Original Article
A Brief Measure of Unbearable Psychache
Mikayla C. Pachkowski BA,
Alexis M. May PhD,
Michelle Tsai MA,
E. David Klonsky PhD,
Corresponding Author
Mikayla C. Pachkowski BA
Department of Psychology, University of British Columbia, Vancouver, BC, Canada
Address correspondence to Mikayla C. Pachkowski, Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, BC, Canada V6T1Z4; E-mail: [email protected].Search for more papers by this authorAlexis M. May PhD
Department of Psychology, Wesleyan University, Middletown, CT, USA
Search for more papers by this authorMichelle Tsai MA
Surrey Mental Health & Substance Use Services, Fraser Health Authority, Surrey, BC, Canada
Search for more papers by this authorE. David Klonsky PhD
Department of Psychology, University of British Columbia, Vancouver, BC, Canada
Search for more papers by this authorMikayla C. Pachkowski BA,
Alexis M. May PhD,
Michelle Tsai MA,
E. David Klonsky PhD,
Corresponding Author
Mikayla C. Pachkowski BA
Department of Psychology, University of British Columbia, Vancouver, BC, Canada
Address correspondence to Mikayla C. Pachkowski, Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, BC, Canada V6T1Z4; E-mail: [email protected].Search for more papers by this authorAlexis M. May PhD
Department of Psychology, Wesleyan University, Middletown, CT, USA
Search for more papers by this authorMichelle Tsai MA
Surrey Mental Health & Substance Use Services, Fraser Health Authority, Surrey, BC, Canada
Search for more papers by this authorE. David Klonsky PhD
Department of Psychology, University of British Columbia, Vancouver, BC, Canada
Search for more papers by this authorThis study was supported by a grant from the Surrey Hospital and Outpatient Centre Foundation and by the Fraser Health Authority.
Abstract
Objective
Psychache has been proposed to cause suicide when it becomes unbearable. However, existing measures of psychache do not directly target unbearable psychache. Thus, the purpose of the current study was to provide initial validation for a brief measure of unbearable psychache.
Method
Three items were selected to create the Unbearable Psychache Scale (UP3). Psychometric properties were assessed in two populations: (1) an online sample composed of 1,006 adults (53% male) from various locations in the United States and (2) a sample of 190 psychiatric inpatient adults (47% male) from a hospital in Western Canada.
Results
In both samples, the UP3 demonstrated excellent internal reliability, and strong convergent and predictive validity. Additionally, the UP3 predicted significant variance in suicidal ideation over and above documented correlates of suicidal ideation including general psychache, hopelessness, perceived burdensomeness, and low belongingness.
Conclusions
The UP3 is a brief, psychometrically sound measure of unbearable psychache that may be well-suited for use in research protocols and clinical assessments.
References
- Abramson, L. Y., Alloy, L. B., Hogan, M. E., Whitehouse, W. G., Gibb, B. E., Hankin, B. L., et al. (2000). The hopelessness theory of suicidality. In T. Joiner, & M. D. Rudd (Eds.), Suicide science: Expanding the boundaries (pp. 17–32). Norwell, MA: Kluwer Academic Publishers.
- Aish, A. M., Wasserman, D., & Renberg, E. S. (2001). Does Beck's Hopelessness Scale really measure several components? Psychological Medicine, 31(2), 367–372. https://doi.org/10.1017/S0033291701003300
- Beck, A. T., Brown, G. K., & Steer, R. A. (1997). Psychometric characteristics of the scale for suicide ideation with psychiatric outpatients. Behaviour Research and Therapy, 35(11), 1039–1046. https://doi.org/10.1016/S0005-7967(97)00073-9
- Beck, A. T., Kovacs, M., & Weissman, A. (1979). Assessment of suicidal intention: The scale for suicidal ideation. Journal of Consulting and Clinical Psychology, 47, 343–352. https://doi.org/10.1037/0022-006X.47.2.343
- Beck, A. T., & Steer, R. A. (1991). Manual for Beck Scale for Suicide Ideation. San Antonio, TX: Psychological Corporation.
