(PS11-11) Assessing Psychological Pain Across Three Measures Among College Students with a History of Suicidal Ideation

In 2020, 13.4% of college students experienced suicidal ideation (SI) (DeVylder et al., 2021). Psychological pain (also known as psychache), an intense feeling of suffering (Chen et al., 2023), is strongly associated with SI (Rakoff et al., 2023). Several instruments have been developed that include items assessing psychological pain, including the 3-item Psychache Scale (PAS; Holden et al., 2001), the 6-item unbearability subscale of the Suicide Cognitions Scale (SCS; Rudd & Bryan, 2021), and one item on the Attentional Fixation on Suicide Experiences Questionnaire-Revised (AFSEQ-R, Mandel et al., 2022), specifically “I couldn’t take it anymore.” We sought to examine the relationship between psychological pain measured across these three instruments, as well as the degree to which other forms of suicide-related cognitions, such as unlovability and unsolvability as captured by the SCS and AFSEQ-R, explain unique variance in SI beyond psychological pain. The sample consisted of 56 college students (mean age = 19.6±2.2, 68% assigned female at birth) who endorsed a lifetime history of SI on the Self-injurious Thoughts and Behaviors Interview (Fox et al., 2020). Participants completed self-report measures, including the PAS, SCS, AFSEQ-R, Beck Hopelessness Scale (BHS, Beck et al., 1974), and Beck Depression Inventory – 2nd Edition (BDI-II, Beck et al., 1996), as part of a larger study of suicide-related cognitions. 37.5% (n = 21) endorsed SI in the past 2 weeks on BDI-II item #9. A principal components analysis found a single component, including all 10 psychache-related items (from the PAS, SCS-unbearability, AFSEQ-R item #3) explained 64.2% of the variance. Scores on the PAS were correlated with subscale scores on the SCS and AFSEQ-R (rs = .34 - .77), with 59% variance shared between the PAS and SCS-unbearability. Multivariate logistic regression analyses found that only PAS scores predicted the presence of SI (OR = 1.42, 95%CI[1.07, 1.89]; OR = 1.37, 95%CI[1.04, 1.64]) but not total scores on the SCS (OR = .99, 95%CI[.90,1.08]) or AFSEQ-R (OR = 1.04, 95%CI[.98, 1.11]). Finally, the relationship between PAS and presence of SI was not mediated by BHS scores, as the direct effect was significant (β = .24, p = .04), but the indirect effect through BHS was not (β = .11, p = .09). In conclusion, psychological pain is a particularly influential cognitive risk factor for SI among college students and maybe a more important target than related constructs, such as thoughts of unlovability, unsolvability, or hopelessness.