBQ-R is one of the few empirically validated measures of suicide risk within college student populations (Osman et al., 2001). It has demonstrated robust internal consistency, particularly among individuals who identify as Hispanic/Latinx (Chang et al., 2010). In the current investigation, the SBQ-R indicated a high level of internal reliability (α = .85).

Somatic Symptoms

The Somatic Symptom Scale (SSS-8; Gierk et al., 2014) is a brief, 8-item self-report questionnaire. It assesses somatic symptom burden for the last seven days using a 5-point Likert scale ranging from 0 = not at all, to 4 = very much. Some examples of somatic symptoms include stomach or bowel problems, back pain, headaches, and trouble sleeping. Items are summed and higher scores are indicative of higher somatic symptom burden. Cutoff scores identify individuals with low (4–7), medium (8–11), high (12–15), and very high (16–32) somatic symptom burden. The PHQ-15, from which the SSS-8 is derived, has demonstrated good psychometric properties among Latinx samples in the United States, including strong internal consistency (α = .87) and adequate test–retest reliability (Cariello et al., 2020). More recently, the SSS-8 itself has shown excellent reliability in Latinx populations (α = .93; Buitron et al., 2023). In the present study, Cronbach’s Alpha was .83.

Self-Efficacy

Perceived self-efficacy was measured using the General Self-Efficacy Scale (GSE; Schwarzer & Jerusalem, 1995). A typical item is, “I can remain calm when facing difficulties because I can rely on my coping abilities.” Responses to the 10 items, rated on a 4-point Likert scale (1 = not at all true, 4 = exactly true), are summed. The GSE has been tested across diverse populations and validated in Spanish-speaking samples, with reported Cronbach’s alpha values ranging from .75 to .91 (Scholz et al., 2002), including .91 in a study with Latino adults (Torres et al., 2015). The scale showed similarly high reliability in the current study (α = .88).

Depression Severity

The Depression, Anxiety and Stress Scale - 21 Items (DASS-21; Lovibond & Lovibond, 1995) is a self-report tool designed to assess depression, anxiety, and stress. In this study, only the depression scale was used, which includes seven items measuring dysphoria, hopelessness, devaluation of life, self-deprecation, lack of interest, anhedonia, and inertia. Participants rated symptom frequency over the past week on a 0–3 scale. Elevated scores reflect higher symptom levels, with categories ranging from normal (0–4) to extremely severe (14+). A sample item was, “I found it difficult to work up the initiative to do things.” The DASS-21 has shown excellent internal consistency among Latinx undergraduates (α = .93; Holloway-Friesen, 2023), and in this sample, the depression scale had strong reliability (α = .92).

Data Analyses

Data analyses were performed using SPSS Version 28.0. Prior to hypothesis testing, assumption checks and outlier analyses were conducted. Mahalanobis distance values were computed using all variables included in the moderated mediation model, and cases exceeding the chi-square critical value at p < .001 (χ²(df = 6) > 22.46) were identified as multivariate outliers (Tabachnick & Fidell, 2013). A total of five participants met this threshold and were excluded from analyses to reduce potential distortion of parameter estimates, leaving n = 488 for hypotheses testing. Subsequently, Pearson’s bivariate correlations (two-tailed; along with point biserial correlations for binary variables) and an ANOVA were conducted on key demographic variables to identify potential covariates. The proposed moderated-mediation model was tested through the PROCESS macro (version 4.0; Model 7), an SPSS macro for path analysis developed by Hayes (2022). To examine the moderated mediation effects, 5000 bootstrap samples and 95% confidence intervals (CIs) were used. An indirect effect is considered significant if 0 does not fall between the calculated confidence intervals.

