Table 2.
Studies on mental pain and suicide in different clinical samples.
| Study | Title | Aim | Sample information | Measure of mental pain | Measure of suicide |
|---|---|---|---|---|---|
| Barak and Miron (27) | Writing characteristics of suicidal people on the internet: a psychological investigation of emerging social environments | To support, in Study 3, Shneidman’s original argument that there are specific themes that characterized suicidal people, such as unbearable emotional pain (and cognitive constriction), focusing on the content of online writers’ messages | Sample size: 64 online messages by 39 participants in the SAHAR suicidal support forum and by 24 participants in the sexual assault forum Mean age: NA Female: NA |
Leenaars’ (1996) thematic guide for predicting suicide | NA |
| Campos and Holden (39) | Testing models relating rejection, depression, interpersonal needs, and psychache to suicide risk in non-clinical individuals | To evaluate a model of suicide risk based on the contribution of four psychological variables, parental rejection, depression, interpersonal need, and psychache | Sample size: 203 non-clinical participants Mean age: 37.86 (SD = 11.68) Female: 51% |
PAS | SBQ-R |
| Gould et al. (38) | An evaluation of crisis hotline outcomes part 2: suicidal callers | To determine, among other objectives, predictors (i.e., intent to die, psychological pain, hopelessness) of suicidality after the call to crisis services/hotlines | Sample size: 1085 suicidal callers Mean age: NA Female: 61% |
Two items assessing psychological pain | Nine questions about suicidal thoughts, plans, and attempts |
| Gvion et al. (36) | A proposed model of the development of suicidal ideations | To develop a model of suicide ideation in psychiatric patients and the general population taking into account the role of mental pain domain, aggressive-impulsive domain, communication difficulties domain, and life events | Sample size: 196 participants divided into three groups; G1, suicide attempters (92 psychiatric patients); G2, non-attempters (47 psychiatric patients); G3 controls (57 healthy subjects) Mean age: G1 = 38.93 (SD = 13.56) years, G2 = 40.96 (SD = 14.07) years, G3 = 37.28 (SD = 12.34) Female: G1 = 35%, G2 = 30%, G3 = 46% |
OMMP | Item 9 of the BDI LRS |
| Gvion et al. (2) | Aggression–impulsivity, mental pain, and communication difficulties in medically serious and medically non-serious suicide attempters | To evaluate, among other objectives, the role of mental pain, depression, and hopelessness in differentiating suicide attempters from non-attempters | Sample size: 196 participants divided into four groups; G1, medically serious suicide attempters (43); G2, medically non-serious suicide attempters (49); G3, psychiatric control group (47); G4, healthy control group (57) Mean age: G1 = 37.37 (SD = 13.31) years, G2 = 40.31 (SD = 13.76) years, G3 = 40.96 (SD = 14.07), G4 = 37.28 (SD = 12.34) Female: G1 = 40%, G2 = 31%, G3 = 30%, G4 = 46% |
OMMP | LRS Objective Planning Subscale of the SIS |
| Horesh et al. (34) | Medically serious versus non-serious suicide attempts: relationships of lethality and intent to clinical and interpersonal characteristics | To investigate, among other objectives, the relationship between mental pain and subjective/objective suicide intent in both medically serious and medically non-serious attempters | Sample size: 102 participants divided into two groups; G1, patients after a medically serious suicide attempt (35); G2, patients after a medically non-serious suicide attempt (67) Mean age: G1 = 39.70 (SD = 15.30) years, G2 = 37.30 (SD = 14.00) years Female: G1 = 49%; G2 = 54% |
OMMP | SIS LRS |
| Leenars et al. (28) | Suicide notes in alcoholism | To assess whether suicide notes of alcoholics differ from suicide notes of non-alcoholics in Leenars’ dimensions of suicide, including unbearable pain | Sample size: 16 suicide notes of alcoholics and matched suicide notes of non-alcoholics Mean age: NA Female: NA |
