Clinical Dimensions Associated With Psychological Pain in Suicidal Patients: One-Year Follow-up Study

Adrián Alacreu-Crespo, PhD; Sebastien Guillaume, MD, PhD; Stephane Richard-Devantoy, MD, PhD; Aurelie Cazals, MS; Emilie Olié, MD, PhD; Philippe Courtet, MD, PhD

J Clin Psychiatry 2022;83(2):21m14065

ABSTRACT

Objective: Psychological pain is a transdiagnostic factor in mental health and a key clinical dimension to understand suicide in patients with mood disorders. However, less is known about the clinical characteristics that predict high psychological pain. The aim of this study was to fill this gap in a sample of patients with mood disorders.

Methods: Inpatients admitted for a major depressive episode, according to DSM-IV criteria, from 2010 to 2017 were divided into 3 groups: 178 recent suicide attempters (within the last 7 days), 101 past suicide attempters (lifetime history of suicide attempt), and 93 nonattempters (no lifetime history of suicidal act). At inclusion, current psychopathology, medication, personality traits (impulsivity, anxiety, hopelessness), and childhood trauma were assessed. At inclusion and at 1-year follow-up, depressive symptomatology and current and maximal (within the 15 last days) psychological and physical pain were assessed.

Results: At baseline, maximal psychological pain was higher in recent than in past suicide attempters (odds ratio [OR] = 1.18 [1.04–1.35]) and nonattempters (OR = 1.32 [1.16–1.50]). In the multivariate model, depression severity (OR = 1.11 [1.08–1.16]) and worst physical pain (OR = 2.53 [1.28–5.02]) predicted high psychological pain, whereas bipolar disorder (OR = 0.54 [0.29–0.98]) predicted low psychological pain. During the follow-up, the change in maximal psychological pain was predicted by changes in depressive symptomatology (β = 0.46, P < .001) and maximal physical pain (β = 0.42, P < .003). Finally, among depressive symptoms, guilt, lack of initiative, and loss of appetite better explained maximal psychological pain, both at inclusion and at 1 year (all P < .050).

Conclusions: Psychological pain is associated with a recent suicidal act and depressive severity. Due to the strong link between psychological pain and physical pain, future studies should investigate whether psychotropic drugs with analgesic effects protect from psychological pain and therefore from suicide.

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References (42)

