An analysis of the Painful and Provocative Events Scale: Some painful and provocative findings.

This research investigated the latent structure and correlates of the 26-item Painful and Provocative Events Scale (PPES). For a sample of 290 community respondents, results from parallel analysis indicated a 5-factor structure. Based on principal axis factoring with varimax rotation, scales of Intense physicality, Physical and mental trauma, Physical risk taking, Psychopathy, and Body enhancement were constructed, and these demonstrated a pattern of convergent and discriminant correlations with suicide-associated and demographic variables that supported the delineation of these scales as being distinct. In general, results challenge the current scoring of the PPES and, with developed scales being differentially related to demographic variables, indicate that both respondent age and sex require consideration for scale score interpretation.

Nutritional counselling in adults promoting adherence to the Mediterranean diet as adjuvant in the treatment of major depressive disorder (INDEPT): a randomized open controlled trial study protocol.

BACKGROUND: Major Depressive Disorder (MDD) is a leading cause of disability worldwide. Approximately one-third of patients with MDD do not respond to treatment, and often exhibit elevated inflammation biomarkers, which are associated with worse prognosis. Previous research has linked healthier dietary patterns, such as the Mediterranean Diet (MedDiet), with a lower risk of MDD and symptoms of depression, potentially due to their anti-inflammatory properties. The aim of this study is to evaluate the effectiveness of a nutritional counselling intervention promoting MedDiet to alleviate symptoms of depression in adults recently diagnosed with MDD and presenting with elevated inflammation biomarkers. METHODS: This study is a randomized controlled trial (RCT) that will recruit adults from outpatient clinics, between the ages of 18 and 70 years who have been diagnosed with MDD and are currently receiving treatment with the first prescribed antidepressant, and who exhibit elevated inflammation biomarkers (interleukin-6 and/or C-reactive protein). The control group will receive treatment-as-usual (TAU) only. The primary outcome of the study will be the change in symptoms of depression, as measured by the Beck Depression Inventory 2 (BDI-II), after 12 weeks of intervention. Data analysis will follow an intention-to-treat approach. Secondary outcomes will include changes in inflammation biomarkers, quality of life, adherence to the MedDiet, and cost-effectiveness of nutritional counselling. All outcomes will be assessed at baseline, after the 12-week intervention, and at 6- and 12-months post-baseline. DISCUSSION: This study will be the first RCT to evaluate the effect of a nutritional intervention with anti-inflammatory properties, as an adjuvant in the treatment of MDD, in individuals diagnosed with MDD and elevated inflammation biomarkers. The results of this study may contribute to the development of more effective and personalized interventions for MDD patients with elevated inflammation biomarkers.

The Mediating Role of Tolerance for Psychological Pain in the Relationship Between Different Types of Childhood Traumatic Experiences and Suicidal Ideation.

The aim of the present research was to evaluate the mediating effects of facets of the tolerance for psychological pain on the relationship between childhood trauma and suicidal ideation. A sample of 437 community individuals and a sample of 316 college students participated. For the community sample, managing the pain mediated the relationship between childhood trauma, the different types of traumatic experiences and suicidal ideation. In the college sample, managing the pain and enduring the pain mediated the relationship between childhood trauma, the different types of traumatic experiences and suicidal ideation, except for the case of sexual abuse. The present results have potential clinical implications. Mental health professionals should be aware of the long-term consequences of exposure to childhood trauma and need to assess the ability to tolerate psychological pain so as to implement appropriate psychological interventions that help individuals cope with their pain.

Exposure to suicide in the family and suicidal ideation in Portugal during the Covid-19 pandemic: The mediating role of unbearable psychache.

OBJECTIVES: This study tested the mediation effects of two facets of psychache - bearable and unbearable - in the relationship between exposure to suicide in the family and suicidal ideation in Portugal during the Covid-19 pandemic. METHODS: Two hundred and forty-four adults aged between 19 and 64 participated. Two groups were defined: one exposed to suicide in the family (n = 42) and a control group (n = 192). RESULTS: Path analysis using structural equation modelling tested a mediation model. Results demonstrated that unbearable psychache fully mediated the relationship between exposure to suicide and suicidal ideation, even when controlling for the mediation effects of depressive symptoms, the presence of a psychiatric diagnosis, and years of education. CONCLUSIONS: These results suggest that rather than considering just the global experience of psychache in individuals exposed to suicide, researchers and clinicians should look to the presence of unbearable psychache given its contribution to suicidal ideation. PRACTITIONER POINTS: Unbearable psychache fully mediated the relationship between exposure to suicide in the family and suicidal ideation It is not the global experience of psychache that contributes to suicide ideation in individuals exposed to suicide in the family rather the presence of unbearable psychache.