- Beck, A. T., Steer, R. A., Kovacs, M., & Garrison, B. (1985). Hopelessness and eventual suicide: A 10-year prospective study of patients hospitalized with suicidal ideation. The American Journal of Psychiatry, 142(5), 559–563. https://doi.org/10.1176/ajp.142.5.559
- Beck, A. T., Weissman, A., Lester, D., & Trexler, L. (1974). The measurement of pessimism: The Hopelessness Scale. Journal of Consulting and Clinical Psychology, 42(6), 861–865. https://doi.org/10.1037/h0037562
- Behrend, T. S., Sharek, D. J., Meade, A. W., & Wiebe, E. N. (2011). The viability of crowdsourcing for survey research. Behavior Research Methods, 43(3), 800–813. https://doi.org/10.3758/s13428-011-0081-0
- Berlim, M. T., Mattevi, B. S., Pavanello, D. P., Caldieraro, M. A., Fleck, M. P. A., Wingate, L. R., et al. (2003). Psychache and suicidality in adult mood disordered outpatients in Brazil. Suicide and Life-Threatening Behavior, 33(3), 242–248. https://doi.org/10.1521/suli.33.3.242.23220
- Brener, N. D., Kann, L., McManus, T., Kinchen, S. A., Sundberg, E. C., & Ross, J. G. (2002). Reliability of the 1999 Youth Risk Behavior Survey questionnaire. The Journal of Adolescent Health, 31(4), 336–342. https://doi.org/10.1016/S1054-139X(02)00339-7
- Bryan, C. J. (2011). The clinical utility of a brief measure of perceived burdensomeness and thwarted belongingness for the detection of suicidal military personnel. Journal of Clinical Psychology, 67(10), 981–992. https://doi.org/10.1002/jclp.20726
- Bryan, C. J., David Rudd, M., Wertenberger, E., Etienne, N., Ray-Sannerud, B. N., Morrow, C. E., et al. (2014). Improving the detection and prediction of suicidal behavior among military personnel by measuring suicidal beliefs: An evaluation of the Suicide Cognitions Scale. Journal of Affective Disorders, 159, 15–22. https://doi.org/10.1016/j.jad.2014.02.021
- Bryan, C. J., Kanzler, K. E., Grieser, E., Martinez, A., Allison, S., & McGeary, D. (2017). A shortened version of the Suicide Cognitions Scale for identifying chronic pain patients at risk for suicide. Pain Practice, 17(3), 371–381. https://doi.org/10.1111/papr.12464
- Buhrmester, M., Kwang, T., & Gosling, S. D. (2011). Amazon's Mechanical Turk. Perspectives on Psychological Science, 6(1), 3–5. https://doi.org/10.1177/1745691610393980
- Campos, R. C., Gomes, M., Holden, R. R., Piteira, M., & Rainha, A. (2017). Does psychache mediate the relationship between general distress and suicide ideation? Death Studies, 41(4), 241–245. https://doi.org/10.1080/07481187.2016.1251510
- Chesney, E., Goodwin, G. M., & Fazel, S. (2014). Risks of all-cause and suicide mortality in mental disorders: A meta-review. World Psychiatry, 13(2), 153–160. https://doi.org/10.1002/wps.20128
- Chin, J., & Holden, R. R. (2013). Multidimensional future time perspective as moderators of the relationships between suicide motivation, preparation, and its predictors. Suicide and Life-Threatening Behavior, 43(4), 395–405. https://doi.org/10.1111/sltb.12025
- Chu, C., Buchman-Schmitt, J. M., Stanley, I. H., Hom, M. A., Tucker, R. P., Hagan, C. R., et al. (2017). The interpersonal theory of suicide: A systematic review and meta-analysis of a decade of cross-national research. Psychological Bulletin, 143(12), 1313–1345. https://doi.org/10.1037/bul0000123
