Mental Pain and Suicide: A Systematic Review of the Literature

Maria Cristina Verrocchio, Danilo Carrozzino, Daniela Marchetti, Kate Andreasson, Mario Fulcheri, Per Bech, Maria Cristina Verrocchio, Danilo Carrozzino, Daniela Marchetti, Kate Andreasson, Mario Fulcheri, Per Bech

Abstract

Background: Mental pain, defined as a subjective experience characterized by perception of strong negative feelings and changes in the self and its function, is no less real than other types of grief. Mental pain has been considered to be a distinct entity from depression. We have performed a systematic review analyzing the relationship between mental pain and suicide by providing a qualitative data synthesis of the studies.

Methods: We have conducted, in accordance with PRISMA guidelines, a systematic search for the literature in PubMed, Web Of Science, and Scopus. Search terms were "mental pain" "OR" "psychological pain" OR "psychache" combined with the Boolean "AND" operator with "suicid*." In addition, a manual search of the literature, only including the term "psychache," was performed on Google Scholar for further studies not yet identified.

Results: Initial search identified 1450 citations. A total of 42 research reports met the predefined inclusion criteria and were analyzed. Mental pain was found to be a significant predictive factor of suicide risk, even in the absence of a diagnosed mental disorder. Specifically, mental pain is a stronger factor of vulnerability of suicidal ideation than depression.

Conclusion: Mental pain is a core clinical factor for understanding suicide, both in the context of mood disorders and independently from depression. Health care professionals need to be aware of the higher suicidal risk in patients reporting mental pain. In this regard, psychological assessment should include a clinimetric evaluation of mental pain in order to further detect its contribution to suicidal tendency.

Keywords: mental pain; psychache; psychological pain; suicidal behavior; suicidal ideation; suicide attempt.

Figures

Figure 1
Figure 1
Flowchart of the systematic search.

