Self-harm Ideation Research Articles

A prospective study of thoughts of self-harm and suicidal ideation during the postpartum period in women with mood disorders

Individuals with mood disorders are at higher risk for self-harm and suicidal ideation than other psychiatric group. However, the risk of self-harm and suicidal ideation after pregnancy for women with mood disorders is unknown. This investigation assessed the prevalence of thoughts of self-harm and suicidal ideation during the 1-year postpartum period in women with major depressive disorder or bipolar II disorder. Data were collected between June 2005 and March 2010 from a convenience sample of women participating in a study on the course of mood disorders during pregnancy and postpartum. Participant diagnosis was confirmed using the Structured Clinical Interview for DSM-IV. Thoughts of self-harm were assessed using the Edinburgh Postnatal Depression Scale item 10 and suicidal ideation was assessed using the Hamilton Depression Rating Scale item 3. During the 1-year postpartum period, 16.97% reported thoughts of self-harm while 6.16% reported suicidal ideation. Further, those reporting thoughts of self-harm or suicidal ideation postpartum also reported higher levels of depression and hypomanic symptoms. We found that a number of women in our sample of women with a diagnosed mood disorder report experiencing thoughts of self-harm and suicidal ideation during the postpartum.

Self-harm and Suicide Attempts among Young Chinese Adolescents in Hong Kong: Prevalence, Correlates, and Changes

ObjectiveTo examine the prevalence of and changes in self-harm and suicide attempts and to predict these behaviors in relation to family functioning and positive youth development. DesignWe used quantitative data based on a large sample of adolescent participants. Participants had joined this study in a previous year when they were in Grade 7 (Wave 1). The present study focused on Wave 2 data and the comparison with Wave 1 data. Setting and ParticipantsThe participants consisted of 2,579 Grade 8 students from 28 secondary schools in Hong Kong. A multi-stage cluster random sampling was adopted. Main Outcome MeasureSelf-harm behavior, suicide attempt, the Chinese Family Assessment Instrument, the Chinese Positive Youth Development Scale. ResultsApproximately 23.5% of Grade 8 students had engaged in self-harm behavior in the preceding 12 months. Girls showed more self-harm behavior compared with the boys. Nearly 4.0% of adolescents attempted suicide in the preceding 12 months. Perceived family functioning and positive youth development predicted self-harm and suicidal ideation. Among the 4 second-order positive youth development qualities, the construct “general positive youth development qualities” was the strongest predictor of self-harm and suicide attempts. Compared with the Wave 1 data, more suicidal symptoms were observed in Wave 2, although the prevalence of self-harm behavior was similar across time. ConclusionsThe prevalence of self-harm behavior among Chinese adolescents was high, but the level of suicidal behavior was low. Perceived family functioning and positive youth development can be regarded as protective factors for adolescents against self-harm and suicidal behaviors. General positive youth development quality is most important among the 4 second-order positive youth development qualities.