Suicide notes | Suicide notes |
| Levi et al. (32) | Mental pain and its communication in medically serious suicide attempts: an “impossible situation” | To test the hypothesis that mental pain is a general risk factor for suicidal behavior (and communication difficulties are a particular risk factor for medically serious suicidal behavior) | Sample size: 173 subjects divided into three groups; G1, patients after a medically serious suicide attempt (35); G2, patients after a medically non-serious suicide attempt (67); G3 healthy controls (71) Mean age: G1 = 39.70 (SD = 15.30) years; G2 = 37.30 (SD = 14.00) years; G3 = 36.50 (SD = 14.00) years Female: G1 = 49%; G2 = 54%; G3 = 48% |
OMMP | LRS |
| Levi-Belz et al. (35) | Attachment patterns in medically serious suicide attempts: the mediating role of self-disclosure and loneliness | To assess the contribution of attachment style to medical lethality of the suicidal attempt above and beyond mental pain (and the meditational role of communication difficulties in the relationship between attachment style and medically serious suicide attempt) | Sample size: 102 patients divided into two groups; G1, patients after a medically serious suicide attempt (35); G2, patients after a medically non-serious suicide attempt (67) Mean age: G1 = 39.70 (SD = 15.30) years, G2 = 37.30 (SD = 14.00) years Female: G1 = 49%, G2 = 54% |
Mental pain is only indirectly evaluated with measures of depression, hopelessness and negative life events, BDI, BHS, and LES, respectively | LRS SIS |
| Levi-Belz et al. (33) | Mental pain, communication difficulties, and medically serious suicide attempts: a case-control study | To assess the role of mental pain and communication difficulties in medically serious suicide attempt | Sample size: 336 participants divided into four groups; G1, medically serious suicide attempters (78); G2, medically non-serious suicide attempters (116); G3, psychiatric control group (47); G4, healthy control group (95) Mean age: G1 = 38.5 (SD = 14.2) years, G2 = 38.5 (SD = 13.9) years, G3 = 40.9 (SD = 14.0) years, G4 = 38.5 (SD = 14.2) years Female: G1 = 44%, G2 = 44%, G3 = 70%, G4 = 45% |
OMMP | LRS |
| Levinger and Holden (41) | Reliability and validation of the Hebrew Version of the Reasons for Attempting Suicide Questionnaire (RASQ-H) and its importance for mental pain | To evaluate, among other objectives, relationships of the RASQ-H with mental pain and the tolerance of mental pain | Sample size: 97 participants divided into three groups; G1, suicide attempter inpatients (42); G2, non-suicidal psychiatric inpatients (26); G3, non-clinical individuals (29) Mean age: 19.51 (SD = 3.30); data for single groups NA Female: 50% of the total sample; rates for single groups NA |
OMMP TMPS |
RASQ-H BSS MAST LSAS |
| Levinger et al. (40) | The importance of mental pain and physical dissociation in youth suicidality | To assess whether physical dissociation can make a unique contribution to suicidal risk above and beyond the contributions of mental pain and low tolerance for that mental pain | Sample size: 123 young adults divided into three groups; G1, suicidal patients (42); G2, non-suicidal inpatients (36); G3 non-clinical group (45) Mean age: G1 = 18.60 (SD = 3.3) years, G2 = 21.08 (SD = 2.73) years, G3 = 19.29 (SD = 3.07) years Female: G1 = 55%, G2 = 42%, G3 = 56% |
OMMP TMPS |
MAST BSS LSAS |
| May et al. (31) | Descriptive and psychometric properties of the Inventory of Motivations for Suicide Attempts (IMSA) in an inpatient adolescent sample | To investigate, among other objectives, the motivations (e.g., psychache, hopelessness, and escape) adolescents endorsed for their suicide attempts | Sample size: 52 adolescent psychiatric inpatients who attempted suicide Mean age: 14.8 (SD = 1.4) Female: 85% |
