The Mediating Role Of Psychachebetween Psychological Strain And Suicidal Behavior Risk Of University Students

1 BackgroundSuicide is a serious public health problem.According to the latest data of WHO(2018),about 800,000 people die of suicide every year,almost one person every 40 seconds,accounting for 1.4%of all deaths worldwide.Suicide has become the second leading cause of death among 15-29-year-olds globally and the first cause of death among 15-34-year-olds in China,accounting for 19%of all deaths.Studies show that the rate of suicide and suicide ideation among college students are much higher than those in the general population.Among the causes of death in college students,suicide ranks the first.Researches on the risk factors of suicidal behavior have found that social.physiological and psychological factors can lead to the occurrence of suicidal behavior.However,suicide is a very complex social phenomenon,a pathological behavior not caused by a single factor,but by the interaction of various risk factors.Based on the integration of sociological and psychopathological factors,Zhang Jie proposes a theoretical model named the psychological strain of suicide,who argues that strain is different from stress.People can often have stress,which is an univariate phenomenon in life,however,strain here refers to a person who cannot give up at least one of two or more conflict stressors,therefore experiencing the inner struggle and pain.Zhang Jie believes that uncoordinated stress(namely strain)can be interfered or strengthened by psychopathological factors(such as hopelessness,depression,anxiety,etc.)in its path leading to suicidal behaviors.After summarizing more than 40 years of researches on suicide,Shneidman points out that suicide is caused by psychache,which refers to psychological pain caused by injury,guilt,distress,hopelessness,and fear.Psychache is the direct cause of suicide,suicide will not occur if psychological pain doesn't exist,other factors such as depression,hopelessness related to suicide only as they related to unbearable psychological pain.Therefore,it could be concluded that suicide occurs when the individual can not bear psychological pain,which means that suicide or not is also related to the threshold of the individual's tolerance to psychological pain.In conclusion,this study suggests that psychache may play a mediating role regarding the relationship between psychological strain and suicidal behavior.Since suicidal behavior is associated with unbearable psychological pain,this study hypothesized that bearable psychological pain might be associated with mental health,that is,people with a good condition of mental health would have a higher threshold of psychological pain.Correspondingly,there is a lower risk of suicidal behavior.Therefore,mental health may regulate the mediating role of psychological pain.2 Objectives(1)To understand the epidemic characteristics of suicidal behavior risk among college students;(2)To explore factors concerned with suicidal behavior risk among college students;(3)Based on the previous studies and theories on suicide,this study aimed to test whether psychache played a mediating role between psychological strain and suicidal behavior risk,further explored the working mechanism among risk factors of suicidal behavior risk to provide a scientific basis for suicide prevention.3 Methods3.1 SubjectsA random cluster sampling method was used to conduct a questionnaire survey from October 2017 to December 2017 in a University of Jinan City,Shandong Province.Taking college as the sampling unit,three colleges(School of History and Culture,College of Energy and Power Engineering,School of Economics)were randomly selected.All undergraduate students in grade 2017,2016,2015 were chosen to complete the questionnaire.3.2 InstrumentsThe questionnaire consisted of two parts:general demographic information(including gender,age,family economic status,etc.)and pathophysiological factors such as psychological strain scale,psychache scale,depression-anxiety-stress scale,hopelessness scale,Suicidal behavior questionnaire-revised.3.3 Statistical analysisTo describe and analyze the obtained data,SPSS 20.0 statistical software was employed.For the quantitative variable,if it was normally distributed,"mean±standard deviation"was used to describe and t-test was used to make a statistical inference.If it was not normal distribution,the median and inter-quartile range were used to describe and non-parametric rank sum test was used for statistical inference.For the categorical variable,relative index was used to described and the chi-square test was used for statistical inference.Univariate or multivariate Logistic regression analysis was used for the analysis of factors concerned with suicidal behavior risk.PROCESS macro in SPSS software was used to test the possible mediating effects among factors concerned with suicidal behaviors based on bias-corrected nonparametric percentile method and 5000 Bootstrapping sample.Two-tailed P-values less than 0.05 was considered statistically significant in this study.4 Results4.1 Sample characteristicsA total of 1574 valid questionnaires were collected,including 808 male students with an average age of(19.26±1.27)years and 766 girls with an average age of(19.18±1.30)years.There were 930 students whose household registration in the city and 644 people in the countryside.Number of students in grade 2017,2016,2015 were 604(38.40%),519(33.00%),451(28.70%),respectively.4.2 Reliability of Psychopathological scalesThe reliability of the psychopathological scale used in this study was tested.Results showed that Cronbach's coefficients of each scale were above 0.70,which indicated that the reliability was good and had good internal consistency.4.3 Analysis of factors concerned with suicidal behavior riskAfter adjusting for other variables,gender(OR=2.17,95%CI:1.63-2.90),psychological strain(OR=1.01,95%CI:1.01?1.02),psychache(OR=1.03,95%CI:1.01?1.05),interpersonal needs(OR=1.04,95%CI:1.03-1.05),general mental health(OR=2.22,95%CI:1.57?3.15)and poor mental health(OR=3.22,95%CI:1.65^6.32),general academic achievement(OR=.55,95%CI:1.01-2.38)were positively correlated with suicidal behavior risk,but compared with students whose household registration in the city,college students'rural household registration(OR=0.70,95%CI:0.50?1.00)was negatively correlated with suicidal behavior risk.4.4 Mediating effects of Psychache between Psychological strain and suicidal behavior riskAfter controlling other variables,PROCESS macro in SPSS software developed by Hayes in 2013 was used to carry on the mediating analysis(model 4).Results showed that psychological strain(?=0.056,95%CI:0.039-0.072)had a significantly positive effect on psychache.Psychache(?0.032,95%CI:0.011-0.053)had a significantly positive effect on suicidal behavior risk.After adjusting the psychache,the psychological strain(?=0.014,95%CI:0.006-0.022)had a significantly positive effect on suicidal behavior risk.The mediating effect was 0.002(95%CI:0.001?0.003),which accounting for 12.5%of the total effect.Model 14 in PROCESS program was selected to test the moderated mediating effect model.Results showed that psychological strain(?=0.061,95%CI:0.042-0.081)had a significantly positive effect on psychache.Psychache(?=0.032,95%CI:0.009?0.054)had a significantly positive effect on suicidal behavior risk.After further adjustment of psychache,psychological strain(?=0.014,95%CI:0.006?0.022)and mental health(?=-0.649,95%CI:-0.955?-0.344)had a significantly positive effect on suicidal behavior risk,however,the interaction between psychache and mental health(?-0.002,95%CI:-0.026-0.023)had no statistical significance on suicidal behavior risk.5 Conclusions(1)There was gender difference about the suicidal behavior risk among college students.Compared with the male students,the female students had a higher suicidal behavior risk.(2)The risk of suicidal behavior among college students was related to gender,mental health,academic achievement,interpersonal needs,psychological strain,and psychache.(3)The mediating effect of psychache between psychological strain and suicidal behavior risk was statistically significant,but mental health did not work on the mediating effect of psychological pain.