Screening of Postpartum Women Shows High Rates of Depression

Back to table of contents Previous article Next article Clinical and Research NewsFull AccessScreening of Postpartum Women Shows High Rates of DepressionLeslie SinclairLeslie SinclairSearch for more papers by this authorPublished Online:3 May 2013https://doi.org/10.1176/appi.pn.2013.5a10AbstractResearchers say thorough screening of postpartum women will identify women seriously at risk for mental health disorders and save lives.Depression is a frequent complication of childbearing, but how useful is screening new mothers for depression? And what steps should be taken on the basis of such screening?Those are questions Katherine Wisner, M.D., and her colleagues sought to answer when they recently evaluated 10,000 mothers at an urban obstetrical hospital using the Edinburgh Postnatal Depression Scale (EPDS). Suicide accounts for about 20 percent of postpartum deaths. Childbearing is an opportune time for screening and intervention for maternal depression, because of the increased contact with health care professionals.NatesPics/Shutterstock.com In their study, published March 13 in JAMA Psychiatry, the researchers said that this is the largest American population to undergo screening with the EPDS. Wisner is director of the Northwestern University Asher Center for the Study and Treatment of Depressive Disorders, as well as the Norman and Helen Asher Professor of Psychiatry and Behavioral Sciences and a professor of obstetrics and gynecology at Northwestern University Feinberg School of Medicine in Chicago. Wisner was formerly a professor of psychiatry, obstetrics, gynecology, and reproductive sciences and epidemiology at the University of Pittsburgh School of Medicine and performed the research in this study there.Of the postpartum women Wisner and her colleagues screened, 14 percent (1,396 mothers) had positive findings. Screen-positive women were more likely to be younger, African American, publicly insured, single, and less well educated.More of the episodes began postpartum (40.1 percent), followed by those that began during pregnancy (33.4 percent) and before pregnancy (26.5 percent). In this population, 19.3 percent had thoughts about harming themselves; mothers with the highest intensity of self-harm ideation were identified with an EPDS score of 10 or higher. The most common primary diagnoses were unipolar depressive disorders (68.5 percent), and about two-thirds had comorbid anxiety disorders. The researchers noted that a striking number, 22.6 percent, had bipolar disorders and called for the development of strategies to differentiate women with bipolar from unipolar disorders. The overwhelming majority of those with unipolar disorders were identified as having major depressive disorder, a finding the researchers said was consistent with other epidemiological studies. “In the U.S., the vast majority of postpartum women with depression are not identified or treated even though they are at higher risk for psychiatric disorders,” said Wisner in a press release announcing the study. “It’s a huge public-health problem. A woman’s mental health has a profound effect on fetal development as well as her child’s physical and emotional development.” She also lamented that many women do not understand what is happening to them, thinking they’re just stressed or that their feelings are “how having a baby is supposed to feel.”Strengths of the study included the large heterogeneous population of non-treatment-seeking women and psychiatric diagnostic interviews with most of the women with positive screen results. The clinicians who were involved were highly trained to differentiate unipolar from bipolar depression, which may have accounted for the high rate of recognition of bipolar disorder among the participants. Wisner and colleagues noted that intervention for the women in this study, care management vs. usual care for women with depressive disorder, is being analyzed and will be presented in a separate publication. The study was supported by a grant from the National Institute of Mental Health. ■An abstract of “Onset Timing, Thoughts of Self-harm, and Diagnoses in Postpartum Women With Screen-Positive Depression Findings” is posted at http://archpsyc.jamanetwork.com/article.aspx?articleid=1666651. ISSUES NewArchived

Anger as a predictor of psychological distress and self-harm ideation in inmates: A structured self-assessment diary study

Suicidal ideation and behaviour are common among inmates. Anger is found at exaggerated levels and has been associated with suicidal ideation and behaviour in inmate samples suggesting its possible salience in the prediction of suicide. The study investigated relationships between anger, psychological distress, and self-harm/suicidal ideation among inmates. The principles of Ecological Momentary Assessment were considered and a structured self-assessment diary was utilised to examine relationships between the variables of interest. Participants completed a structured self-assessment diary for six consecutive days which included momentary ratings of items describing psychological states of concurrent affects, thoughts, and appraisals related to anger, psychological distress, and self-harm/suicidal ideation. Psychometric assessment measures were also conducted. Temporal associations between predictors and outcomes were investigated. Multilevel modelling analyses were performed. Increased anger was significantly associated with concurrent high levels of self-harm ideation in inmates, when controlling for depression and hopelessness. Temporal analyses also revealed that anger at one time point did not predict suicidal ideation at the next time point. Elucidating the temporal nature of the relationship between anger, psychological distress, and self-harm/suicidal ideation has advanced understanding of the mechanisms of suicidal behaviour, by demonstrating an increased risk of suicide when a male inmate is angry.

Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings.

The period prevalence of depression among women is 21.9% during the first postpartum year; however, questions remain about the value of screening for depression. To screen for depression in postpartum women and evaluate positive screen findings to determine the timing of episode onset, rate and intensity of self-harm ideation, and primary and secondary DSM-IV disorders to inform treatment and policy decisions. Sequential case series of women who recently gave birth. Urban academic women's hospital. During the maternity hospitalization, women were offered screening at 4 to 6 weeks post partum by telephone. Screen-positive women were invited to undergo psychiatric evaluations in their homes. A positive screen finding was an Edinburgh Postnatal Depression Scale (EPDS) score of 10 or higher. Self-harm ideation was assessed on EPDS item 10: "The thought of harming myself has occurred to me" (yes, quite often; sometimes; hardly ever; never). Screen-positive women underwent evaluation with the Structured Clinical Interview for DSM-IV for Axis I primary and secondary diagnoses. Ten thousand mothers underwent screening, with positive findings in 1396 (14.0%); of these, 826 (59.2%) completed the home visits and 147 (10.5%) completed a telephone diagnostic interview. Screen-positive women were more likely to be younger, African American, publicly insured, single, and less well educated. More episodes began post partum (40.1%), followed by during pregnancy (33.4%) and before pregnancy (26.5%). In this population, 19.3% had self-harm ideation. All mothers with the highest intensity of self-harm ideation were identified with the EPDS score of 10 or higher. The most common primary diagnoses were unipolar depressive disorders (68.5%), and almost two-thirds had comorbid anxiety disorders. A striking 22.6% had bipolar disorders. The most common diagnosis in screen-positive women was major depressive disorder with comorbid generalized anxiety disorder. Strategies to differentiate women with bipolar from unipolar disorders are needed. clinicaltrials.gov Identifier: NCT00282776.