The mediating role of tolerance for psychological pain in the relationship of childhood trauma to suicidal ideation in individuals with a substance use disorder.

OBJECTIVES: The association between childhood trauma and suicidal ideation has been well documented in several populations, including individuals with a substance use disorder (SUD). However, a gap still exists in the literature regarding the mechanisms by which childhood trauma later impacts suicide risk. This cross-sectional study tested the effect of childhood trauma on suicidal ideation, as well as the mediating effect of tolerance for psychological pain (managing the pain and enduring the pain) in that relationship, controlling for the effect of depressive symptoms, in individuals with a SUD. METHODS: A sample of 102 adults with a SUD participated in the study. Path analysis by structural equation modelling tested a mediation model. RESULTS: Depressive symptoms and lower levels of managing the pain were found to fully mediate the association between childhood trauma and suicidal ideation. CONCLUSIONS: Our results suggest that depressive symptoms and a lack of ability to manage psychological pain contribute towards explaining why traumatic childhood experiences may result in suicidal cognitions in individuals with SUDs. Moreover, they have relevant implications for prevention and clinical interventions regarding suicidal ideation in this population. PRACTITIONER POINTS: Childhood trauma relates to suicidal ideation in individuals with a substance use disorder. Depressive symptoms contribute towards explaining why traumatic childhood experiences may result in suicidal cognitions. A lack of ability to manage psychological pain also contributes towards explaining this relationship. The obtained results have relevant implications for the prevention of and clinical intervention for suicidal ideation in SUD individuals.

Psychache, unmet interpersonal needs, childhood trauma and suicide ideation in young adults.

This 5-month, 2-wave study evaluated the mediating effects of psychache and unmet interpersonal needs on the relationship between childhood trauma and suicide ideation in 208 young adults, controlling for depression. Path analysis demonstrated that changes in depression, perceived burdensomeness, and thwarted belongingness mediated the relationship between childhood trauma and changes in positive suicide ideation, and that changes in depression and perceived burdensomeness mediated the relationship between childhood trauma and changes in negative suicide ideation. Results indicated the importance of assessing interpersonal needs, in addition to depression, for understanding the mechanism linking childhood trauma to suicide ideation in young adults.

Dimensionality of Suicide Behaviors: Results within Two Samples from Two Different Countries.

Across two countries and two languages, this research examined the multidimensional associations of suicide behaviors (i.e., life-time attempts, life-time communication of intent to others, life-time self-harming, life-time suicide notes, and current suicide ideation) and empirically relevant psychological risk factors (i.e., different facets of mental pain, perceived burdensomeness, thwarted belongingness, and acquired capability), controlling for depressive symptoms. For the Portuguese sample, two underlying dimensions emerged: an ideation dimension and a behavioral dimension, and for the Canadian sample, three dimensions emerged: an ideation dimension and two behavioral dimensions that can be viewed as a splitting of the Portuguese second dimension. Results highlight possible cultural differences between the two countries and that suicide behaviors should be viewed as a multidimensional phenomenon not as a one-dimensional continuum.

Exposure to Suicide in the Family: Suicidal Ideation and Unmet Interpersonal Needs in Young Adults Who Have Lost a Family Member by Suicide.

The aims of the present study were to compare a sample of individuals exposed to suicide in their families with a control group, on suicidal ideation, and to test possible potentiating effects for unmet interpersonal needs. Three hundred eighty-six young Portuguese adults participated. Two groups were defined: a group exposed to suicide in the family (n = 38) and a control group (n = 335). Groups differed significantly on suicidal ideation, on depressive symptoms, and on perceived burdensomeness and tended to differ on thwarted belongingness. Results from a hierarchical multiple regression analysis demonstrated that having lost a family member by suicide and perceived burdensomeness each provided a significant unique contribution to explaining variance in suicidal ideation when controlling for levels of depressive symptoms and having had a psychiatric diagnosis. The interaction between group membership and perceived burdensomeness provided a further enhancement to the statistical prediction of suicidal ideation.