References

    1. W.H.O. Preventing Suicide: A Global Imperative. Luxembourg: World Health Organization; (2014). Available from:
    1. Gvion Y, Horesh N, Levi-Belz Y, Fischel T, Treves I, Weiser M, et al. A aggression-impulsivity, mental pain, and communication difficulties in medically serious and medically non serious suicide attempters. J Child Adolesc Psychopharmacol (2014) 55(1):40–50.10.1016/j.comppsych.2013.09.003
    1. Mee S, Bunney BG, Bunney WE, Hetrick W, Potkin SG, Reist C. Assessment of psychological pain in major depressive episodes. J Psychiatr Res (2011) 45:1504–10.10.1016/j.jpsychires.2011.06.011
    1. Tossani E. The concept of mental pain. Psychother Psychosom (2013) 82:67–73.10.1159/000343003
    1. Shneidman ES. A psychological approach to suicide. In: VandenBos GR, Bryants BK, editors. Cataclysms, Crises, and Catastrophes: Psychology in Action. Washington, DC: American Psychological Association; (1987). p. 147–83.
    1. Shneidman ES. Perspectives on suicidology: further reflections on suicide and psychache. Suicide Life Threat Behav (1998) 28:245–50.
    1. Flamenbaum R, Holden RR. Psychache as a mediator in the relationship between perfectionism and suicidality. J Couns Psychol (2007) 54(1):51–61.10.1037/0022-0167.54.1.51
    1. Shneidman ES. Suicide as psychache. J Nerv Ment Dis (1993) 181:145–7.10.1097/00005053-199303000-00001
    1. Orbach I, Mikulincer M, Sirota P, Gilboa-Schechtman E. Mental pain: a multimensional operationalization and definition. Suicide Life Threat Behav (2003) 33:219–30.10.1521/suli.33.3.219.23219
    1. Buchwald A. Too Soon to Say Goodbye. 1st ed New York: Random House; (2006).
    1. Nahaliel S, Sommerfeld E, Orbach I, Weller A, Apter A, Zalsman G. Mental pain as a mediator of suicidal tendency: a path analysis. Compr Psychiatry (2014) 55:944–51.10.1016/j.comppsych.2013.12.014
    1. Soumani A, Damigos D, Oulis P, Masdrakis V, Ploumpidis D, Mavreas V, et al. Mental pain and suicide risk: application of the Greek version of the mental pain and the tolerance of mental pain scale. Psychiatriki (2011) 22(4):330–40.
    1. Troister T, Holden RR. Factorial differentiation among depression, hopelessness, and psychache in statistically predicting suicidality. Meas Eval Couns Dev (2013) 46:50–63.10.1177/0748175612451744
    1. DeLisle MM, Holden RR. Depression, hopelessness, and psychache as increasingly specific predictors of suicidal manifestations. Can Clin Psychol (2004) 15:7–10.
    1. Reisch T, Seifritz E, Esposito F, Wiest R, Valach L, Michel K. An fMRI study on mental pain and suicidal behavior. J Affect Disord (2010) 126(1):321–5.10.1016/j.jad.2010.03.005
    1. Xie W, Li H, Luo X, Fu R, Ying X, Wang N, et al. Anhedonia and pain avoidance in the suicidal mind: behavioral evidence for motivational manifestations of suicidal ideation in patients with major depressive disorder. J Clin Psychol (2014) 70(7):681–92.10.1002/jclp.22055
    1. de Leon J, Baca-García E, Blasco-Fontecilla H. From the serotonin model of suicide to a mental pain model of suicide. Psychother Psychosom (2015) 84:323–9.10.1159/000438510
    1. Beck AT, Kovacs M, Weissman A. Hopelessness and suicidal behavior: an overview. JAMA (1975) 234:1146–9.10.1001/jama.234.11.1146
    1. Troister T, Davis MP, Lowndes A, Holden RRA. Five-month longitudinal study of psychache and suicide ideation: replication in general and high-risk university students. Suicide Life Threat Behav (2013) 43(6):611–20.10.1111/sltb.12043
    1. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol (2009) 62:1006–12.10.1016/j.jclinepi.2009.06.005
    1. Berlim MT, Mattevi BS, Pavanello DP, Caldieraro MA, Fleck MPA, Wingate LR, et al. Psychache and sucidality in adults mood disordered outpatients in Brazil. Suicide Life Threat Behav (2003) 33(3):242–8.10.1521/suli.33.3.242.23220
    1. Olié E, Guillaume S, Jaussent I, Courtet P, Jollant F. Higher psychological pain during a major depressive episode may be a factor of vulnerability to suicidal ideation and act. J Affect Disord (2010) 120:226–30.10.1016/j.jad.2009.03.013
    1. Caceda R, Durand D, Cortes E, Prendes-Alvarez S, Moskovciak T, Harvey P, et al. Impulsive choice and psychological pain in acutely suicidal depressed patients. Psychosom Med (2014) 76:445–51.10.1097/PSY.0000000000000075
    1. Huanhuan L, Weizhen X, Xinwei L, Rog F, Chuan S, Xiangyu Y, et al. Clarifyng the role of psychological pain in the risks of suicidal ideation and suicidal acts among patients with major depressive episodes. Suicide Life Threat Behav (2014) 44(1):77–88.10.111/sltb.12056
    1. van Heeringen K, Van den Abbeele D, Vervaet M, Soenen L, Audenaert K. The functional neuroanatomy of mental pain in depression. Psychiatry Res (2010) 181:141–4.10.1016/j.pscychresns.2009.07.011
    1. Meerwijk EL, Weiss SJ. Does suicidal desire moderate the association between frontal delta power and psychological pain? PeerJ (2016) 4(4):e1538.10.7717/peerj.1538
    1. Barak A, Miron O. Writing characteristics of suicidal people on the internet: a psychological investigation of emerging social environments. Suicide Life Threat Behav (2005) 35(5):507–24.10.1521/suli.2005.35.5.507
    1. Leenars A, Lester D, Wenckstern S. Suicide notes in alcoholism. Psychol Rep (1999) 85:363–4.10.2466/pr0.1999.85.2.363
    1. Orbach I, Mikulincer M, Gilboa-Schechtman E, Sirota P. Mental pain and its relationship to suicidality and life meaning. Suicide Life Threat Behav (2003) 33(3):231–41.10.1521/suli.33.3.231.23213
