Are visual analogue scales valid instruments to measure psychological pain in psychiatric patients?

OBJECTIVE

The Psychological-Physical-Pain Visual Analogue Scale (PPP-VAS) was thought to probably help in identifying patients at risk of suicide. However, no data on its validity to measure psychological pain was available. Our main aim was to investigate the convergent validity of the PPP-VAS using two well-validated scales of psychological pain, the Orbach and Mikulincer Mental Pain scale (OMMP) and the Holden et al. Psychache Scale.

METHODS

This multicentre study recruited a total of 1618 adult psychiatric inpatients and outpatients in Italy. Psychological pain was evaluated using the OMMP, Holden et al., and PPP-VAS scales. Psychiatric status, suicidal status, physical pain, depression, and hopelessness were also assessed.

RESULTS

A structural equation model (SEM) using the items of psychological pain from the PPP-VAS showed that items loaded significantly on the psychological pain factor and showed good fit. Similarly, a second SEM model using the three scales of psychological pain showed acceptable fit and converged into a psychological pain construct. Correlations between the PPP-VAS and depression, hopelessness, and physical pain showed moderate correlations (r = 0.43 to r = 0.67). Finally, psychological pain evaluated with the PPP-VAS was significantly related with recent suicidal ideation in all patients (OR [95 % CI] = 1.07 [1.05, 1.09]) and recent suicide attempts in moderately to severely depressed patients, OR [95 % CI] = 1.01 [1.02, 1.03].

CONCLUSION

The PPP-VAS showed good psychometric properties in evaluating psychological pain. The characteristics of the PPP-VAS makes this scale a great option for its use in clinical practice to detect patients at risk of suicide.

Their final words: An analysis of suicide notes from the United States

The present study sought to explore motivations (affective, relationships, life events, injury/medical diagnosis) in suicide notes (N = 49) from the U.S. Authors ranged in age from 18 to 74 years and were majority male (73.5%). Four raters analyzed the notes and, through a series of meetings, came to a consensus on the motives behind each note writers' suicide in terms of the broader motivational themes and the narrower second-level themes. All notes were primarily affectional in nature, with some gender and age differences. For example, suicide notes from males frequently refer to financial hardships whereas suicide notes from females were more focused on lowered self-worth and notes written by younger persons focused more on affect and relationships, while notes written by older adults focused on life events and marriage difficulties and separation. Findings illuminate the varied nature of suicide motivations but also highlight important patterns across groups.

Ethological Problems with the Interpersonal Theory of Suicide

Joiner and colleagues' Interpersonal Theory of Suicide (IPTS), a prominent "desire-capability" model of suicide-based on the common-sense idea that people take their own lives because they want to, and can-is critiqued from a biological perspective. Tinbergen's ethological "four questions" guide the analysis: evolution, survival value, ontogeny, and proximate causation, each addressing a different aspect of biological understanding. Problems for IPTS emerge with all four. As a parsimonious solution, the desire-capability hypothesis is reconceived as an ultimate, instead of proximate, mode of explanation. By this light, desire and capability for suicide combined in our species' ancestral past, thus making suicide a recurrent survival threat, and driving the evolution of special-purpose defensive adaptations. This stance tallies with the pain-brain theory of the evolution of suicide, and with Joiner and colleagues' own investigation into organismic anti-suicide defenses, which appears to conflict conceptually with IPTS. These defenses' evolved algorithm may make suicide an intrinsically aleatory phenomenon, opaque to usefully accurate prediction. Positive implications for prevention and research are proposed.

Sensitivity to ostracism is blunted in suicide attempters only when they report suicidal ideation

BACKGROUND

Modified pain perception is at the core of many theories on suicide; however, studies on the relationship between pain perception and suicidal behavior (attempt) have produced contradictory results. In this experimental study, we investigated whether physical pain and social pain are concomitantly influenced by suicidal ideation (SI) and past suicidal behavior.

METHODS

155 inpatients with depression (90 with and 65 without past history of suicide attempt) were included. They underwent thermal stimulation of the skin to assess physical pain tolerance and played the Cyberball game to assess their sensitivity to ostracism (social pain). Participants self-assessed current SI through the specific item in the Beck Depression Inventory.

RESULTS

Pain tolerance was not associated with history of suicide attempt, current SI, and their interaction. Social pain was associated with the interaction between history of suicide attempt and current SI. Social pain was decreased in suicide attempters, compared with non-attempters, only when they reported current SI.