Associations Between Frequency of Bullying Involvement and Adjustment in Adolescence

ObjectiveTo examine whether infrequent bullying perpetration and victimization (once or twice a month) are associated with elevated levels of internalizing and externalizing problems and to assess evidence for a minimum frequency threshold for bullying involvement. MethodsThe analytic sample included 128,681 6th, 9th, and 12th graders who completed the 2010 Minnesota Student Survey. Logistic regression and general linear models examined the association between bullying frequency and adjustment correlates including emotional distress, self-harm, physical fighting, and substance use while controlling for demographic characteristics. Gender and grade were included as moderators. ResultsInfrequent bullying perpetration and victimization were associated with increased levels of all adjustment problems relative to those who did not engage in bullying in the past 30 days. Grade moderated many of these findings, with perpetration frequency being more strongly related to substance use, self-harm, and suicidal ideation for 6th graders than 12th graders, whereas victimization frequency was associated with self-harm more strongly for 12th graders than 6th graders. Evidence for minimum thresholds for bullying involvement across all outcomes, grades, and bullying roles was inconsistent. ConclusionsInfrequent bullying involvement may pose risks to adolescent adjustment; thus, clinicians and school personnel should address even isolated instances of bullying behavior. Researchers should reexamine the use of cut points in bullying research in order to more fully understand the nature of bullying in adolescence. These data indicate the need for prevention and intervention programs that target diverse internalizing and externalizing problems for bullies and victims, regardless of bullying frequency.

Victimization and poly-victimization among school-aged Chinese adolescents: Prevalence and associations with health

ObjectiveGiven the limited number of systematic studies on child victimization in China, this study aimed to investigate the prevalence of child victimization and poly-victimization, and to examine the associations between victimization and negative health outcomes. MethodUsing a 2-stage stratified sampling procedure, 18,341 adolescents aged 15 to 17years old were recruited from 6 cities in China during 2009 and 2010. Adolescents completed a self-administered questionnaire containing items about child victimization and health outcomes (e.g. health-related quality of life, posttraumatic stress disorder [PTSD], depression, deliberate self-harm, and suicide ideation). Structured multiphase logistic regression analyses were conducted to examine the associations between these factors. ResultsThe lifetime prevalence of at least one form of victimization was 71%, whereas that of poly-victimization was 14%. Child victimization in the preceding year was associated with gender, age, number of siblings, and location of schools. Child victims were more likely to report PTSD and depressive symptoms, self-harm ideation, and poor physical and mental health. ConclusionThis study provided reliable estimates of the association between child victimization and health using a large and diverse sample in China. Based on the nature of the documented associations, several suggestions for public health professionals were offered.

Not hysteria: ovarian teratoma-associated anti-N-methyl-d-aspartate receptor encephalitis

We report a case of a 33-year-old nulliparous woman who, following a short prodromal illness, experienced a series of psychiatric and behavioural symptoms. These included states of terror, insomnia, delirium, self-harm and suicidal ideation, facial dyskinesias, verbigeration, cognitive impairment, reduced responsiveness, violence and paranoia. A diagnosis of anti-N-methyl-d-aspartate (NMDAR) encephalitis was made 50 days after symptom onset. Early tumour removal is associated with an improved prognosis and a laparoscopic oophorectomy was performed following detection of a dermoid cyst. Within 24 hours of the operation there was marked improvement in cognitive function and appetite.

