Testing Shneidman's Theory of Suicide: Psychache as a Prospective Predictor of Suicidality and Comparison with Hopelessness
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Shneidman (1993) has theorized that psychache (i.e., intolerable psychological pain) is the key cause of suicide, and accounts for the effect of all other psychological factors. Two studies are presented that test Shneidman’s theory, and compare the influence of psychache on suicidality relative to that of hopelessness. In the first study, a causal hypothesis was examined using a longitudinal design. Undergraduate students (N = 588) completed measures of psychache, hopelessness, and suicide ideation at two time points four months apart. Results supported the hypothesis that psychache has a causal role in suicidality, as change in suicide ideation was predicted by change in psychache. However, the hypothesis that psychache would fully mediate the effect of hopelessness was not supported, as only a small and partial mediation effect was evidenced, and change in hopelessness also contributed unique variance to the prediction of suicide ideation. In a second study, the hypotheses that psychache is necessary and sufficient for suicide were examined. Undergraduate students (N = 1,333) were prescreened for high and low levels of psychache and hopelessness, and those who met cutoff criteria (N = 184) were selected to make up four groups with combinations of these constructs. Groups were compared with respect to various measures of suicide ideation, motivations, and behaviours using one-way multivariate analyses of variance. In general, dependent measures significantly differed by level of psychache, but not by level of hopelessness. This pattern of group differences supported the hypothesis that psychache is necessary for suicide. However, the claim that psychache is sufficient was not consistently supported, as some suicide criteria were significantly elevated only for groups exhibiting high levels of both psychache and hopelessness. Taken together, the results of this dissertation provide strong support for the key role of psychache in suicide and its parity with hopelessness as a statistical predictor of suicidality. These findings improve understanding of the suicidal state of mind, and have important implications for clinical practice.