Cited by 775Suicide and Self-Harm StudiesPsychological Treatments and DisordersMental Health and Psychiatry

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Commentary: Suicide as Psychache

SHNEIDMAN, EDWIN S.·1993·The Journal of Nervous and Mental Disease

DOI 10.1097/00005053-199303000-00001

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Treating depressive disorders with the Unified Protocol: A preliminary randomized evaluation
Sauer-Zavala, S. E., Bentley, K. H., Steele, S. J., Wilner, J. G., Ametaj, A., Nauphal, M., Cardona, N. D., Wang, M., Farchione, T. J., & Barlow, D. H. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.11.072 · Cited by 55
“(2017b), leading theoretical models point to the experience of intense negative affect as a key factor in the development and maintenance of suicidal thoughts and behaviors (e.g., Baumeister, 1990; Beck, 1986; Joiner, 2007; Linehan 1993; Shneidman, 1993); indeed, neuroticism is associated with suicidal ideation even w…”
Background
Suicide notes of adolescents: A life-span comparison.
Leenaars, A. A., de Wilde, E. J., Wenckstern, S., & Kral, M. J. (2001) · Canadian Journal of Behavioural Science/Revue canadienne des sciences du comportement · doi:10.1037/h0087127 · Cited by 52
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Research endeavours into suicide: a need to shift the emphasis
Cutcliffe, J. R. (2003) · British Journal of Nursing · doi:10.12968/bjon.2003.12.2.11058 · Cited by 50
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Addressing Patients’ Psychic Pain
Yager, J. (2015) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2015.14081012 · Cited by 49
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Levinger, S., Somer, E., & Holden, R. R. (2015) · Journal of Trauma & Dissociation · doi:10.1080/15299732.2014.989644 · Cited by 50
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Suicide Prediction – A Shift in Paradigm Is Needed
Hawgood, J. L., & Leo, D. D. (2016) · Crisis · doi:10.1027/0227-5910/a000440 · Cited by 48
Differentiating suicidal motivations and manifestations in a forensic sample.
Holden, R. R., & Kroner, D. G. (2003) · Canadian Journal of Behavioural Science/Revue canadienne des sciences du comportement · doi:10.1037/h0087184 · Cited by 49
Investigating prolonged social withdrawal behaviour as a risk factor for self-harm and suicidal behaviours
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“However, in the longer term, the psychological pain or ‘ psych-ache ’ of people with chronic suicidal beliefs 41 and the inability to leave the secluded environment of the withdrawal 14 may exacerbate the impairments, although more inquiry is needed before conclusions can be made.”
Background
An interpersonal neurobiology perspective on the mind and mental health: personal, public, and planetary well-being
Siegel, D. J., & Drulis, C. (2023) · Annals of General Psychiatry · doi:10.1186/s12991-023-00434-5 · Cited by 50
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Suicide ideation during the COVID-19 outbreak in German university students: Comparison with pre-COVID 19 rates
Brailovskaia, J., Teismann, T., Friedrich, S., Schneider, S., & Margraf, J. (2021) · Journal of Affective Disorders Reports · doi:10.1016/j.jadr.2021.100228 · Cited by 47
“Mental pain describes a subjective perception of negative changes or an impending destruction of the self that can be associated with loneliness, helplessness and anxiety (Cassel, 1982; Orbach et al., 2003; Shneidman, 1993).”
Psychological Intervention, Spontaneous Remission, Hopelessness, and Psychiatric Disturbance in Adolescent Parasuicides
Pillay, A. L., & Wassenaar, D. R. (1995) · Suicide and Life-Threatening Behavior · doi:10.1111/j.1943-278x.1995.tb00961.x · Cited by 47
The concept of psychological distress and its assessment: A clinimetric analysis of the SCL-90-R.
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Women in Cultural Transition: Suicidal Behavior in South African Indian Women
Wassenaar, D. R., Veen, M. B. W. V. D., & Pillay, A. L. (1998) · Suicide and Life-Threatening Behavior · doi:10.1111/j.1943-278x.1998.tb00628.x · Cited by 46
Reappraisal and Suppression Each Moderate the Association Between Stress and Suicidal Ideation: Preliminary Evidence From a Daily Diary Study
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“…J. Franz pfranz@g.harvard.edu 1 Department of Psychology, Harvard University, Cambridge, MA, USA 2 Department of Psychology, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA 1 3 these types of stressful events is a proximal causal factor in STBs (Baumeister 1990; Shneidman 1993).”
Background
From the Serotonin Model of Suicide to a Mental Pain Model of Suicide
