Psychache, Hopelessness, and Suicidal Ideation and Behaviors: A Cross-Sectional Study from China.

This study explored the relationship between variables emphasized in the theory's first step of the three-step theory (3ST)-psychache, hopelessness, and their interaction-to suicide-related variables (i.e., lifetime suicidal ideation and attempt, past-year suicidal ideation, communication of suicidal thoughts, and self-reported future suicide attempt likelihood). Chinese undergraduate students (N = 11,399; mean age = 20.69 ± 1.35) from seven provinces participated in this cross-sectional survey. They answered the Suicidal Behaviors Questionnaire-Revised, Psychache Scale, and Beck Hopelessness Scale. Bivariate and multivariate analyses were used to examine the association between psychache, hopelessness, and hopelessness × psychache interaction on the outcome variables. Bivariate analyses showed that psychache and hopelessness were correlated with suicidal ideation and behaviors. In multiple regression models, the interaction between psychache and hopelessness was significantly associated with past-year suicidal ideation and self-report chances of a future suicide attempt, p < 0.001, though effect sizes for the interaction term were small. The results are broadly consistent with the 3ST's proposition of how the combination of pain and hopelessness is related to various suicide-related variables. The low prevalence of suicide-related communication should inform future suicide prevention measures by encouraging help-seeking. Psychache as a correlate of the self-reported likelihood of a future attempt could be further investigated.

Utility of Single Items within the Suicidal Behaviors Questionnaire-Revised (SBQ-R): A Bayesian Network Approach and Relative Importance Analysis.

The Suicidal Behaviors Questionnaire-Revised (SBQ-R) comprises four content-specific items widely used to assess the history of suicide-related thoughts, plans or attempts, frequency of suicidal ideation, communication of intent to die by suicide and self-reported likelihood of a suicide attempt. Each item focuses on a specific parameter of the suicide-related thoughts and behaviors construct. Past research has primarily focused on the total score. This study used Bayesian network modeling and relative importance analyses on SBQ-R data from 1160 U.S. and 1141 Chinese undergraduate students. The Bayesian network analysis results showed that Item 1 is suitable for identifying other parameters of the suicide-related thoughts and behaviors construct. The results of the relative importance analysis further highlighted the relevancy of each SBQ-R item score when examining evidence for suicide-related thoughts and behaviors. These findings provided empirical support for using the SBQ-R item scores to understand the performances of different suicide-related behavior parameters. Further, they demonstrated the potential value of examining individual item-level responses to offer clinically meaningful insights. To conclude, the SBQ-R allows for the evaluation of each critical suicide-related thought and behavior parameter and the overall suicide risk.

Associations among Distress Rumination, Somatic Anxiety, and Suicidal Ideation in Chinese College Students - Shandong Province, China, 2019-2020.

What is already known about this topic?: The literature has consistently demonstrated that distress rumination following a traumatic event has significant implications for mental health. However, the potential association between distress rumination and suicidality, as well as the underlying mechanisms driving this relationship, remains to be elucidated. What is added by this report?: The current study demonstrated a significant, positive correlation between distress rumination and suicidal ideation in college students who have encountered traumatic events. The findings indicate that somatic anxiety serves as a mediator between distress rumination and suicidal ideation. What are the implications for public health practice?: Interventions aimed at reducing somatic anxiety may contribute to a decrease in suicidal ideation. Assessing and addressing somatic anxiety symptoms in college students experiencing distressful rumination following traumatic events could potentially lower the risk of suicide.

Item Response Theory and Differential Item Functioning Analyses With the Suicidal Behaviors Questionnaire-Revised in US and Chinese Samples.