- Chu, C., Klein, K. M., Buchman-Schmitt, J. M., Hom, M. A., Hagan, C. R., & Joiner, T. E. (2015). Routinized assessment of suicide risk in clinical practice: An empirically informed update. Journal of Clinical Psychology, 71(12), 1186–1200. https://doi.org/10.1002/jclp.22210
- Conejero, I., Olié, E., Calati, R., Ducasse, D., & Courtet, P. (2018). Psychological pain, depression, and suicide: Recent evidences and future directions. Current Psychiatry Reports, 20(5), 33. https://doi.org/10.1007/s11920-018-0893-z
- DeLisle, M. M., & Holden, R. R. (2009). Differentiating between depression, hopelessness, and psychache in university undergraduates. Measurement and Evaluation in Counseling and Development, 42(1), 46–63. https://doi.org/10.1177/0748175609333562
- Dhingra, K., Klonsky, E. D., & Tapola, V. (2018). An empirical test of the three-step theory of suicide in U.K. university students. Suicide and Life-Threatening Behavior, 49, 1–10. https://doi.org/10.1111/sltb.12437
- Ducasse, D., Holden, R. R., Boyer, L., Artéro, S., Calati, R., Guillaume, S., et al. (2018). Psychological pain in suicidality. The Journal of Clinical Psychiatry, 79(3), 22–27. https://doi.org/10.4088/JCP.16r10732
- Flamenbaum, R., & Holden, R. R. (2007). Psychache as a mediator in the relationship between perfectionism and suicidality. Journal of Counseling Psychology, 54(1), 51–61. https://doi.org/10.1037/0022-0167.54.1.51
- Franklin, J. C., Ribeiro, J. D., Fox, K. R., Bentley, K. H., Kleiman, E. M., Huang, X., et al. (2017). Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research. Psychological Bulletin, 143(2), 187–232. https://doi.org/10.1037/bul0000084
- Gvion, Y., Horresh, N., Levi-Belz, Y., Fischel, T., Treves, I., Weiser, M., et al. (2014). Aggression-impulsivity, mental pain, and communication difficulties in medically serious and medically non-serious suicide attempters. Comprehensive Psychiatry, 55(1), 40–50. https://doi.org/10.1016/j.comppsych.2013.09.003
- Hill, R. M., Rey, Y., Marin, C. E., Sharp, C., Green, K. L., & Pettit, J. W. (2015). Evaluating the Interpersonal Needs Questionnaire: Comparison of the reliability, factor structure, and predictive validity across five versions. Suicide and Life-Threatening Behavior, 45(3), 302–314. https://doi.org/10.1111/sltb.12129
- Holden, R. R., Mehta, K., Cunningham, E. J., & McLeod, L. D. (2001). Development and preliminary validation of a scale of psychache. Canadian Journal of Behavioural Science, 33(4), 224–232. https://doi.org/10.1037/h0087144
- Joiner, T. (2005). Why people die by suicide. Cambridge, MA: Harvard University Press.
- Klonsky, E. D., & May, A. M. (2015). The three-step theory (3ST): A new theory of suicide rooted in the “ideation-to-action” framework. International Journal of Cognitive Therapy, 8(2), 114–129. https://doi.org/10.1521/ijct.2015.8.2.114
- Klonsky, E. D., May, A. M., & Saffer, B. Y. (2016). Suicide, suicide attempts, and suicidal ideation. Annual Review of Clinical Psychology, 12(1), 307–330. https://doi.org/10.1146/annurev-clinpsy-021815-093204
- Kolbe, L. J., Kann, L., & Collins, J. L. (1993). Overview of the youth risk behavior surveillance system. Public Health Reports (Washington, D.C. 1974), 108 (Suppl 2), 2–10.
