An Ecological Momentary Assessment Study of the Influence of Psychic Pain on Suicidal Ideation and Planning

Psychic pain (PsyPn) refers to intense emotional suffering that is experienced as both unbearable and irreversible. PsyPn has been shown in cross-sectional studies to be associated with greater depression, distress, and suicide risk. Although PsyPn is frequently discussed as a primary driver of suicide, few studies have evaluated its short-term predictive value for detecting changes in risk, and few have examined how PsyPn influences risk in interaction with other established factors, such as hopelessness. To address these gaps, the current study utilized ecological momentary assessment (EMA) to identify links between PsyPn, well-established psychosocial risk factors for suicide (hopelessness, loneliness, and burdensomeness), and the short-term emergence of suicidal ideation (SI) and planning. Thirty-nine adults across three clinical sites enrolled in the study after being identified during prescreen as being at elevated suicide risk. Subjects completed a baseline measure of vulnerability to PsyPn (Psychic Pain Scale), followed by an EMA protocol evaluating negative mental states, PsyPn, and SI and planning six times daily over a 14-day period. Multilevel modeling was used to estimate both within-and between-person associations between PsyPn, negative mental states, and SI and planning. Across suicide-related outcomes and timescales, PsyPn was associated with increased suicide risk, and greater PsyPn at both baseline and near-term levels amplified the influence of other daily living risk factors on suicide-related outcomes. The implications of these findings for suicide risk assessment and intervention are discussed, particularly in terms of informing specific targets and timescales of interventions.