Comparative Analysis of Mandated Versus Voluntary Administrations of Post-Deployment Health Assessments Among Marines

Little empirical data exist regarding candidness of service members' responses on the mandated Post-Deployment Health Reassessment (PDHRA) administered 3 to 6 months postdeployment. This study reports on the agreement between responses from U.S. Marines on a subset of the military-administered mandatory PDHRA items and answers to the same subset of items embedded in confidential research surveys. Results show that personnel are clearly underreporting certain symptoms and conditions on the mandatory PDHRA. The most dramatic increases in reporting on the research study's PDHRA items, as indicated by the percentage ratio, were for self-harming ideation and concern about harming others, each of which has about 14 times the endorsement percentage on the survey as on the official PDHRA. Lack of agreement for some items may be the result of resolution or onset of more acute conditions, but disagreement on sensitive behavioral concerns suggests that mandated PDHRAs are not effective screens for those domains.

Traumatic Stress among Homeless Young Adults: Challenges and Treatment Issues

Traumatic Stress among Homeless Young Adults: Challenges and Treatment Issues Homeless emerging adults are one of this nation’s most underserved populations and are particularly vulnerable to the detrimental effects of trauma exposure, including developing PTSD. These young people typically reside in unstable and often abusive situations marked by violence and danger. They survive on the street through engaging in high risk behaviors, such as dumpsterdiving for food, panhandling/begging for money, and selling drugs or sex for money or shelter. These conditions result in a significant risk for serious health and mental health problems, including malnutrition, sexually transmitted diseases, depressive symptoms, posttraumatic stress, drug overdose and increased potential for selfharm and suicidal ideation.

Emergency Department Assessment of Self-Harm Risk Using Psychometric Questionnaires

To examine several potential predictive screening tools for emergency department assessment of risk of self-harm. Adult patients presenting with self-harm or suicidal ideation were enrolled at 2 emergency departments at large teaching hospitals in Edmonton, Alberta. Patients completed a brief interview assessing demographics and psychiatric history and several questionnaires (the Beck Hopelessness Scale, the Barrett Impulsiveness Scale [BIS], and the Brief Symptom Inventory [BSI]) and drug and alcohol abuse screens (Drug Abuse Screening Test [DAST-10] and the Cut down, Annoyed, Guilt, Eye-opener [commonly referred to as CAGE] Questionnaire). At 3 months, patients were followed up via telephone and electronic health records to ascertain self-harm outcome. Questionnaires and their subscales were assessed using logistic regression. Receiver operating characteristic (ROC) analysis was performed on the results. Among the 157 patients enrolled, 49% were women and 36% (of the total) were aged 18 to 29 years. Several of the subscales of the BSI and BIS as well as the DAST-10 were significant predictors of self-harm (P < 0.05). ROC analysis showed that none of the scales in isolation were very strong predictors. Hierarchical regression analysis that combined the significant scales with clinical risk factors that were significantly related to self-harm (that is, age, education level, history of self-harm, and whether they presented with self-harm or only suicidal ideation) indicated that the BIS and DAST-10 questionnaires each added significantly to the predictive ability of a model with these risk factors. While many of the questionnaires and their related constructs are related to future self-harm, none of them are particularly strong and their diagnostic usefulness is limited.

Gender Roles, Suicidal Ideation, and Self-Harming in Young Adults

This study investigates whether positive and negative conventional gender roles relate to suicidal ideation and self-harming in different ways among young adults. Participants completed an online survey about previous self-harm, recent suicidal ideation, and positive and negative aspects of conventional masculinity and femininity. Logistic regression analyses showed that negative femininity positively predicted self-harm and recent suicidal ideation status. Positive femininity was unrelated. Positive masculinity was negatively related to suicidal ideation and self-harming while negative masculinity was negatively related to self-harming only. The findings suggest that it is not the conventional feminine gender role per se that is associated with suicidality but specific negatively evaluated aspects. Conceptualizing gender as a multivariate construct may be useful in the gender socialization theory of suicidal behavior.

Deliberate self-harm in children and adolescents: an 11-year case note study.