Background: Despite the widespread use of the Suicidal Behaviors Questionnaire-Revised (SBQ-R) and advances in item response theory (IRT) modeling, item-level analysis with the SBQ-R has been minimal. Aims: This study extended IRT modeling strategies to examine the response parameters and potential differential item functioning (DIF) of the individual SBQ-R items in samples of US (N = 320) and Chinese (N = 298) undergraduate students. Method: Responses to the items were calibrated using the unidimensional graded response IRT model. Goodness-of-fit, item parameters, and DIF were evaluated. Results: The unidimensional graded response IRT model provided a good fit to the sample data. Results showed that the SBQ-R items had various item discrimination parameters and item severity parameters. Also, each SBQ-R item functioned similarly between the US and Chinese respondents. In particular, Item 1 (history of attempts) demonstrated high discrimination and severity of suicide-related thoughts and behaviors (STBs). Limitations: The use of cross-sectional data from convenience samples of undergraduate students could be considered a major limitation. Conclusion: The findings from the IRT analysis provided empirical support that each SBQ-R item taps into STBs and that scores for Item 1 can be used for screening purposes.

The Suicidal Behaviors Questionnaire-Revised (SBQ-R) and its Chinese version (C-SBQ-R): Further validity testing using the culture, comprehension, and translation bias procedure.

The Suicidal Behaviors Questionnaire-Revised (SBQ-R), a 4-item instrument for assessing and screening suicide-related thoughts and behaviors, has been translated into several different languages. In this study, we examined the psychometric properties of the SBQ-R and a new Chinese version of the instrument (C-SBQ-R) for college student samples. We used the culture, comprehension, and translation bias (CCT) procedure to examine the responses of independent Chinese college student samples who completed the C-SBQ-R (N1 = 298) and the SBQ-R (N2 = 292) and a U.S. college student sample (N3 = 320) who completed the SBQ-R. We found that the samples' C-SBQ-R and SBQ-R scale scores showed acceptable internal consistency reliability estimates, factor structures, and concurrent validity estimates. Measurement invariance was established across groups differing in (a) language but not culture, (b) culture but not language, and (c) both language and culture. Receiver operating characteristic curve analysis results showed that the cutoff score of 7 was similar for both the C-SBQ-R and the SBQ-R in screening for suicide-related thoughts and behaviors. Our findings provided empirical support that the psychometric properties of the C-SBQ-R and the SBQ-R are similar; both could be used to assess the suicide-related thoughts and behaviors constructs. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Towards Higher Psychometric Properties: Testing the Psychological Strain Scales with Larger Samples.

This study aimed to further test the psychometric properties of the Psychological Strain Scales (PSS) with larger samples. A cluster sampling method was employed to recruit 13,250 college students from seven provinces in China. Descriptive statistics, item statistics, Cronbach's alpha, factor analysis, and correlation analysis were evaluated. Cronbach's alpha coefficient was 0.958 and Guttman's split-half coefficient was 0.866. All the item-total correlations were larger than 0.45 except one. Results from Exploratory Factor Analysis and Confirmatory Factor Analysis supported the four dimensions of psychological strains (value strain, aspiration strain, deprivation strain, and coping strain). The PSS was strongly correlated to the Depression, Anxiety, and Stress Scale (DASS-21), which was commonly used to measure risk for suicide and was predictive ofsuicidality as measured by the SBQ-R. The PSS was a self-report instrument with high reliability and validity which could be applied for extensive use in research to measure psychological strains.HighlightsThis is the first study testing the psychometric properties of the PSS in an unusually large sample.Confirmatory factor analysis was applied to provide empirical evidence to the four-factor structure of the PSS.Psychological strains were found to be significantly correlated with depression, anxiety, and stress symptoms and predictive of suicidality.

Using Contemporary Psychometric Methods to Construct and Validate Scores on a Short-Form Version of the Psychological Strain Scales.

BACKGROUND: The 40-item Psychological Strain Scales (PSS) was developed to measure four dimensions of psychological strains based on the Strain Theory of Suicide. Although the PSS has been increasingly used in recent years, the dimensionality and scoring of the PSS remained to be thoroughly examined using the Item Response Theory (IRT) approach. METHODS: Data came from a large sample of 11,412 Chinese undergraduate students. A bifactor-IRT model, specifying one general strain factor and four specific strains factors, was examined for fit to the sample data. A detailed item analysis, with analysis of the differential item functioning (DIF) of the items across gender, was undertaken to evaluate the dimensionality of the PSS. The associations among the PSS scale scores with scores on the concurrent measures, assessing psychache and suicidal behaviors, were examined. RESULTS: IRT-derived specific bifactor indices showed that the PSS was unidimensional, and thus the PSS total scores should be reported. Unidimensional subset of 5 items identified (Item 9, Item 12, Item 14, Item 16, and Item 20), using bifactor-IRT modeling and incremental validation, were selected to construct a potential short form of the PSS (PSS-SF). The PSS-SF scale scores demonstrated strong psychometric properties and associations with scores on the concurrent measures assessing relevant constructs. LIMITATIONS: This study used cross-sectional data from a non-clinical sample of Chinese undergraduate students. CONCLUSIONS: The PSS-SF should be considered as a unidimensional instrument with potential in enhancing our understanding and measurement of psychological strains with reduced response burden.