Results

Descriptive Statistics and Bivariate Correlations

Preliminary analyses revealed normal distributions for the variables under investigation. Table 1 displays the mean and standard deviations for age, somatic symptom burden, self-efficacy, depression severity, and suicide risk. Overall, most participants reported medium to very high somatic symptom burden (56%), mild to very severe depression (60%), and a low risk of suicide (71%). The somatic symptoms, ranked from most to least frequently reported over the last 7 days (ranging from a little bit to very much), included feeling tired or having low energy (90%), experiencing headaches (67%), trouble sleeping (65%), pain in arms, legs, or joints (55%), stomach or bowel issues (53%), dizziness (42%), and chest pain or shortness of breath (31%).

Table 1.

Descriptive statistics and correlations for main study variables.

Variables	Mean	SD	1	2	3	4	5	6
1. Suicide risk	5.58	4.00	–
2. Somatic symptom burden	9.65	5.10	0.370*	–
3. Self-efficacy	31.11	5.10	−0.240*	−0.157*	–
4. Depression severity	6.53	5.27	0.638*	0.477*	−0.378*	–
5. Age	22.17	5.63	−0.206*	−0.135*	0.154*	−0.206*	–
6. Sex**			0.168*	0.258*	−0.154*	0.182*	0.036	–

Note. N = 493;

^*p < .01;

^**point-biserial correlation.

Bivariate correlations (see Table 1) were performed to explore the relations of age, and sex, with suicide risk, aiming to identify potential covariates. In addition, a one-way ANOVA was conducted to assess whether suicide risk differed across racial groups, and an independent samples t-test examined differences based on immigration status—both also intended to inform covariate selection. The ANOVA revealed no significant differences in suicide risk across racial groups, F(3, 470) = 0.48, p = .70. Similarly, immigration status was not significantly associated with suicide risk, t(461.17) = −0.85, p = .40, 95% CI [−1.04, 0.41]. Based on significant bivariate associations with suicide risk, only age and sex were retained as covariates in the moderated mediation model. Specifically, age was negatively associated with suicide risk, while sex showed a positive association, with female participants reporting higher suicide risk than male participants.

Moderated Mediation Analysis

A moderated mediation analysis was performed to explore the mediating role of self-efficacy (M) in the relation between somatic symptom burden (X) and suicide risk (Y), and the moderating effect of depression (W) on the relation between somatic symptom burden and self-efficacy (Table 2). The results confirmed the first hypothesis: there was a direct and significant effect of somatic symptom burden on suicide risk (b = .151, SE = .021, t = 7.11, p < .001, 95% CI [0.109, 0.192]). Regarding the second hypothesis, the analysis revealed a significant positive interaction between somatic symptom burden and depression severity in predicting self-efficacy (b = .015, p < .05). Specifically, at higher levels of depression symptoms (+1 SD), the relation between somatic symptom burden and self-efficacy was significant and positive (b = .115, t = 2.540, p < .05, 95% CI [.026, .204]). However, this association was not significant at average (0 SD; b = .034, t = .921, p = .36, 95% CI [−.038, .106]) or low levels of depression (–1 SD; b = −.047, t = −.928, p = .35, 95% CI [−.148, .053]).

Table 2.

Results for coefficient estimates in the moderated mediation model.

	M: Self-efficacy			Y: Suicide risk
Variables	b	SE	t	b	SE	t
Age	0.061	0.044	1.384	−0.109	0.028	−3.909***
Gender	−1.345	0.553	−2.433*	0.714	0.356	2.007*
Somatic symptom burden (X)	0.034	0.037	0.921***	0.151	0.021	7.111***
Depression severity (W)	−0.382	0.047	−8.063***
Somatic symptom burden X Depression severity	0.015	0.006	2.601*
Self-efficacy (Y)				−0.095	0.027	−3.454**
Constant	31.992	1.334	23.925***	9.625	1.210	7.953***
R2	0.170			0.197
F	19.717***			29.564***

Note. n = 488.

^*p < .05.

^**p < .01.

^***p < .001.

