Mental Pain and Suicide: A Systematic Review of the Literature

Abstract

BackgroundMental 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.MethodsWe 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.ResultsInitial 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.ConclusionMental 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.

Assessment of psychological pain in suicidal veterans

“…These results are compatible with our findings in MDE subjects and are supported by a comprehensive review in which mental pain was found to be a stronger factor of vulnerability to suicidal ideation than depression [8]. …”

Examination of interoception along the suicidality continuum

“…For instance, both thought (Pettit et al., ) and emotional (Kaplow, Gipson, Horwitz, Burch, & King, ) suppression have been linked to increased suicidal ideation, indicating that a tendency to ignore or distract oneself from sensations of pain or discomfort might be detrimental and lead to increased suicidality. Similarly, a tendency to worry or experience emotional distress along with sensations of pain or discomfort may lead to increased thoughts of suicide, as both mental and physical pain are linked to suicidal ideation (Ratcliffe, Enns, Belik, & Sareen, ; Verrocchio et al., ). In contrast, high levels of distress tolerance have been associated with suicidal behavior (Anestis, Gratz, Bagge, & Tull, ; Anestis, Tull, Bagge, & Gratz, ) and is suggested to function in a similar manner to capability for suicide, such that the ability to persist through pain and distress may confer risk for suicide attempts (in contrast, low distress tolerance is often associated with suicidal thoughts and other forms of psychopathology).…”

Reexamining the Mental Pain–Suicidality Link in Adolescence: The Role of Tolerance for Mental Pain

“…Several instruments have been constructed for assessing mental pain (e.g., Holden, Mehta, Cunningham, & McLeod, ; Orbach, Mikulincer, Gilboa‐Schechtman, et al., ; Shneidman, ), and dozens of studies have empirically examined Shneidman's mental pain – suicidality hypotheses (see Ducasse et al., ; Verrocchio et al., for systematic reviews and meta‐analysis). For example, Holden et al.…”