Psychological pain and suicidal ideation in undergraduates: The role of pain avoidance.

In the present study, the first with a Western sample, we tested the relationship between three dimensions of psychological pain and suicidal ideation in a sample of 331 Portuguese college students. When controlling for the effect of depressive symptoms, the avoidance dimension, but not the cognitive and affective dimensions of psychological pain, made a significant contribution in predicting the three indicators of suicidal ideation. According to these results, psychotherapeutic action may focus either on enabling clients to tolerate mental pain or on providing more effective and adaptive strategies to cope with this pain.

Psychological pain and previous suicide attempts in young adults: Results with the Portuguese version of the Psychache Scale.

OBJECTIVES: In this study, we tested whether the unbearable pain scale of the Psychache Scale provides value for the statistical prediction of a previous suicide attempt; we evaluated whether psychological pain has incremental value in the statistical prediction of a previous suicide attempt relative to the reporting of having had a psychiatric diagnosis, and we established a cut-score for the Psychache Scale. METHOD: Two samples participated: a sample consisting of 1,460 young adults and a sample of 628 Portuguese community adults. RESULTS AND CONCLUSIONS: Results demonstrated that unbearable pain is not a stronger predictor of a previous suicide attempt than is the bearable pain score of the Psychache Scale; that the total score of the Psychache scale provides an additional statistically significant contribution to the statistical prediction of a previous suicide attempt relative to the reporting of having had a psychiatric diagnosis.

The multidimensionality of suicide risk factors and criteria in a nonclinical population: Replication across two countries and two languages.

Across two countries and two languages, this research examined the multidimensional associations between suicidality (e.g., past ideation/attempts, communication of intent) and empirically important psychological risk factors (e.g., mental pain, perceived burdensomeness, thwarted belongingness). For samples of 228 Canadian and 331 Portuguese university undergraduates, four dimensions emerged in each sample with two of these, intrapersonal and interpersonal, demonstrating strong replicability across countries and languages. It was concluded that suicidality is a phenomenon that demonstrates some multidimensional similarities across cultures.

Assessing psychache as a suicide risk variable: Data with the Portuguese version of the psychache scale.

Several studies have consistently related psychological pain to suicide risk. Psychache, according to Shneidman's perspective and measured by the Psychache Scale has been confirmed as an important variable in risk prediction. In the present study, we evaluated psychache as a construct related to suicide risk using data obtained with the Portuguese version of the Psychache Scale translated from the original English version. A community sample of 628 individuals responded to the Portuguese version of the Psychache Scale, the Suicidal Behavior Questionnaire-Revised, the CES-D Scale, the Beck Hopelessness Scale, and the Suicide Ideation Questionnaire. Results supported the unidimensional scoring of the Psychache scale, its ability to differentiate between individuals at-risk for suicide from individuals not at-risk, its relationship with different, but related, constructs and its ability to predict suicide ideation.

Avoidance of psychological pain and suicidal ideation in community samples: Replication across two countries and two languages.

OBJECTIVES: A multidimensional psychological pain model of suicide has been developed that includes three dimensions: affective, cognitive, and avoidance. In the present research, we evaluated the relationships between the three dimensions of psychological pain and suicidal ideation. METHOD: Two community samples from Portugal and the U.S. participated in the research. RESULTS: Hierarchical multiple regression analysis demonstrated that when controlling for the effects of depressive symptoms and psychache, the avoidance dimension, but not the cognitive or affective dimension of psychological pain, explained significant, and unique variance in suicidal ideation in each sample. CONCLUSION: Even when individuals perceive psychological pain, there may not be an elevated risk of suicide, provided that they do not consider suicide as a form of coping to decrease that pain.

Exposure to suicide in the family: Suicide risk and psychache in individuals who have lost a family member by suicide.