Furthermore, the moderated mediation analysis indicated a significant index of moderated mediation concerning suicide risk (index = −.002; 95% CI = [−.003, −.0002]). The indirect effect of somatic symptom burden on suicide risk through self-efficacy was significant and negative at higher levels of depression (+1 SD; estimate = −.011; 95% CI = [−.024, −.001]), but no significant indirect effects were observed at average (0 SD; b = −.003; 95% CI = [−.012, .004]) or low levels of depression (–1 SD; b = .005; 95% CI = [−.006, .015]). These results suggest a nuanced association where the impact of somatic symptom burden on suicide risk is mediated by self-efficacy, contingent upon the level of depression severity. Specifically, higher levels of depression severity intensify the mediating effect of self-efficacy between somatic symptom burden and suicide risk.

Discussion

The findings from the current study provide insights into the relations among somatic symptoms, self-efficacy, depression, and suicide risk among Latinx immigrant college students. Specifically, it was hypothesized that a greater somatic symptom burden would be associated with an increased risk of suicide. Furthermore, it was posited that self-efficacy would mediate the relationship between somatic symptom burden and suicide risk. Depression was expected to moderate the link between somatic symptoms and self-efficacy, such that individuals with higher depression severity would report lower self-efficacy and greater suicide risk, while those with lower depression severity would show higher self-efficacy and reduced suicide risk. The results partially supported these hypotheses, though not in the anticipated direction. As predicted, greater somatic symptom burden was significantly associated with elevated suicide risk. However, the mediating role of self-efficacy was significant only at higher levels of depression severity, with no significant indirect effects observed at low or average levels of depression. Interestingly, at higher levels of depression, somatic symptom burden was positively associated with self-efficacy, which in turn was linked to lower suicide risk.

These results support prior research demonstrating that somatic symptoms are significantly associated with suicide risk (Fang et al., 2019; Jeon et al., 2016; Torres et al., 2021) and extend this literature by identifying this association within a Latinx immigrant college student population. Further, self-efficacy mediated this link only at high depression, where greater somatic burden unexpectedly corresponded with stronger coping ability and reduced suicide risk. Although statistically significant, the indirect effect at high depression levels was small (estimate = −.011), and as such, we urge caution in interpreting its clinical significance. Still, its potential impact should not be underestimated: a one-point increase in somatic symptom burden corresponds to a .011 increase in suicide risk via decreased self-efficacy. Indeed, Carey et al. (2023) demonstrated that even small mean shifts in mental health measures can lead to meaningful increases in the number of individuals crossing clinical thresholds when considered at a population level. Thus, future research should assess the real-world impact of small indirect effects and examine whether strengthening self-efficacy meaningfully reduces suicide risk in clinical settings.

To better understand this counterintuitive finding, alternative explanations should be considered. Possible mechanisms include measurement artifact, response bias, unmeasured confounding variables, or reverse causality–particularly given the cross-sectional design. Cultural strengths or coping styles not captured by our measures may also contribute. Indeed, a previous research study found that the coping strategy of support seeking was directly linked to a reduction in suicidal ideation, with no effect on perceived stress or depressive symptoms (Khurana & Romer, 2012). Therefore, coping strategies may be at play, but not necessarily reducing stress or feelings of hopelessness. These findings underscore the importance of further investigating the types of coping strategies that influence self-efficacy and suicide risk, particularly in high-risk diverse population.

The current study challenges traditional views of self-efficacy by revealing that its protective influence may not diminish uniformly under stress but rather adapts to the individual’s emotional context. Instead of declining under psychological and physical distress, self-efficacy may remain intact or even activate in high-risk individuals. This aligns with prior work indicating that individuals with higher general self-efficacy tend to use more active coping strategies, such as planning, positive reframing, and problem-focused approaches, even when managing chronic and physically distressing conditions (Schwarzer & Warner, 2012). For example, patients with gastrointestinal disease or cancer who reported higher self-efficacy were more likely to engage in adaptive strategies like humor, fighting spirit, and information seeking, while those with lower self-efficacy relied more on maladaptive strategies such as behavioral disengagement and self-blame (Luszczynska, Scholz et al., 2005). In the context of the current study, Latinx immigrant college students with both high depression and high somatic symptom burden may be engaging in similar coping processes that help maintain or even reinforce their sense of efficacy. Importantly, research has also shown that Latinx individuals frequently draw on resilience to buffer mental health risks (Sanchez-Garciasguirre et al., 2025), suggesting that cultural and personal strengths may support the preservation of self-efficacy in times of distress.

