Assessment of Psychological Pain in Suicidal Veterans

Research Paper Title

Assessment of psychological pain in suicidal veterans.

Background

Psychological pain is a relatively understudied and potentially important construct in the evaluation of suicidal risk. Psychological pain also referred to as ‘mental pain’ or ‘psychache’ can be defined as an adverse emotional reaction to a severe trauma (e.g., the loss of a child) or may be associated with an illness such as depression. When psychological pain levels reach intolerable levels, some individuals may view suicide as the only and final means of escape.

Methods

To better understand psychological pain, the researchers had previously developed and validated a brief self-rating 10-item scale, Mee-Bunney Psychological Pain Assessment Scale (MBP) in depressed patients and non-psychiatric controls. Their results showed a significant increase in psychological pain in the depressed patients compared to controls. They also observed a significant linear correlation between psychological pain and suicidality in the depressed patient cohort.

The current investigation extends their study of psychological pain to a diagnostically heterogeneous population of 57 US Veterans enrolled in a suicide prevention programme. In addition to the MBP, the researchers administered the Columbia Suicide Severity Rating Scale (C-SSRS), Beck Depression Inventory (BDI-II), Beck Hopelessness Scale (BHS), and the Barratt Impulsiveness Scale (BIS-11).

Suicidal patients scoring above a predetermined threshold for high psychological pain also had significantly elevated scores on all the other assessments.

Results

Among all of the evaluations, psychological pain accounted for the most shared variance for suicidality (C-SSRS). Stepwise regression analyses showed that impulsiveness (BIS) and psychological pain (MBP) contributed more to suicidality than any of the other combined assessments. The researchers followed patients for 15 months and identified a subgroup (24/57) with serious suicide events. Within this subgroup, 29% (7/24) had a serious suicidal event (determined by the lethality subscale of the C-SSRS), including one completed suicide.

Conclusions

Their results build upon their earlier findings and recent literature supporting psychological pain as a potentially important construct. Systematically evaluating psychological pain along with additional measures of suicidality could improve risk assessment and more effectively guide clinical resource allocation toward prevention.

Reference

Reist, C., Mee, S., Fujimoto, K., Rajani, V., Bunney, W.E. Bunney, B.G. (2017) Assessment of psychological pain in suicidal veterans. PLoS One. 12(5): e0177974. Published online 2017 May 30. doi: 10.1371/journal.pone.0177974.

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