A comparison between American and Chinese college students on suicide-related behavior parameters / Comparación entre estudiantes universitarios estadounidenses y chinos en parámetros de comportamiento relacionados con el suicidio

BACKGROUND/OBJECTIVE: The United States (US) and China are the two largest economies, but recent and directly comparable studies on suicide-related behaviors in the two countries are lacking. By using the Suicidal Behaviors Questionnaire-Revised (SBQ-R), item-level comparison was performed in assessing self-reported suicide-related behaviors between the US and Chinese undergraduates. METHOD: This study involved a total of 3,185 college students aged between 18 to 24 years (1,185 US college students, and 2,000 Chinese students who were randomly selected from a large sample of 11,806 Chinese college students). Participants filled out the 4-item SBQ-R. RESULTS: Participants' responses were compared by country and sex. There was a higher overall risk of suicide-related behaviors among US students (24.3%) compared to Chinese students (17.0%). US students also reported higher lifetime attempt, past-year ideation, and lifetime threat. US female college students reported the highest suicide-related behaviors compared to other sub-groups. CONCLUSIONS: There is a need to tailor specific interventions to alleviate college students' suicide-related behaviors in the US and China, with a particular focus on US females

ANTECEDENTES/OBJETIVO: Estados Unidos y China son las dos economías mundiales más grandes, pero faltan estudios recientes y comparables sobre comportamientos relacionados con el suicidio entre ambos países. Mediante el Suicidal Behavior Questionnaire-Revised (SBQ-R) se realizó una comparación a nivel de ítems para evaluar los comportamientos autoinformados relacionados con el suicidio entre estudiantes universitarios de Estados Unidos y China. MÉTODO: Este estudio involucró a 3.185 estudiantes universitarios con edades comprendidas entre 18 y 24 años (1.185 estadounidenses y 2.000 chinos que fueron seleccionados al azar de una gran muestra de 11.806). Los participantes completaron el SBQ-R de cuatro ítems. RESULTADOS: Las respuestas de los participantes se compararon por país y sexo. Hubo un mayor riesgo general de conductas relacionadas con el suicidio entre estudiantes estadounidenses (24,3%) en comparación con los chinos (17,0%). Los estadounidenses también informaron mayor intento vital, ideación el año anterior y amenaza vital. Las estudiantes universitarias estadounidenses informaron las tasas más altas relacionadas con el suicidio en comparación con otros subgrupos. CONCLUSIONES: Existe la necesidad de adaptar intervenciones específicas para aliviar los comportamientos relacionados con el suicidio en estudiantes universitarios en ambos países, con una atención particular en las mujeres estadounidenses

Depression, Anxiety, and Stress as a Function of Psychological Strains: Towards an Etiological Theory of Mood Disorders and Psychopathologies.

BACKGROUND: The etiological factors of mood disorders and psychopathologies are understudied. In this paper, we explored whether social psychological strains are related to depression, anxiety, and stress in non-clinical populations. METHODS: 6,305 college students (39.3% men; 60.7% women) from six Chinese provincial-level jurisdictions completed a paper-and-pencil survey with Psychological Strain Scales (PSS-40) and Depression, Anxiety, and Stress Scales-21 (DASS-21), both validated in Chinese populations. RESULTS: Both PSS-40 and DASS-21 have high internal consistency reliabilities, and are highly correlated with each other. Hence, Chinese college students with greater psychological strains (value, aspiration, deprivation, or coping) have greater depression, anxiety, and stress. These results still held after controlling for relevant socio-demographic variables in the multiple regression models. LIMITATIONS: This was a cross-sectional study, and the sample only included several provinces in mainland China, not a representative sample of all of them. CONCLUSIONS: Mood disorders and psychopathologies are linked to suicidal thoughts and behaviors. The results of this study extend the Strain Theory of Suicide from explaining the risk factors of suicidality to mood disorders and psychopathologies. Hence, these findings can inform prevention measures among college students, and possibly the general population.