To retrospectively examine the case-notes of all children and adolescents admitted with deliberate self-harm (DSH) or suicidal ideation during the study period 1993-2003. The study aimed to identify underlying reasons why children and adolescents engage in DSH, and to identify common psychiatric, psychosocial and familial factors which may predispose or contribute to an individual's engagement in such behaviour. All children presenting to the hospital with DSH or suicidal ideation were identified and data collected from their case notes. A study specific questionnaire was designed to collect demographic details, details on clinical presentation, past attempts, comorbid psychiatry disorders, family history and family circumstances. Information was also recorded on hospital stay and discharge planning. During the 11-year period, 231 children presented with suicidal ideation or behaviour. The mean age was 12.85 with an age range from 6-17 years, with a female:male ratio of 2.5:1. Overdose was the most common method (81.2%) and paracetamol most commonly the drug of choice. More than half of the group (55.7%) expressed a wish to die. More than half (51.8%) had expressed suicidal ideation in the past, 31% had made a previous attempt, and 11.7% had been previously admitted. Of the children 8% presented with suicidal behaviour more than once over the study period. There was a family history of completed suicide in 6.6%. Deliberate self-harm in young people is a significant public health problem in Ireland. During the period of this study, rates have continued to increase. There is an urgent need for national bodies such as the National Suicide Review Group to extend their focus to include those under age 18 and for services to be developed that might reduce DSH behaviours. More research is needed in the area of childhood suicidal behaviour.

Displacement and Suicide Risk for Juvenile Justice-Involved Youth with Mental Health Issues

This article examined the relationship between suicide behaviors and displacement, as defined by out-of-home placement, in a sample of juvenile-justice-involved youth with mental health issues. Participants included boys and girls between the ages of 10 and 18 who were enrolled in a juvenile justice diversion program for children with mental or behavioral health problems. Data collected included youth-reported suicide and self-harm ideation, caregiver reports of previous suicide attempts, and whether the youth had been in an out-of-home placement in the year prior to enrollment in the program. Logistic regression analyses indicated that youth who had recently been in an out-of-home placement reported significantly less suicide ideation and marginally less self-harm ideation than youth who had not been in an out-of-home placement. Out-of-home placement status had no impact on caregiver reports of previous youth suicide attempts.

Providing 24-hour child and adolescent mental health services: demand and outcomes

Aims and methodThe provision of 24-hour specialist child and adolescent mental health services (CAMHS) is a key target for service commissioners. However, a lack of data exist on models of service delivery or levels of need for out-of-hours specialist CAMHS to guide service development. We aim to describe a model of 24-hour service provision and provide information on the demand for and outcome of assessments of a service in Dublin, Ireland, using a 6-year retrospective case study design.ResultsA total of 468 emergency presentations occurred during the study period; 80% presented with self-harm or suicidal ideation. Two-thirds presented outside of working hours. All presentations received a specialist CAMHS consultation. Over 50% required admission to a paediatric ward and 80% required onward referral to specialist CAMHS.Clinical implicationsThere is a need for a 24-hour specialist CAMHS and this allows increased rates of specialist assessment and onward referral for a high-risk group.

Does Screening High School Students for Psychological Distress, Deliberate Self-Harm, or Suicidal Ideation Cause Distress – And Is It Acceptable?

Programs designed to detect students at risk of depression and suicidality have shown success (Shaffer et al., 2004). The current study sought to examine whether or not such a program was acceptable to participants and whether or not it caused distress. Participants were boys aged 14 to 16. Participants were assessed using an on-line questionnaire; acceptability was measured via postal questionnaire. Of 272 participants, 31 (11.4%) were considered at-risk; 13 required ongoing support, 8 of whom had not previously sought help. Overall screening did not appear to cause significant undue distress, although some differences were evident between at-risk and not at-risk students. All participants found the program acceptable. When conducted carefully, early detection programs can be an effective and acceptable method of identifying at-risk adolescents.

Prevalence and correlates of lifetime deliberate self-harm and suicidal ideation in naturalistic outpatients: The Leiden Routine Outcome Monitoring study

Deliberate self-harm and suicidal ideation (DSHI) are common phenomena in general and mental health populations. Identifying factors associated with DSHI may contribute to the early identification, prevention and treatment of DSHI. Aims of the study are to determine the prevalence and correlates of lifetime DSHI in a naturalistic sample of psychiatric outpatients with mood, anxiety or somatoform (MAS) disorders. Of 3798 consecutive patients from January 2004 to December 2006, 2844 (74.9%) patients were analyzed (mean age=37.5, SD=12.0; age range: 18-65; 62.7% women). Lifetime DSHI was assessed with routine outcome monitoring (ROM), including demographic parameters, DSM-IV diagnosis, depressive symptoms, symptoms of anxiety, general psychopathology and personality traits. Of the 2844 subjects, 55% reported lifetime DSHI. In multivariable logistic regression analysis, the most important factors associated with lifetime DSHI were being unmarried, low education, high number of psychiatric diagnoses, lower anxiety scores, higher depression scores and the personality trait of emotional dysregulation. Deliberate self-harm may have been under-reported in self-report questionnaires; The assessment of personality traits may have been influenced by state psychopathology; traumatic events were not assessed. The findings suggest that DSHI is common among psychiatric outpatients with MAS disorders and that current symptoms and underlying personality vulnerabilities were independently involved in DSHI. Whether symptoms of somatic anxiety are protective should be confirmed in subsequent studies. These findings may help clinicians in identifying patients at risk for deliberate self-harm and suicide.

