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

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.

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.

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).

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.