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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.
This book offers a theoretical framework for diagnosis and risk assessment of a patient's entry into the world of suicidality, and for the creation of preventive and public-health campaigns aimed at the disorder. The book also provides clinical guidelines for crisis intervention and therapeutic alliances in psychotherapy and suicide prevention.
Suicide is undoubtedly a worldwide major challenge for the public health. It is estimated that more than 150,000 persons in Europe die as a result of suicide every year and in several European countries suicide represents the principal cause of death among young people aged 14–25 years. It is true that suicide is a complex (and yet not fully understood) phenomenon and may be determined by the interaction between various factors, such as neurobiology, personal and familiar history, stressful events, sociocultural environment, etc. The suicide is always a plague for the population at risk and one of the most disgraceful events for a human being. Moreover, it implies a lot of pain often shared by the relatives and persons who are close to suicide subjects. Furthermore, it has been widely demonstrated that the loss of a subject due to suicide may be one of the most distressing events that may occur in mental health professionals resulting in several negative consequences, such as burnout, development of psychiatric symptoms and lower quality of life and work productivity. All considered, it is clear that the suicide prevention is a worldwide priority and every effort should be made in order to improve the early recognition of imminent suicide, manage suicidal subjects, and strengthen suicide prevention strategies. In our opinion, the first step of prevention is the improvement of knowledge in the field: this was the aim of this present special issue on Frontiers in Psychiatry. In this special issue, several papers have contributed to the suicide knowledge from several viewpoints and we hope that this will contribute to improve and disseminate knowledge on this topic.
Suicidal ideation among the homeless is 10 times greater than in the general population. Therefore, research helping mental health professionals better predict and potentially prevent suicide within the homeless population is an important societal focus. Various cognitive theories of depression and hopelessness have been proposed to explain suicidality, however, to date, none of these are able to fully explain the phenomenon. More recently, Shneidman has suggested a theory of psychache (i.e., unbearable psychological pain) to explain suicidality. Although this theory has been supported by investigations with university students, there has not been much research exploring psychache with populations at high risk for suicide. The current study attempts to assess Shneidman's theory with a high risk population, namely the homeless. Ninety-seven men were recruited at homeless shelters and drop-in centres. Participants completed questionnaires assessing criterion measures of suicidality and psychological predictors of depression, hopelessness, life meaning, and psychache. Analyses revealed that psychache was the only variable with statistical predictive ability over and above the other three psychological variables in predicting suicide ideation, motivation, preparation, and attempt history. This finding indicates that psychache is a better predictor of suicidality than depression, hopelessness, and life meaning and supports Shneidman's model of psychache as the most proximal cause of suicide. Results also indicate the potential use of a scale assessing psychache in mental health settings to predict those who are, and are not, at risk for suicide.
Shneidman presents basic ideas of the common characteristics of suicide. He offers a fresh definition of the phenomenon, which includes direct implications for preventive action.
First Published in 1999. Routledge is an imprint of Taylor & Francis, an informa company.
The Suicidal Crisis has everything clinicians need to evaluate the risk of imminent suicide. What sets it apart is its clinical focus on those at the highest risk--the book includes individual case studies of acutely suicidal individuals, detailed instructions on how to conduct risk assessments, test cases with answer keys, and empirically validated Suicidal Crisis risk assessment scales.
In this book international experts address a range of key current issues relating to suicide. The opening chapters discuss nosology, definitions, clinical determinants, and conceptual models of the suicide process and consider the evidence regarding potential biomarkers of suicide risk based on neuroscientific research. Adopting a neo-Durkheimian perspective, the role of various social factors in the genesis of suicidal behavior is then explored in depth. Practical user-friendly tools that facilitate risk assessment by clinicians are provided, and detailed consideration is given to efficient and innovative strategies for the prevention of suicide and the treatment of suicidal behavior, such as psychotherapy, psychopharmacological approaches, and effective organization of care, including surveillance and the use of online tools. The final part of the book focuses on the need for and development of a personalized approach within the field of suicide prevention.
Drawing on more than 60 years of experience in the field of suicidology, Edwin S. Shneidman has compiled and reflected on the 13 most thought-provoking works on suicide from the 20th century. Serving a large audience, this volume will be of interest to those doing research, those helping prevent suicide through community intervention or clinical practice, and those who have been touched by suicide in some personal capacity.