Cultural strengths or coping styles not captured by our measures may also contribute. For example, Latinx individuals may be more likely to express psychological distress through somatic symptoms, which are viewed as more socially and medically acceptable (Kirmayer & Young, 1998). In fact, prior research has shown that Latinx individuals believe they are more likely to receive care if they report physical rather than psychological problems (Canino et al., 1992). This may help explain the seemingly paradoxical association between somatic distress and self-efficacy at high depression levels, as physical complaints might serve as a culturally sanctioned coping signal that elicits support or boost a person’s sense of control when they are managing distress. Additionally, sources of cultural resilience–such as familism, spiritual or religious coping, and bicultural competence–may help maintain a sense of self-efficacy even under high levels of psychological and physical distress (Thomas Hebdon et al., 2023). However, given the study’s cross-sectional design, further longitudinal research is needed to determine whether somatic symptoms directly promote coping confidence or whether high self-efficacy individuals are simply more inclined to recognize and respond to distress. Future studies should also explore how culturally influenced coping strategies and healthcare engagement shape self-efficacy and suicide risk over time.

The descriptive and bivariate correlation results also offer valuable context for interpreting the study’s main findings and highlight several important patterns within this sample of Latinx immigrant college students. A majority of participants reported experiencing medium to very high somatic symptom burden and mild to very severe levels of depression, consistent with existing research pointing to elevated distress in Latinx college students (Eisenberg et al., 2013; Lerman Ginzburg et al., 2021). Notably, despite these high rates of physical and emotional symptoms, most participants were classified as low risk for suicide, suggesting the presence of potential protective factors. The most frequently endorsed somatic symptoms–fatigue, headaches, and sleep difficulties–are commonly observed in individuals with elevated psychological distress (Kapfhammer, 2006) and may reflect culturally salient ways of expressing emotional suffering. The significant inverse relationship between age and suicide risk suggests that younger students may be more vulnerable to suicidal thoughts or behaviors, aligning with national data showing heightened suicide risk among Latinx individuals aged 15–24 (CDC, 2022). Additionally, the finding that females reported higher suicide risk than males reflects recent trends in suicide-related outcomes among Latinx women, despite their historically lower rates of death by suicide (Curtin & Hedegaard, 2019). Although racial and immigration differences were nonsignificant, these variables may still matter when considered with structural and sociocultural factors. These findings underscore the importance of age and gender sensitive assessments and interventions, and they support the inclusion of age and sex as covariates in modeling the psychosocial mechanisms underlying suicide risk in this population.

Findings from this study have important clinical and intervention implications for working with Latinx immigrant college students. Given the cross-sectional design and small indirect effect observed, any recommendations are exploratory rather than prescriptive. First, the significant link between somatic symptom burden and suicide risk highlights the need for healthcare providers and mental health practitioners to assess physical symptom complaints carefully, even when a clear medical cause is not identified. Given the cultural relevance of somatic expressions of distress in Latinx populations, clinicians should avoid dismissing somatic complaints and instead use them as an indicator for broader mental health evaluation, including suicide risk assessment. Second, although the data suggest a possible protective role of self-efficacy at high levels of depression, more research is needed to understand the mechanisms behind this effect. Any intervention efforts aimed at strengthening self-efficacy should be approached with caution and further evaluated in longitudinal or experimental studies. Thus, while self-efficacy may emerge as a promising intervention target in future work, the current findings do not yet support its clinical application. Finally, these findings reinforce the importance of integrated care models that address both mental and physical health within primary care and campus counseling settings, ensuring that somatic and emotional symptoms are treated in a holistic, culturally responsive manner.