- Levi, Y., Horesh, N., Fischel, T., Treves, I., Or, E., & Apter, A. (2008). Mental pain and its communication in medically serious suicide attempts: An “impossible situation”. Journal of Affective Disorders, 111(2–3), 244–250. https://doi.org/10.1016/j.jad.2008.02.022
- May, A. M., & Klonsky, E. D. (2011). Validity of suicidality items from the Youth Risk Behavior Survey in a high school sample. Assessment, 18(3), 379–381. https://doi.org/10.1177/1073191110374285
- May, A. M., & Klonsky, E. D. (2013). Assessing motivations for suicide attempts: Development and psychometric properties of the Inventory of Motivations for Suicide Attempts. Suicide and Life-Threatening Behavior, 43(5), 532–546. https://doi.org/10.1111/sltb.12037
- May, A. M., O'Brien, K. H. M., Liu, R. T., & Klonsky, E. D. (2016). Descriptive and psychometric properties of the Inventory of Motivations for Suicide Attempts (IMSA) in an inpatient adolescent sample. Archives of Suicide Research, 20(3), 476–482. https://doi.org/10.1080/13811118.2015.1095688
- Mee, S., Bunney, B. G., Bunney, W. E., Hetrick, W., Potkin, S. G., & Reist, C. (2011). Assessment of psychological pain in major depressive episodes. Journal of Psychiatric Research, 45, 1504–1510. https://doi.org/10.1016/j.jpsychires.2011.06.011
- Meerwijk, E. L., & Weiss, S. J. (2011). Toward a unifying definition of psychological pain. Journal of Loss and Trauma, 16(5), 402–412. https://doi.org/10.1080/15325024.2011.572044
- Mills, J. F., Green, K., & Reddon, J. R. (2005). An evaluation of the Psychache Scale on an offender population. Suicide and Life-Threatening Behavior, 35(5), 570–580. https://doi.org/10.1521/suli.2005.35.5.570
- Montemarano, V., Troister, T., Lambert, C. E., & Holden, R. R. (2018). A four-year longitudinal study examining psychache and suicide ideation in elevated-risk undergraduates: A test of Shneidman's model of suicidal behavior. Journal of Clinical Psychology, 74, 1–13. https://doi.org/10.1002/jclp.22639
- Nock, M. K., Borges, G., Bromet, E. J., Alonso, J., Angermeyer, M., Beautrais, A., et al. (2008). Cross-national prevalence and risk factors for suicidal ideation, plans and attempts. British Journal of Psychiatry, 192(2), 98–105. https://doi.org/10.1192/bjp.bp.107.040113
- Nock, M. K., Holmberg, E. B., Photos, V. I., & Michel, B. D. (2007). Self-injurious thoughts and behaviors interview: Development, reliability, and validity in an adolescent sample. Psychological Assessment, 19(3), 309–317. https://doi.org/10.1037/1040-3590.19.3.309
- O'Connor, R. C. (2011). Towards an integrated motivational-volitional model of suicidal behaviour. In R. C. O'Connor, S. Platt, & J. Gordon (Eds.), International handbook of suicide prevention: Research, policy, and practice (pp. 181–198). Chichester, UK: Wiley-Blackwell.
10.1002/9781119998556.ch11 Google Scholar
- O'Connor, R. C., & Nock, M. K. (2014). The psychology of suicidal behaviour. The Lancet. Psychiatry, 1(1), 73–85. https://doi.org/10.1016/S2215-0366(14)70222-6
- Olié, E., Guillaume, S., Jaussent, I., Courtet, P., & Jollant, F. (2010). Higher psychological pain during a major depressive episode may be a factor of vulnerability to suicidal ideation and act. Journal of Affective Disorders, 120(1–3), 226–230. https://doi.org/10.1016/j.jad.2009.03.013
- Orbach, I., Mikulincer, M., Sirota, P., & Gilboa-Schechtman, E. (2003). Mental pain: A multidimensional operationalization and definition. Suicide and Life-Threatening Behavior, 33(3), 219–230. https://doi.org/10.1521/suli.33.3.219.23219
- Patterson, A. A., & Holden, R. R. (2012). Psychache and suicide ideation among men who are homeless: A test of Shneidman's model. Suicide and Life-Threatening Behavior, 42(2), 147–156. https://doi.org/10.1111/j.1943-278X.2011.00078.x
- Rizvi, S. J., Iskric, A., Calati, R., & Courtet, P. (2017). Psychological and physical pain as predictors of suicide risk: Evidence from clinical and neuroimaging findings. Current Opinion in Psychiatry, 30(2), 159–167. https://doi.org/10.1097/YCO.0000000000000314
- Shahnaz, A., Saffer, B. Y., & Klonsky, E. D. (2018). The relationship of perfectionism to suicide ideation and attempts in a large online sample. Personality and Individual Differences, 130, 117–121. https://doi.org/10.1016/j.paid.2018.04.002
- Shneidman, E. S. (1993). Suicide as psychache: A clinical approach to self-destructive behavior. Northvale, NJ: Aronson.