Gunn JF III. The social pain model: understanding suicide through evolutionary psychology. Crisis. 2017;38(5):281–286. PubMed CrossRef
Verrocchio MC, Carrozzino D, Marchetti D, et al. Mental pain and suicide: a systematic review of the literature. Front Psychiatry. 2016;20(7):108. PubMed CrossRef
Shneidman ES. Suicide as psychache. J Nerv Ment Dis. 1993;181(3):145–147. PubMed CrossRef
Ducasse D, Holden RR, Boyer L, et al. Psychological pain in suicidality: a meta-analysis. J Clin Psychiatry. 2018;79(3):16r10732. PubMed CrossRef
Cáceda R, Durand D, Cortes E, et al. Impulsive choice and psychological pain in acutely suicidal depressed patients. Psychosom Med. 2014;76(6):445–451. PubMed CrossRef
Cáceda R, Kordsmeier NC, Golden E, et al. Differential processing of physical and psychological pain during acute suicidality. Psychother Psychosom. 2017;86(2):116–118. PubMed CrossRef
Orbach I, Mikulincer M, Gilboa-Schechtman E, et al. Mental pain and its relationship to suicidality and life meaning. Suicide Life Threat Behav. 2003;33(3):231–241. PubMed CrossRef
Sun X, Li H, Song W, et al. ROC analysis of three‐dimensional psychological pain in suicide ideation and suicide attempt among patients with major depressive disorder. J Clin Psychol. 2020;76(1):210–227. PubMed
Alacreu-Crespo A, Olié E, Seneque M, et al. Decision-making skills moderate the relationship between psychological and physical pain with suicidal behavior in depressed patients. Psychother Psychosom. 2019;88(3):190–191. PubMed CrossRef
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(7):689–693. CrossRef
Troister T, D’Agata MT, Holden RR. Suicide risk screening: comparing the Beck Depression Inventory-II, Beck Hopelessness Scale, and Psychache Scale in undergraduates. Psychol Assess. 2015;27(4):1500–1506. PubMed CrossRef
Alacreu-Crespo A, Cazals A, Courtet P, et al. Brief assessment of psychological pain to predict suicidal events at one year in depressed patients. Psychother Psychosom. 2020;89(5):320–323. PubMed CrossRef
Tossani E. The concept of mental pain. Psychother Psychosom. 2013;82(2):67–73. PubMed CrossRef
Meerwijk EL, Weiss SJ. Toward a unifying definition: response to “The Concept of Mental Pain.” Psychother Psychosom. 2014;83(1):62–63. PubMed
Olié E, Guillaume S, Jaussent I, et al. Higher psychological pain during a major depressive episode may be a factor of vulnerability to suicidal ideation and act. J Affect Disord. 2010;120(1-3):226–230. PubMed CrossRef
Holden RR, Mehta K, Cunningham EJ, et al. Development and preliminary validation of a scale of psychache. Can J Behav Sci. 2001;33(4):224–232. CrossRef
Li H, Xie W, Luo X, et al. Clarifying 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):78–88. PubMed CrossRef
Chambers E, Belicki K. Using sleep dysfunction to explore the nature of resilience in adult survivors of childhood abuse or trauma. Child Abuse Negl. 1998;22(8):753–758.
Jollant F, Voegeli G, Kordsmeier NC, et al. A visual analog scale to measure psychological and physical pain: A preliminary validation of the PPP-VAS in two independent samples of depressed patients. Prog Neuropsychopharmacol Biol Psychiatry. 2019;90:55–61. PubMed CrossRef
Ey H. Contribution to the study of the relations of melancholic crises and of crises of neurotic depression. Evol Psychiatr (Paris). 1955;3:532–553. PubMed
Sheehan DV, Lecrubier Y, Sheehan KH, et al. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59(suppl 20):22–33, quiz 34–57. PubMed
van Heeringen K, Mann JJ. The neurobiology of suicide. Lancet Psychiatry. 2014;1(1):63–72. PubMed CrossRef
Sackeim HA. The definition and meaning of treatment-resistant depression. J Clin Psychiatry. 2001;62(suppl 16):10–17. PubMed
Beck AT. Beck Depression Inventory. Depression. 1961;2006:2–4.
Baylé FJ, Bourdel MC, Caci H, et al. Factor analysis of French translation of the Barratt Impulsivity Scale (BIS-10). Can J Psychiatry. 2000;45(2):156–165. PubMed CrossRef
Larsen RJ, Diener E. A multitrait-multimethod examination of affect structure: hedonic level and emotional intensity. Pers Individ Dif. 1985;6(5):631–636. CrossRef
Harvey PD, Greenberg BR, Serper MR. The affective lability scales: development, reliability, and validity. J Clin Psychol. 1989;45(5):786–793. PubMed CrossRef
Beck AT, Weissman A, Lester D, et al. The measurement of pessimism: the Hopelessness Scale. J Consult Clin Psychol. 1974;42(6):861–865. PubMed CrossRef
Bernstein DP, Fink L, Handelsman L, et al. Initial reliability and validity of a new retrospective measure of child abuse and neglect. Am J Psychiatry. 1994;151(8):1132–1136. PubMed CrossRef
Grömping U. Relative importance for linear regression in R: the package relaimpo. J Stat Softw. 2006;17(1).1–27
Cáceda R, Carbajal JM, Salomon RM, et al. Slower perception of time in depressed and suicidal patients. Eur Neuropsychopharmacol. 2020;40:4–16. PubMed CrossRef
Calati R, Laglaoui Bakhiyi C, Artero S, et al. The impact of physical pain on suicidal thoughts and behaviors: Meta-analyses. J Psychiatr Res. 2015;71:16–32. PubMed CrossRef
Zis P, Daskalaki A, Bountouni I, et al. Depression and chronic pain in the elderly: links and management challenges. Clin Interv Aging. 2017;12:709–720. PubMed CrossRef
Finnerup NB, Attal N, Haroutounian S, et al. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurol. 2015;14(2):162–173. PubMed CrossRef
Banafshe HR, Mesdaghinia A, Arani MN, et al. Lithium attenuates pain-related behavior in a rat model of neuropathic pain: possible involvement of opioid system. Pharmacol Biochem Behav. 2012;100(3):425–430. PubMed CrossRef
Yerevanian BI, Koek RJ, Mintz J. Lithium, anticonvulsants and suicidal behavior in bipolar disorder. J Affect Disord. 2003;73(3):223–228. PubMed CrossRef
Del Matto L, Muscas M, Murru A, et al. Lithium and suicide prevention in mood disorders and in the general population: A systematic review. Neurosci Biobehav Rev. 2020;116:142–153. PubMed CrossRef
Yovell Y, Bar G, Mashiah M, et al. Ultra-low-dose buprenorphine as a time-limited treatment for severe suicidal ideation: a randomized controlled trial. Am J Psychiatry. 2016;173(5):491–498. PubMed CrossRef
Fava GA, Tomba E, Brakemeier EL, et al. Mental pain as a transdiagnostic patient-reported outcome measure. Psychother Psychosom. 2019;88(6):341–349. PubMed CrossRef
Oquendo MA, Barrera A, Ellis SP, et al. Instability of symptoms in recurrent major depression: a prospective study. 2004;161(2):255-261.
Milak MS, Keilp J, Parsey RV, et al. Regional brain metabolic correlates of self-reported depression severity contrasted with clinician ratings. J Affect Disord. 2010;126(1-2):113–124. PubMed CrossRef
Kross E, Berman MG, Mischel W, et al. Social rejection shares somatosensory representations with physical pain. Proc Natl Acad Sci U S A. 2011;108(15):6270–6275. PubMed CrossRef