This work may not be copied, distributed, displayed, published, reproduced, transmitted, modified, posted, sold, licensed, or used for commercial purposes. By downloading this file, you are agreeing to the publisher’s Terms & Conditions.

Original Research

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

Ilya Baryshnikov, MD, PhD; Tom H. Rosenström, PhD; and Erkki T. Isometsä, MD, PhD

Published: April 8, 2024


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 (< .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.

J Clin Psychiatry 2024;85(2):23m14926

Author affiliations are listed at the end of this article.

Volume: 85

Quick Links:

Continue Reading…

Subscribe to read the entire article


Buy this Article as a PDF