A Prospective Study of Psychache and its Relationship to Suicidality
Suicide Ideation , Psychache
Suicide takes the lives of over 3,500 Canadians each year, making prevention an important public health concern. Identifying psychological predictors of suicide risk is essential because these variables may be amenable to change in treatment, unlike demographic or historical factors. Although past research reveals that both hopelessness and depression are moderately strong predictors of suicidal outcomes, neither one of these constructs alone, or combined, is able to fully account for suicidality. Shneidman postulated that a different psychological construct, termed psychache, is a unique predictor of suicide when controlling for depression and hopelessness, and research has supported this assertion. Although evidence for psychache as a predictor of suicidal outcomes is accumulating, previous research has limitations, namely the use of cross-sectional research and a focus on healthy student populations. In addition, it has been suggested that because scales measuring depression, hopelessness, and psychache correlate highly, they are not distinct constructs, but instead represent a single syndrome. The general purpose of the current studies is to establish the importance of psychache as a predictor of suicidal ideation. In order to address past limitations in the literature on psychache, three related studies were conducted. The first study was cross-sectional and examined a general group of undergraduate students. Factor analysis showed that psychache, depression, and hopelessness are three correlated, but distinct, variables. The second study was a longitudinal study where self-report measures were administered to high-risk undergraduate students. A two-year follow-up revealed that psychache was the only significant predictor of suicidal ideation at follow-up, and that its inclusion rendered the predictive value of depression and hopelessness to nonsignificant levels. The final study involved two groups of undergraduates and was a longitudinal study with a five-month follow-up. One group was a general university sample, and the other was a group of high-risk students. The two groups were analyzed separately, but showed almost identical results, lending support to the generalization of results from university samples to clinical samples. In addition, for each group, psychache was a unique predictor of suicidal ideation and suicide preparation, after controlling for depression and hopelessness. Overall, these studies suggest that psychache is distinct from depression and hopelessness, and is a better predictor of suicidality than depression or hopelessness when studied longitudinally in both general and high-risk undergraduate students. The findings also indicate congruence between low and high-risk samples, highlighting the generalizability of psychache as a predictor. This research has implications for the assessment of suicide risk and treatment for individuals experiencing suicidal ideation. It is hoped that these studies will help bring psychache forward as a pre-eminent risk factor alongside depression and hopelessness.