    1. Pompili M, Lester D, Leenars A, Tatarelli R, Girardi P. Psychache and suicide: a preliminary investigation. Suicide Life Threat Behav (2008) 38(1):116–21.10.1521/suli.2008.38.1.116
    1. May AM, O’Brien KHM, Liu RT, Klonsky ED. Descriptive and psychometric properties of the inventory of motivations for suicide attempts (IMSA) in an inpatient adolescent sample. Arch Suicide Res (2016) 1–7.10.1080/13811118.2015.1095688
    1. Levi Y, Horesh N, Fischel T, Treves I, Or E, Apter A. Mental pain and its communication in medically serious suicide attempts: an “impossible situation”. J Affect Disord (2008) 111:244–50.10.1016/j.jad.2008.02.022
    1. Levi-Belz Y, Gvion Y, Horesh N, Fischel T, Treves I, Or E, et al. Mental pain, communication difficulties, and medically serious suicide attempts: a case-control study. Arch Suicide Res (2014) 18:74–87.10.1080/13811118.2013.809041
    1. Horesh N, Levi Y, Apter A. Medically serious versus non serious suicide attempts: relationships of lethality and intent to clinical and interpersonal characteristics. J Affect Disord (2012) 136:286–93.10.1016/j.jad.2011.11.035
    1. Levi-Belz Y, Gvion Y, Horesh N, Apter A. Attachment patterns in medically serious suicide attempts: the mediating role of self-disclosure and loneliness. Suicide Life Threat Behav (2013) 43(5):511–22.10.1111/sltb.12035
    1. Gvion Y, Horesh N, Levi-Belz Y, Apter A. A proposed model of the development of suicidal ideations. Compr Psychiatry (2015) 56:93–102.10.1016/j.comppsych.2014.09.019
    1. Trakhtenbrot R, Gvion Y, Levi-Belz Y, Horesh N, Fischel T, Weiser M, et al. Predictive value of psychological characteristics and suicide history on medical lethality of suicide attempts: a follow-up study of hospitalized patients. J Affect Disord (2016) 199:73–80.10.1016/j.jad.2016.03.054
    1. Gould MS, Kalafat J, HarrisMunfakh JL, Kleinman M. An evaluation of crisis hotline outcomes part 2: suicidal callers. Suicide Life Threat Behav (2007) 37(3):338–52.10.1521/suli.2007.37.3.338
    1. Campos RC, Holden RR. Testing models relating rejection, depression, interpersonal needs, and psychache to suicide risk in nonclinical individuals. J Clin Psychol (2015) 71(10):994–1003.10.1002/jclp.22196
    1. Levinger S, Somer E, Holden RR. The importance of mental pain and physical dissociation in youth suicidality. J Trauma Dissociation (2015) 16:322–39.10.1080/15299732.2014.989644
    1. Levinger S, Holden RR. Reliability and validation of the Hebrew version of the reasons for attempting suicide questionnaire (RASQ-H) and its importance for mental pain. Suicide Life Threat Behav (2014) 44(5):486–96.10.1111/sltb.12087
    1. Lester D. Psychache, depression, and personality. Psychol Rep (2000) 87:940.10.2466/PR0.87.7.940-940
    1. Leenars AA, Lester D. A note on Shneidman’s psychological pain assessment scale. Omega: J Death Dying (2005) 50(4):301–7.10.2190/WH9X-80M3-NJ54-5GCU
    1. DeLisle M, Holden RR. Differentiating between depression, hopelessness, and psychache in university undergraduates. Meas Eval Couns Dev (2009) 42(1):46–63.10.1177/0748175609333562
    1. Troister T, Holden RR. Comparing psychache, depression, and hopelessness in their associations with suicidality: a test of Shneidman’s theory of suicide. Pers Individ Dif (2010) 49:689–93.10.1016/j.paid.2010.06.006
    1. Holden RR, Mehta K, Cunningham EJ, McLeod LD. Development and preliminary validation of a scale of psychache. Can J Behav Sci (2001) 33:224–32.10.1037/h0087144
    1. You Z, Song J, Wu C, Qin P, Zhou Z. Effects of life satisfaction and psychache on risk for suicidal behaviour: a cross-sectional study based on data from Chinese undergraduates. BMJ Open (2014) 4:e004096.10.1136/bmjopen-2013-004096
    1. Troister T, Holden RR. A two-year prospective study of psychache and its relationship to suicidality among high-rosk undergraduates. J Clin Psychol (2012) 68(9):1019–27.10.1002/jclp.21869
    1. Campos RC, Holden RR, Laranjeira P, Troister T, Oliveira AR, Costa F, et al. Self-report depressive symptoms do not directly predict suicidality in nonclinical individuals: contributions toward a more psychosocial approach to suicide risk. Death Stud (2016) 40(6):335–49.10.1080/07481187.2016.1150920
    1. Mills J, Green K, Reddon J. An evaluation of the psychache scale on an offender population. Suicide Life Threat Behav (2005) 35(5):570–80.10.1521/suli.2005.35.5.570
    1. Pereira E, Kroner D, Holden RR, Flamenbaum R. Testing Shneidman’s model of suicidality in incarcerated offenders and in undergraduates. Pers Individ Dif (2010) 49:912–7.10.1016/j.paid.2010.07.029
    1. Coohey C, Easton S, Kong J, Bockenstedt JKW. Sources of psychological pain and suicidal thoughts among homeless adults. Suicide Life Threat Behav (2015) 45(3):271–80.10.1111/sltb.12126
    1. Patterson AA, Holden RR. Psychache and suicide ideation among men who are homeless: a test of Shneidman’s model. Suicide Life Threat Behav (2012) 42(2):147–56.10.1111/j.1943278X.2011.00078.x
    1. Shelef L, Fruchter E, Hassidim A, Zalsman G. Emotional regulation of mental pain as moderator of suicidal ideation in military settings. Eur Psychiatry (2015) 30:765–9.10.1016/j.eurpsy.2014.12.004
    1. Jobes DA. The challenge and the promise of clinical suicidology. Suicide Life Threat Behav (1995) 25(4):437–49.
    1. Bech P. Clinical Psychometrics. Oxford: Wiley Blackwell; (2012).
    1. Fava GA, Tomba E, Sonino N. Clinimetrics: the science of clinical measurements. Int J Clin Pract (2012) 66:11–5.10.1111/j.1742-1241.2011.02825.x

Source: PubMed

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

3
Abonner