FC15-04 - The leiden routine outcome monitoring study

IntroductionIt is likely that’real-life patients’ differ from randomized controlled trial (RCT) patients and from non-treatment seeking populations. However, much of what is known about characteristics of patients with depression and anxiety is based on RCTs and studies in the general population. Data on’naturalistic’ or’real-life patients’ are scarce.Objectives &amp; aimsIn several studies so far, we investigated specific characteristics of patients with depression and anxiety in routine psychiatric specialty care. We studied gender differences in depression, and differences in age of onset of depression. Another study aimed to establish predictors for deliberate self-harm and suicidal ideation (DSHI) in patients with depression and anxiety.MethodsWe used baseline data of the Routine Outcome Monitoring (ROM) study. From 2004–2007, 3798 patients had been routinely assessed with ROM, by specially trained nurses. ROM consists of both self report and observational instruments.ResultsFemale patients with depression reported more severe complaints on self-report instruments, as well as worse general health. Observational instruments showed no differences. In addition, patients with depression onset before the age of 18 reported more current suicidality and previous suicide attempts. Finally, low education, being unmarried, comorbidity, more severe symptoms of anxiety and depression, and emotional instability were independent predictors of DSHI.ConclusionsOur findings in naturalistic outpatients differed from previous findings based on RCTs and studies in the general population. Since our findings are based on routinely obtained measurements in treatment seeking patients, these data may reflect the phenomenology of real life patients more closely.

Preventing Suicide in Young People: Systematic Review

Risk of suicide attempt, suicidal ideation and deliberate self-harm is high among young people, yet limited evidence exists regarding effective interventions, particularly from randomized controlled trials. The aim of this study was to conduct a systematic review and meta-analysis of all randomized controlled trials testing interventions for adolescents and young adults who have presented to a clinical setting with any of these behaviours. The Cochrane Central Register of Controlled Trials, Medline, EMBASE and PsycINFO were searched for articles published from 1980 to June 2010. The following keywords formed the basis of the search strategy: 'self-injurious behaviour', 'attempted suicide', 'suicide', 'suicidal behaviour', 'self-inflicted wounds', 'self-mutilation', 'self-harm'. We also hand searched conference abstracts from two major suicide prevention conferences and the reference lists of all retrieved articles and previous reviews. There were 15 trials included in the review, with six ongoing trials also identified. In general, the reporting of the conduct of trials was poor, making it difficult to assess the risk of bias. The reporting of outcome data was inconsistent. No differences were found between treatment and control groups except in one study that found a difference between individual cognitive behavioural therapy and treatment as usual. The evidence regarding effective interventions for adolescents and young adults with suicide attempt, deliberate self-harm or suicidal ideation is extremely limited. Many more methodologically rigorous trials are required. However, in the meantime CBT shows some promise, but further investigation is required in order to determine its ability to reduce suicide risk among young people presenting to clinical services.

Testing Shneidman’s model of suicidality in incarcerated offenders and in undergraduates

Suicidality constitutes a major health issue for society in general and incarcerated populations in particular. Shneidman’s model of suicide proposes that psychache (i.e., intense psychological pain) is the pre-eminent psychological cause of suicidality and mediates the influence of all other psychological correlates such as depression or hopelessness. The current research evaluates Shneidman’s model for samples of 73 male federal offenders, 80 male undergraduates, and 80 female undergraduates. Consistent with Shneidman’s theory, psychache was both a significant and a more important statistical predictor of reported self-harming ideation and action than was either depression or hopelessness. Further, this relatively greater importance of psychache for the statistical prediction of suicidality was not moderated either by offender status or by sex. Overall, findings support the applicability of Shneidman’s model of suicidality to incarcerated individuals and indicate the model’s generalizability across sex and offender status.