LIMITATIONS

Cyberball game may not be representative of everyday stress and ecological social context.

CONCLUSIONS

Unlike what suggested by many theories, pain tolerance does not seem to be necessary to attempt suicide. Suicide attempters with current SI displayed blunted sensitivity to ostracism and could be less willing to restore social affiliation compared with non-attempters.

The impulsiveness level influences the salivary cortisol response and social stress sensitivity in suicidal patients

INTRODUCTION

Suicide attempters (SA) are more vulnerable to social stress and show disturbed cortisol response in stressful conditions compared with psychiatric and healthy controls. Recent data suggest that this dysregulation might be related to impulsivity traits. However, little is known about the emotional consequences of social stress in SA exposed to stress.

OBJECTIVES

The aim of our study was to evaluate the cortisol and emotional responses to social stress in patients with depression with and without suicide attempt, by taking into account impulsivity traits and depression severity.

METHODS

67 adult women (41 SA and 26 affective controls (AC,i.e. without suicide attempt history)) with lifetime history of major depressive episode were included. Patients performed the Trier Social Stress Test (TSST), a well-validated social stress task. Patients provided seven saliva samples, to measure the cortisol response, and filled in questionnaires to assess psychological pain, positive and negative mood, and anxiety at different time points (from 10 min before to 120 min after the TSST). Moderated regression models were used including suicide attempt history, depression severity, and impulsivity as independent variables and their interactions.

RESULTS

In patients with low depression and high impulsivity, salivary cortisol response during the TSST was higher in SA than in AC (p < .001). Psychological pain, negative mood, and anxiety were increased in all patients just after the TSST, followed by a decrease at 120 min. Positive mood recovery was slower in SA, and in patients with high impulsivity and low depression level (p < .001).

CONCLUSIONS

Impulsivity traits have an important role in suicidal vulnerability in stress conditions. Impulsivity traits might help to differentiate patients at risk of suicide who are highly sensitive to stress when depression level is low. Higher impulsiveness may increase the sensitivity to emotional distress that translates into inadequate physiological responses.

Pharmacological Strategies for Suicide Prevention Based on the Social Pain Model: A Scoping Review

Suicidal behaviour is a public health problem whose magnitude is both substantial and increasing. Since many individuals seek medical treatment following a suicide attempt, strategies aimed at reducing further attempts in this population are a valid and feasible secondary prevention approach. An evaluation of the available evidence suggests that existing treatment approaches have a limited efficacy in this setting, highlighting the need for innovative approaches to suicide prevention. Existing research on the neurobiology of social pain has highlighted the importance of this phenomenon as a risk factor for suicide, and has also yielded several attractive targets for pharmacological strategies that could reduce suicidality in patients with suicidal ideation or a recent attempt. In this paper, the evidence related to these targets is synthesized and critically evaluated. The way in which social pain is related to the “anti-suicidal” properties of recently approved treatments, such as ketamine and psilocybin, is examined. Such strategies may be effective for the short-term reduction in suicidal ideation and behaviour, particularly in cases where social pain is identified as a contributory factor. These pharmacological approaches may be effective regardless of the presence or absence of a specific psychiatric diagnosis, but they require careful evaluation.

Relationship of Self-Compassion, Hope, and Emotional Control to Perceived Burdensomeness, Thwarted Belongingness, and Suicidal Ideation

Background: Cultivating positive feelings of self in relationships with others can affect perceptions of belongingness and burdensomeness. Aims: The present study examines the relationships of self-compassion, hope, and emotional control to thwarted belongingness, perceived burdensomeness, and suicidal ideation. Method: Participants were 481 college students who completed scales measuring self-compassion, hope, emotional control, thwarted belongingness, perceived burdensomeness, and suicidal ideation. Results: Correlation and parallel mediation analysis results show relationships between self-compassion, hope, and emotional control with perceived burdensomeness, thwarted belongingness, and suicidal ideation. Limitations: The study is limited by its cross-sectional design, sample demographics, and inability to distinguish between individuals with suicidal ideation and those who attempt suicide. Conclusion: The results show that the relationships of self-compassion, hope, and emotional control to perceived burdensomeness, thwarted belongingness, and suicidal ideation are worth further investigation.