- Shneidman, E. S. (1996). The suicidal mind. New York, NY: Oxford University Press.
10.1093/oso/9780195103663.001.0001 Google Scholar
- Shneidman, E. S. (1998). Perspectives on suicidology. Further reflections on suicide and psychache. Suicide and Life-Threatening Behavior, 28(3), 245–250. https://doi.org/10.1111/j.1943-278X.1998.tb00854.x
- Shneidman, E. S. (1999). The Psychological Pain Assessment Scale. Suicide and Life-Threatening Behavior, 29(4), 287–294. https://doi.org/10.1111/j.1943-278X.1999.tb00524.x
- Tillman, J. G., Clemence, A. J., Cree, R., Lewis, K. C., Stevens, J. L., & Reiss, D. (2017). The persistent shadow of suicide ideation and attempts in a high-risk group of psychiatric patients: A focus for intervention. Comprehensive Psychiatry, 77, 20–26. https://doi.org/10.1016/j.comppsych.2017.05.005
- Tossani, E. (2013). The concept of mental pain. Psychotherapy and Psychosomatics, 82(2), 67–73. https://doi.org/10.1159/000343003
- Troister, T., Davis, M. P., Lowndes, A., & Holden, R. R. (2013). A five-month longitudinal study of psychache and suicide ideation: Replication in general and high-risk university students. Suicide and Life-Threatening Behavior, 43(6), 611–620. https://doi.org/10.1111/sltb.12043
- Troister, T., & Holden, R. R. (2010). Comparing psychache, depression, and hopelessness in their associations with suicidality: A test of Shneidman's theory of suicide. Personality and Individual Differences, 49(7), 689–693. https://doi.org/10.1016/j.paid.2010.06.006
- Troister, T., & Holden, R. R. (2012). A two-year prospective study of psychache and its relationship to suicidality among high-risk undergraduates. Journal of Clinical Psychology, 68(9), 1019–1027. https://doi.org/10.1002/jclp.21869
- Troister, T., & Holden, R. R. (2013). Factorial differentiation among depression, hopelessness, and psychache in statistically predicting suicidality. Measurement and Evaluation in Counseling and Development, 46(1), 50–63. https://doi.org/10.1177/0748175612451744
- Van Orden, K. A., Cukrowicz, K. C., Witte, T. K., & Joiner, T. E. (2012). Thwarted belongingness and perceived burdensomeness: Construct validity and psychometric properties of the Interpersonal Needs Questionnaire. Psychological Assessment, 24(1), 197–215. https://doi.org/10.1037/a0025358
- Van Orden, K. A., Witte, T. K., Gordon, K. H., Bender, T. W., & Joiner, T. E. (2008). Suicidal desire and the capability for suicide: Tests of the interpersonal-psychological theory of suicidal behavior among adults. Journal of Consulting and Clinical Psychology, 76(1), 72–83. https://doi.org/10.1037/0022-006X.76.1.72
- Verrocchio, M. C., Carrozzino, D., Marchetti, D., Andreasson, K., Fulcheri, M., & Bech, P. (2016). Mental pain and suicide: A systematic review of the literature. Frontiers in Psychiatry, 7, 108. https://doi.org/10.3389/fpsyt.2016.00108
- WHOQOL (1998). Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychological Medicine, 28(3), 551–558.
- World Health Organization (2014). Preventing suicide: A global imperative. Geneva, Switzerland: World Health OrganizationRetrieved from http://apps.who.int/iris/bitstream/10665/131056/1/9789241564779_eng.pdf?ua=1.
- Yip, P. S. F., & Cheung, Y. B. (2006). Quick assessment of hopelessness: A cross-sectional study. Health and Quality of Life Outcomes, 4, 1–6. https://doi.org/10.1186/1477-7525-4-13
