Multivariate Associations Between R-PAS Variables and Suicidal Ideation and Behaviors in Help-Seeking Adolescents

Background/Objectives: Suicidal ideation and behavior in adolescence remain difficult to assess due to their multifactorial and fluctuating nature. Performance-based measures may provide additional information on psychological correlates associated with suicidality beyond self-report and interview data. Methods: This study examined multivariate associations between RorschachPerformance Assessment System (R-PAS) variables and suicidality in a clinical sample of 153 help-seeking adolescents. Elastic net penalized regression models were estimated to evaluate joint patterns of R-PAS variables derived from the Suicide Concern Composite (SC-Comp) and selected developmentally relevant indices, controlling for age, sex at birth, sociodemographic and clinical factors. Suicidal ideation severity and lifetime suicidal behavior were assessed using the Columbia-Suicide Severity Rating Scale (C-SSRS). Results: For both outcomes, morbid content (MOR) and Location, Space, and Object Qualities-Complexity (LSO-Cmplx) emerged as consistent multivariate correlates, with vigilance-avoidance (VFD) contributing only in the model for suicidal ideation severity. Model performance was modest (R² = 0.09), indicating limited explanatory power. The findings do not support clinical or predictive use of R-PAS variables for suicidal ideation and behaviors, but indicate a small set of reproducible multivariate associations within this sample. Conclusions: The results suggest that certain R-PAS variables show weak but consistent associations with suicidality in a help-seeking adolescent sample. Given the cross-sectional design and modest explanatory power, the findings should be interpreted as exploratory and hypothesis-generating, and further studies are needed to clarify the robustness and meaning of these associations.