Psychological pain as a predictor of suicidality: A longitudinal, prospective study
According to Shneidman, suicide is primarily the result of psychological pain, or subjective psychological distress from negative emotions including sadness, loneliness, and anxiety. Several studies report that psychological pain is correlated with past depression, suicidal ideation, and suicide attempts. The current study distinguishes psychological pain as a risk factor for suicidal behavior that is separate from depressive mood. It was hypothesized that psychological pain, even without depressive mood, would predict future suicidal behavior and mediate the effects of other risk factors for suicide.
This study reanalyzed data from the 10-year and 25-year follow-up interviews of the Copenhagen Schizophrenia High-Risk Project. The Copenhagen project started in 1962 with 207 children of mothers with schizophrenia and 104 children with no family history of mental illness. At baseline, the sample was 59% male, 75% from urban settings, and 15 years of age with 7 years of education on average.
Analysis of 2x2 contingency tables was used to assess simple risk factor associations with suicidal behavior, and hierarchical logistic regression was used to examine multivariate relationships. The psychological pain scale used in this study was developed by selecting items consistent with Shneidman's theory, followed by factor analysis and tests for reliability.
Psychological pain had a significant association with future suicidal behavior. Psychiatric disorders (Major Depression, Schizophrenia, and Substance Abuse) were also associated with future suicidal behavior. Presence of quality adult friends had a negative association with suicidal behavior. The psychiatric disorders and psychosocial factors that were associated with future suicidal behavior were also associated with psychological pain. Finally, the effects of most risk factors for suicidal behavior were mediated by psychological pain in the series of hierchical logistic regressions.
Psychological pain can help predict future suicidal behavior, even when depressive mood is not included in the construct. The effects of psychological pain would be strengthened with depressive mood included in the construct. Suicide prevention should focus on subjective psychological pain. Future studies can improve this research by including more subjective ratings, and using contemporary samples with greater racial and ethnic diversity.
0347: Mental health