Limitations

Despite its contributions, this study has several limitations that offer important directions for future research. First, because the study was cross-sectional, we cannot determine cause-and-effect relationships or know which came first–somatic symptoms, depression, self-efficacy, or suicide risk. Longitudinal studies are needed to examine how these factors evolve over time during the college years, a period marked by major developmental and social changes (Arnett, 2000). Understanding whether somatic or depressive symptoms emerge first will be critical for informing timely and targeted interventions.

Second, the generalizability of the findings is constrained by the demographic characteristics of the sample. Although the study focuses on Latinx immigrant college students–a population that remains underrepresented in the literature–the sample was predominantly female (80%) and of Mexican origin (75%). This composition may limit applicability to the broader Latinx population. Gender differences in suicide outcomes are particularly important to note: while Latina females are more likely to report suicidal ideation and somatic symptoms (Rogers et al., 2018), Latino men die by suicide at more than four times the rate of Latina women, even as national rates decline (Salud America, 2023). As such, our findings may underrepresent suicide risk factors relevant to Latinx men. At the same time, the overrepresentation of Latina women may reflect the demographic that disproportionately struggles with somatic symptoms and suicidal ideation (Rogers et al., 2018), suggesting that our sample composition, while skewed, aligns with the subgroup of Latinx college students who might be most impacted by these challenges. In addition to gender differences, cultural norms, distress expression, and coping strategies can differ significantly across national origins. Future research should strive to include more gender-balanced and culturally diverse Latinx samples to better capture within-group variability in risk and resilience.

Further, although the measures used in this study demonstrated strong internal consistency in our sample, their cross-cultural validity in Latinx populations remains limited. The SSS-8 somatic symptom scale, while widely used, has not been formally validated in U.S. Latinx or Spanish-speaking immigrant populations. In addition, cutoff scores used in referenced studies may not generalize across cultures. Future studies should consider using culturally adapted measures or evaluating measurement equivalence to ensure that constructs like somatic symptoms are interpreted appropriately within specific cultural contexts.

Finally, the study did not account for broader contextual or cultural variables that are likely to shape the relations under investigation. For instance, although our interpretations highlight cultural factors such as familism and religious coping, these constructs were not directly measured and therefore remain an important gap. Similarly, continuity of healthcare, access to primary care, and specific coping strategies were not assessed, yet each may influence how students manage somatic symptoms and develop self-efficacy. Future research should examine how these cultural and contextual factors–including healthcare utilization, coping styles, and culturally rooted resources–interact with mental and physical health across the college years, particularly among Latinx immigrant student populations.

Conclusion

Overall, the present study contributes important insights into the complex relations among somatic symptom burden, self-efficacy, depression, and suicide risk in Latinx immigrant college students. The findings highlight somatic symptom burden as a significant predictor of suicide risk and suggest a potential role for self-efficacy under conditions of elevated depression severity. However, given the unexpected direction of effects and the study’s cross-sectional design, these findings should be interpreted with caution. We urge replication of this moderated mediation model in longitudinal and experimental designs to better understand the mechanisms at play. These results underscore the importance of considering both physical and psychological factors when assessing suicide risk and designing culturally responsive interventions. Future research should prioritize identifying culturally specific coping strategies, assessing symptom expression across Latinx subgroups, and evaluating how self-efficacy functions over time. Integrated approaches that address both somatic and psychological symptoms remain a promising direction for supporting Latinx students, but clinical applications should await further empirical validation.

Highlights.

• Greater somatic symptoms were linked to higher suicide risk in Latinx immigrant students.

• Self-efficacy mediated this relation at high levels of depression severity.

• Higher somatic symptoms were associated with higher self-efficacy at greater depression levels.

• Results highlight the need for integrated and culturally responsive interventions.