A comparison between American and Chinese college students on suicide-related behavior parameters.

BACKGROUND/OBJECTIVE: The United States (US) and China are the two largest economies, but recent and directly comparable studies on suicide-related behaviors in the two countries are lacking. By using the Suicidal Behaviors Questionnaire-Revised (SBQ-R), item-level comparison was performed in assessing self-reported suicide-related behaviors between the US and Chinese undergraduates. METHOD: This study involved a total of 3,185 college students aged between 18 to 24 years (1,185 US college students, and 2,000 Chinese students who were randomly selected from a large sample of 11,806 Chinese college students). Participants filled out the 4-item SBQ-R. RESULTS: Participants' responses were compared by country and sex. There was a higher overall risk of suicide-related behaviors among US students (24.3%) compared to Chinese students (17.0%). US students also reported higher lifetime attempt, past-year ideation, and lifetime threat. US female college students reported the highest suicide-related behaviors compared to other sub-groups. CONCLUSIONS: There is a need to tailor specific interventions to alleviate college students' suicide-related behaviors in the US and China, with a particular focus on US females.

ANTECEDENTES/OBJETIVO: Estados Unidos y China son las dos economías mundiales más grandes, pero faltan estudios recientes y comparables sobre comportamientos relacionados con el suicidio entre ambos países. Mediante el Suicidal Behavior Questionnaire-Revised (SBQ-R) se realizó una comparación a nivel de ítems para evaluar los comportamientos autoinformados relacionados con el suicidio entre estudiantes universitarios de Estados Unidos y China. MÉTODO: Este estudio involucró a 3.185 estudiantes universitarios con edades comprendidas entre 18 y 24 años (1.185 estadounidenses y 2.000 chinos que fueron seleccionados al azar de una gran muestra de 11.806). Los participantes completaron el SBQ-R de cuatro ítems. RESULTADOS: Las respuestas de los participantes se compararon por país y sexo. Hubo un mayor riesgo general de conductas relacionadas con el suicidio entre estudiantes estadounidenses (24,3%) en comparación con los chinos (17,0%). Los estadounidenses también informaron mayor intento vital, ideación el año anterior y amenaza vital. Las estudiantes universitarias estadounidenses informaron las tasas más altas relacionadas con el suicidio en comparación con otros subgrupos. CONCLUSIONES: Existe la necesidad de adaptar intervenciones específicas para aliviar los comportamientos relacionados con el suicidio en estudiantes universitarios en ambos países, con una atención particular en las mujeres estadounidenses.

Meaning in life as a protective factor against suicidal tendencies in Chinese University students.

BACKGROUND: A substantial increase in rates of suicide worldwide, especially among late adolescents and young adults, has been observed. It is important to identify specific risk and protective factors for suicide-related behaviors among late adolescents and young adults. Identifying specific factors across the masses, not only in the Western, but also in the Asian context, helps researchers develop empirically informed intervention methods for the management of protective and risk factors of suicide. METHODS: In the current study, 2074 students (706 males), filled out the Meaning in Life Questionnaire, with subscales of Search for Meaning (MLQ-S) and Presence of Meaning (MLQ-P); the Future Disposition Inventory-24 (FDI-24), with subscales of Positive Focus (PF), Suicide Orientation (SO), and Negative Focus (NF); and the Beck Hopelessness Scale (BHS). These scales measure protective and risk factors that are linked to suicidal behaviors; while suicidal behaviors were measured by the Suicidal Behaviors Questionnaire-Revised (SBQ-R). Mediation analyses were performed to test the models with both the MLQ-S and MLQ-P as the mediators between a) hopelessness, as measured by BHS and suicidal behaviors; and b) PF, SO, and NF, as measured by FDI-24, and suicidal behaviors. RESULTS: We found that only MLQ-P mediated the relation between hopelessness and suicidal behaviors; while both MLQ-P and MLQ-S mediated PF, SO, and NF (as measured by FDI-24), and suicidal behaviors, respectively. CONCLUSION: Meaning in life, including both the presence of meaning in life and search for meaning, can be good protective factors against suicidal behaviors.

