Psychache Predicts Suicide Attempter Status Change in Students Starting University.

OBJECTIVES: Unlike many investigations that focus on suicide ideation rather than suicidal behavior, the present research evaluates the merit and relative efficacy of psychache (i.e., unbearable mental pain) for predicting self-reported suicide attempts among university students who are starting university. METHOD: A sample of 516 elevated-risk undergraduates was assessed during the first three weeks of starting university and, again, 10 weeks later. RESULTS: Psychache and depression, but not hopelessness, could predict change in suicide attempter status. When measures of psychache, depression, and hopelessness were considered simultaneously, only psychache provided significant, unique predictive power. CONCLUSIONS: Findings are interpreted as supporting Shneidman's model whereby psychache is seen as the cause of suicide.

A four-year longitudinal study examining psychache and suicide ideation in elevated-risk undergraduates: A test of Shneidman's model of suicidal behavior.

OBJECTIVES: Using a 4-year follow-up design, this research investigated Shneidman's model of psychache (i.e., intense mental pain/anguish) as the cause of suicide. Operationalizing suicidal manifestations using suicide ideation, we evaluated Shneidman's assertion that psychache is the prominent predictor of suicide ideation and that other suicide-related psychological variables associate with suicide ideation only through psychache. METHOD: Eighty-two undergraduates at elevated suicide risk were assessed at baseline and follow-up with measures of suicide ideation and three psychological predictors: depression, hopelessness, and psychache. RESULTS: At baseline, only psychache and neither depression nor hopelessness contributed significant, unique information to statistically predicting suicide ideation. For 4-year change in suicide ideation, only psychache and neither depression nor hopelessness provided significant, unique information. CONCLUSIONS: Results provided partial support for Shneidman's contention of the importance of psychache for suicidal behavior and that other psychological factors are only important to suicide insofar as they relate through psychache.

Self-report depressive symptoms do not directly predict suicidality in nonclinical individuals: Contributions toward a more psychosocial approach to suicide risk.

Although suicidality is associated with mental illness in general and depression in particular, many depressed individuals do not attempt suicide and some individuals who attempt to or do die by suicide do not present depressive symptoms. This article aims to contribute to a more psychosocial approach to understanding suicide risk in nonclinical populations. In advocating a psychosocial perspective rather than a depression-focused approach, this article presents four diverse studies that demonstrate sampling and measurement invariance in findings across different populations and specific measures. Study 1 tests the mediation effects of 2 interpersonal variables, thwarted belongingness and perceived burdensomeness, in the association between depressive symptoms and recent suicidality. Studies 2 and 3 evaluate the contribution of hopelessness and psychache, beyond depressive symptoms, to suicidality. Study 4 tests the contribution of life events behind depressive symptoms, and other relevant sociodemographic and clinical variables, to the estimation of "future suicidality." Overall, results demonstrate that depressive symptoms do not directly predict suicidality in nonclinical individuals, but that other psychosocial variables mediate the association between depressive symptoms and suicidality or predict suicidality when statistically controlling for depressive symptoms. The article contributes to understanding some of the nonpsychopathological factors that potentially link depressive symptoms to suicide risk and that might themselves contribute to suicidality, even when controlling for depressive symptoms.

Suicide risk screening: Comparing the Beck Depression Inventory-II, Beck Hopelessness Scale, and Psychache Scale in undergraduates.

The current research evaluates the effectiveness and relative merits of 3 screening measures (the Beck Depression Inventory-II, the Beck Hopelessness Scale, and the Psychache Scale) in evaluating preexisting suicide risk factors for a sample of 7,522 undergraduate students. All measures demonstrated significant diagnostic accuracy for indicating suicide ideation, previous single and multiple suicide attempts, and a recent suicide attempt, which are all serious risk factors for subsequent death by suicide in university students. However, the Psychache Scale displayed superior performance in accurately identifying suicide risk compared with both the Beck Depression Inventory-II and the Beck Hopelessness Scale. Identifying students most at risk for suicide requires diagnostically efficient measures, thus preliminary cut-scores for identifying at-risk students are provided.

A five-month longitudinal study of psychache and suicide ideation: replication in general and high-risk university students.

Shneidman's (1993) model of psychache as the cause of suicide was evaluated in a 5-month longitudinal study of psychological pain and suicide ideation. Replicating across general (N = 683) and high-risk undergraduates (N = 262), psychache was significantly associated with suicide ideation, and change in psychache was significantly associated with change in suicide ideation. For general suicide ideation and suicide preparation, these significant results were maintained even when depression and hopelessness were statistically controlled. This research is a unique contribution being the first large-sample longitudinal study that evaluates and supports Shneidman's psychache causal model of suicidality in general and high-risk groups.

A two-year prospective study of psychache and its relationship to suicidality among high-risk undergraduates.

OBJECTIVES: Edwin Shneidman's theory of suicide was tested by examining the relationships of depression, hopelessness, and psychache with suicide ideation, longitudinally. DESIGN: Forty-one high-risk students who were suicide ideators completed questionnaires measuring depression, hopelessness, psychache, and suicide ideation at baseline and 2 years later. RESULTS: Regression analyses showed that at baseline and at follow-up, psychache was the only unique contributor to the statistical prediction of suicide ideation. When examining change over time, change in psychache was the only factor that added significant unique variance to the prediction of change in suicide ideation. CONCLUSIONS: Results support Shneidman's assertion that other psychological factors, such as depression and hopelessness, are only important to suicide insofar as their relationship with psychache, and that psychache and suicide ideation co-vary over time.

Review of predictors of suicide within 1 year of discharge from a psychiatric hospital.

Previous research has shown that suicide risk is highest in the year after people have been discharged from a psychiatric hospital. As such, identifying predictors of suicide within this time frame is important. Results from a systematic database search showed that all significant suicide predictors--those found in more than one study--could be grouped into factors related to suicidality, patient care factors, and demographic and psychopathological factors. Increased knowledge of suicide predictors for this particularly high-risk time, identified in this review, can help inform prevention and intervention efforts that may significantly reduce suicide rates.