Psychache scale of the IMSA | Interview assessing lifetime suicide attempts C-SSRS |
| Nahaliel et al. (11) | Mental pain as a mediator of suicidal tendency: a path analysis | To examine the mediating role of mental pain in the relationship between number of lifetime losses, self-destruction, and suicidal tendency | Sample size: 150 adults divided into three groups; G1, suicide attempt patients (50); G2, non-suicidal psychiatric patients (50); G3, healthy controls (50) Mean age: G1 = 43.26 (SD = 14.5) years, G2 = 43.86 (SD = 15.4) years, G3 = 40.40 (SD = 16.1) years Female: G1 = 70%, G2 = 70%, G3 = 68% |
OMMP | MAST |
| Orbach et al. (29) | Mental pain and its relationship to suicidality and life meaning | To test, among other objectives, Shneidman’s proposition – on the relationship between mental pain and suicide – by comparing the mental pain of suicidal and non-suicidal individuals | Sample size: 91 subjects divided into three groups; G1, suicide attempters patients (32); G2, non-suicide attempters patients (29); G3 control participants (30) Mean age: G1 = 32.43 (SD = 5.43) years, G2 = 34.28 (SD = 6.71) years, G3 = 31.62 (SD = 5.84) years Female: G1 = 56%, G2 = 62%, G3 = 53% |
OMMP | MAST |
| Pompili et al. (30) | Psychache and suicide: a preliminary investigation | To explore the usefulness of Shneidman’s measure of psychache using a sample of psychiatric patients. one specific objective was to address the association between PPAS score and current suicidal risk and suicidal history | Sample size: 88 psychiatric patients Mean age: for males and females, 41.8 (SD = 14.0) years and 41.2 (SD = 14.1) years, respectively Female: 60% |
PPAS | Section about suicidal risk of the MINI integrated with Clinician’s opinion |
| Reisch et al. (15) | An fMRI study on mental pain and suicidal behavior | To investigate the neural correlates of script-driven recall of mental pain plus suicide action | Sample size: 10 individuals who had attempted suicide 1 to 4 weeks prior to the interview Mean age: 38.5 (SD = 13.1) years Female: 100% |
OMMP Mental pain sequences from narrative interviews |
Suicide action and suicide attempt sequences from narrative interviews |
| Trakhtenbrot et al. (37) | Predictive value of psychological characteristics and suicide history on medical lethality of suicide attempts: a follow-up study of hospitalized patients | To test, among other assumptions, the hypothesis that mental pain, depression, and hopelessness are positively related to follow-up suicide attempt | Sample size: 153 subjects divided into three groups; G1, patients hospitalized for a medically serious suicide attempt (53); G2, patients hospitalized for a medically non-serious suicide attempt (64); G3, psychiatric control group (36) Mean age: G1 = 37.60 (SD = 12.25) years; G2 = 37.74 (SD = 13.05) years; G3 = 40.27 (SD = 13.26) years Female: G1 = 59%; G2 = 61%; G3 = 69% |
OMMP | Clinician assessment of suicide attempts, medical severity of the attempts, and medical severity of the follow-up attempt |
NA, not available; G1, Group 1; G2, Group 2; G3, Group 3; G4, Group 4; S1, Study 1; S2, Study 2.
C-SSRS Columbia Suicide Severity Rating Scale; BDI Beck Depression Inventory; BHS Beck Hopelessness Scale; BSS Beck Scale for Suicide Ideation; IMSA Inventory of Motivations for Suicide Attempts; LES Life Event Scale; LRS Lethality Rating Scale; LSAS Lethality of Suicide Attempt Scale; MAST Multi-Attitude Suicidal Tendencies Scale; MBPPAS Mee–Bunney Psychological Pain Assessment Scale; MINI, Mini International Neuropsychiatric Interview; OMMP Orbach and Mikulincer Mental Pain Scale; PAS Psychache Scale; PPAS Psychological Pain Assessment Scale; RASQ-H Hebrew Reasons for Attempting Suicide Questionnaire; SBQ-R Suicidal Behavior Questionnaire-Revised; SIS Suicide Intent Scale; TMPS Tolerance for Mental Pain Scale.