Associations between depression, anxiety, stress, hopelessness, subjective well-being, coping styles and suicide in Chinese university students.

Suicide is a major public health concern worldwide. This study aimed to predict the suicidal behavior of Chinese university students by studying psychological measures such as hopelessness, orientation to happiness, meaning in life, depression, anxiety, stress, and coping styles. In November 2016, a stratified-clustered-random sampling approach was utilized to select subjects from two large public medical-related universities in Shandong province, China. This sample consisted of 2,074 undergraduate students (706 males, 1,368 females; mean age = 19.79±1.39 years). The students' major risk factors for suicide were depression, anxiety, stress, and hopelessness, and the students' minor risk factors included orientation to happiness and coping styles (including self-distraction, self-blame and substance use). Notably, the presence of meaning in life had a positive effect on preventing suicide and acted as a protective factor, which suggests that it is important to identify risk factors as well as protective factors relevant to the target population group in order to increase the effectiveness of counseling and suicide prevention programs.

Evaluation of a Digital Game-Based Learning Program for Enhancing Youth Mental Health: A Structural Equation Modeling of the Program Effectiveness.

BACKGROUND: Digital game-based learning (DGBL) makes use of the entertaining power of digital games for educational purposes. Effectiveness assessment of DGBL programs has been underexplored and no attempt has been made to simultaneously model both important components of DGBL: learning attainment (ie, educational purposes of DGBL) and engagement of users (ie, entertaining power of DGBL) in evaluating program effectiveness. OBJECTIVE: This study aimed to describe and evaluate an Internet-based DGBL program, Professor Gooley and the Flame of Mind, which promotes mental health to adolescents in a positive youth development approach. In particular, we investigated whether user engagement in the DGBL program could enhance their attainment on each of the learning constructs per DGBL module and subsequently enhance their mental health as measured by psychological well-being. METHODS: Users were assessed on their attainment on each learning construct, psychological well-being, and engagement in each of the modules. One structural equation model was constructed for each DGBL module to model the effect of users' engagement and attainment on the learning construct on their psychological well-being. RESULTS: Of the 498 secondary school students that registered and participated from the first module of the DGBL program, 192 completed all 8 modules of the program. Results from structural equation modeling suggested that a higher extent of engagement in the program activities facilitated users' attainment on the learning constructs on most of the modules and in turn enhanced their psychological well-being after controlling for users' initial psychological well-being and initial attainment on the constructs. CONCLUSIONS: This study provided evidence that Internet intervention for mental health, implemented with the technologies and digital innovations of DGBL, could enhance youth mental health. Structural equation modeling is a promising approach in evaluating the effectiveness of DGBL programs.

Hope and Hopelessness: The Role of Hope in Buffering the Impact of Hopelessness on Suicidal Ideation.

OBJECTIVES: The present study investigated whether hope and hopelessness are better conceptualized as a single construct of bipolar spectrum or two distinct constructs and whether hope can moderate the relationship between hopelessness and suicidal ideation. METHODS: Hope, hopelessness, and suicidal ideation were measured in a community sample of 2106 participants through a population-based household survey. RESULTS: Confirmatory factor analyses showed that a measurement model with separate, correlated second-order factors of hope and hopelessness provided a good fit to the data and was significantly better than that of the model collapsing hope and hopelessness into a single second-order factor. Negative binomial regression showed that hope and hopelessness interacted such that the effect of hopelessness on suicidal ideation was lower in individuals with higher hope than individuals with lower hope. CONCLUSIONS: Hope and hopelessness are two distinct but correlated constructs. Hope can act as a resilience factor that buffers the impact of hopelessness on suicidal ideation. Inducing hope in people may be a promising avenue for suicide prevention.