OBJECTIVE: The aim of the present study was to compare a sample of Portuguese individuals exposed to suicide in their families with a control group, for lifetime suicidality. This study also evaluated the incremental value of psychache (i.e., extreme psychological pain) in determining suicide risk beyond the contribution associated with having lost a family member by suicide. METHOD: A total of 225 community adults participated. Two groups were defined: a group exposed to suicide (n = 53), and a control group (n = 172). RESULTS: Results demonstrated that groups did significantly differ on the total score of the Suicide Behaviors Questionnaire-Revised (SBQ-R), on the four individual SBQ-R items, and on psychache. Results from a hierarchical multiple regression analysis demonstrated that having lost a family member by suicide and the construct of psychache each provided a significant unique contribution to explaining variance in suicide risk. The interaction between group membership and psychache also provided a further enhancement to the statistical prediction of suicide risk. CONCLUSION: Findings are discussed with regard to their implications for clinical intervention and postvention.

Interpersonal Needs, Depressive Symptoms, and Suicide Ideation in a Sample of Portuguese Elderly Patients Recovering from Acute Medical Conditions.

The aim of the present study was to test whether perceived burdensomeness and thwarted belongingness are related to suicide ideation, when controlling for depressive symptoms. The sample consisted of elderly patients recovering from acute medical conditions who were recruited in a medical recovery clinic. Results demonstrated that depressive symptoms and thwarted belongingness related to the suicide ideation item of the Beck Depression Inventory-II, used as an indicator of suicide ideation. Depressive symptoms and thwarted belongingness also discriminated between participants with suicide ideation and participants without suicide ideation as defined by suicide items of the Symptom-Driven Diagnostic System for Primary Care. Results are discussed in terms of potential cultural influences, and clinical implications are highlighted.

Does psychache mediate the relationship between general distress and suicide ideation?

This study evaluated whether psychache (i.e., mental pain) mediates the association between general distress, assessed as the frequency and the intensity of psychological symptoms in the previous week, and suicide ideation in community adults. For a sample of 202 adults, psychache fully mediated the relationship between suicide ideation and the frequency of psychological symptoms, and partially mediated the relationship between suicide ideation and the intensity of psychological symptoms. As such, mental pain fully or partially explains the process linking the frequency and the intensity of general distress to suicide ideation and, thus, mental pain is a target for potential intervention.

Suicide Ideation in Older Adults Recovering from Acute Conditions in a Clinical Recovery Facility.

The aim of the current study was to assess suicide ideation in a sample of older adults recovering from acute conditions in a clinical recovery facility of the Portuguese Red Cross. Four indicators of suicide ideation were used. Clinical, contextual, and psychological variables-namely, previous suicide attempts, death of a family member by suicide, loneliness, and interpersonal needs-were also tested to determine whether they were related to suicide ideation. Findings show suicide ideation is frequent at admission and related to patients' previous suicide attempts. Death of a family member by suicide and patients' functional dependency are related to some indicators of suicide ideation, and loneliness and interpersonal needs are important psychological variables relating to suicide ideation. Interpersonal needs were related to suicide ideation even after controlling for previous suicide attempts. Implications of the results for clinical practice are discussed. [Journal of Gerontological Nursing, 43(9), 31-37.].

The moderating effect of gender on the relationship between coping and suicide risk in a Portuguese community sample of adults.

Background and aims(s): The study evaluated the contribution of coping strategies, based on the Toulousiane conceptualization of coping, to the prediction of suicide risk and tested the moderating effect of gender, controlling for depressive symptoms. METHOD: A two-time data collection design was used. A community sample of 195 adults (91 men and 104 women) ranging in age from 19 to 65 years and living in several Portuguese regions, mostly in Alentejo, participated in this research. RESULTS: Gender, depressive symptoms, control, and withdrawal and conversion significantly predicted suicide risk and gender interacted with control, withdrawal and conversion, and social distraction in the prediction of suicide risk. Coping predicted suicide risk only for women. CONCLUSIONS: Results have important implications for assessment and intervention with suicide at-risk individuals. In particular,the evaluation and development of coping skills is indicated as a goal for therapists having suicide at-risk women as clients.

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.

Suicidal ideation and distress in family members bereaved by suicide in Portugal.

The present study assessed the impact of suicide and distress on suicidal ideation in a sample of 93 Portuguese family members bereaved by suicide. A control community sample of 102 adults also participated. After controlling for educational level, those bereaved by the suicide of a family member were found to have higher levels of suicidal ideation. Forty-two percent of family members had Suicide Ideation Questionnaire scores at or above the cutoff point. General distress, depression, anxiety, and hostility related to suicidal ideation, whereas time since suicide also interacted with general distress and depression in predicting suicidal ideation.