Psychological Pain as a Risk Factor for Suicidal Ideation: An Ecological Momentary Assessment Study on Inpatients With Depression With and Without Comorbid Borderline Personality Disorder.

Objective

Psychological pain (PP) is a potentially important risk factor for suicide. However, its temporal stability and association with suicidal ideation (SI) remain obscure. Whether PP represents a risk factor for SI independently of depression, anxiety, and hopelessness or is more prominent and temporally unstable in patients with depression and borderline personality disorder (BPD) is also unclear.

Methods

From November 2020 to December 2022, psychiatric inpatients with depression without (N = 37) and with (N = 30) BPD were recruited to an ecological momentary assessment (EMA) study, wherein their PP, severity of depression, SI, and hopelessness were assessed 3 times daily using visual analog scales. Multilevel regression models were estimated.

Results

Altogether, 4,320 EMA observations were collected. PP correlated with hopelessness (r = 0.417), depression (r = 0.339), and anxiety (r = 0.496), but the between-patient variance of PP remained at 1.26 (95% CI, 1.025-1.533) after controlling for these variables. The within-patient variance of PP was associated with SI (β = 0.17 [95% CI, 0.12-0.22]) with a magnitude comparable to hopelessness (β = 0.1 [95% CI, 0.05-0.15]) and depression (β = 0.12 [95% CI, 0.08-0.17]). Patients with depression and BPD reported higher daily PP and SI (P < .001) and a more prominent within-patient variation in PP.

Conclusions

In psychiatric inpatients with depression, besides depression and hopelessness, PP represents an independent risk factor for SI, varying within a timescale of days. Depressive patients with BPD may experience more prominent and temporally unstable PP, likely underlying their higher vulnerability to SI.