Assessment of psychological pain in suicidal veteransReport as inadecuate

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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. To better understand psychological pain, we 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. Our results showed a significant increase in psychological pain in the depressed patients compared to controls. We also observed a significant linear correlation between psychological pain and suicidality in the depressed patient cohort. The current investigation extends our study of psychological pain to a diagnostically heterogeneous population of 57 US Veterans enrolled in a suicide prevention program. In addition to the MBP, we 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. 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. We 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. Our results build upon our 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.

Author: Christopher Reist , Steven Mee , Ken Fujimoto , Vivek Rajani , William E. Bunney , Blynn G. Bunney



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