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Cognitive, Emotional, Temperament, and Personality Trait Correlates of Suicidal Behavior
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Treating Suicidal Thoughts and Behaviors Within an Emotional Disorders Framework: Acceptability and Feasibility of the Unified Protocol in an Inpatient Setting
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Do Patterns and Types of Negative Affect During Hospitalization Predict Short-Term Post-Discharge Suicidal Thoughts and Behaviors?
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“1 3 et al., 2019) for the role of shame in STBs (Hastings et al., 2000; Maltsberger et al., 2011; Shneidman, 1993).”
Background
Anhedonia and Suicide
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“…A uthor M anuscript why some and not others engage in suicidal behavior may be found in the individual ability to bear psychological pain, which is central to many theories that describe why people attempt and die by suicide (Baumeister, 1990; Leenaars, 1996; Maltsberger, 2004; Shneidman, 1993).”
Background
A visual analog scale to measure psychological and physical pain: A preliminary validation of the PPP-VAS in two independent samples of depressed patients
Jollant, F., Voegeli, G., Kordsmeier, N. C., Carbajal, J. M., Richard‐Devantoy, S., Turecki, G., & Cáceda, R. (2018) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2018.10.018 · Cited by 43
“Shneidman proposed “an introspective experience of negative emotions such as anger, despair, fear, grief, shame, guilt, hopelessness, loneliness and loss” (Shneidman, 1993).”
Managing the risk of suicide in acute psychiatric inpatients: A clinical judgement analysis of staff predictions of imminent suicide risk
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Prevalence and associated factors of suicidal ideation among college students during the COVID-19 pandemic in China: a 3-wave repeated survey
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Self-report depressive symptoms do not directly predict suicidality in nonclinical individuals: Contributions toward a more psychosocial approach to suicide risk
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“Shneidman (1993) has suggested that extreme mental pain (i.e., psychache) is the primary factor responsible for suicide behaviors and that other variables relate to suicide only through psychache.”
Background
The prisoners of despair: right hemisphere deficiency and suicide
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The specificity of mental pain in borderline personality disorder compared to depressive disorders and healthy controls
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Rasmussen, K. A., Slish, M. L., Wingate, L. R., Davidson, C. L., & Grant, D. M. (2012) · Suicide and Life-Threatening Behavior · doi:10.1111/j.1943-278x.2011.00074.x · Cited by 39
Shame-proneness in attempted suicide patients
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Anodyne Psychotherapy for Suicide: A Psychological View of Suicide
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Self-citation
Multidimensional Future Time Perspective as Moderators of the Relationships between Suicide Motivation, Preparation, and Its Predictors
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Editorial: The Psychology of Suicide: From Research Understandings to Intervention and Treatment
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The Role of Emotion Dysregulation in Understanding Suicide Risk: A Systematic Review of the Literature
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“Shneidman [5] proposed that suicide is caused by unbearable and intolerable psychological pain, named ‘ psychache ’.”
Background
Testing the Integrated Motivational-Volitional Model of Suicidal Behavior in Chinese Adolescents
Li, X., Ren, Y., Zhang, X., Zhou, J., Su, B., Liu, S., Cai, H., Liu, J., & You, J. (2020) · Archives of Suicide Research · doi:10.1080/13811118.2019.1690607 · Cited by 48
“Shneidman (1993) theorized that psychological pain, or psychache, is a necessary condition for 373 Archives of Suicide Research, 25:373–389, 2021 # 2020 International Academy for Suicide Research ISSN: 1381-1118 print/1543-6136 online DOI: 10.1080/13811118.2019.1690607 suicide to occur.”
BackgroundInfluential
I just want to matter: Examining the role of anti-mattering in online suicide support communities using natural language processing
Deas, N., Kowalski, R. M., Finnell, S., Radovic, E., Carroll, H., Robbins, C. E., Cook, A., Hurley, K. J., Cote, N., Evans, K., et al. (2022) · Computers in Human Behavior · doi:10.1016/j.chb.2022.107499 · Cited by 39
Mental turmoil, suicide risk, illness perception, and temperament, and their impact on quality of life in chronic daily headache
Filippis, S. D., Erbuto, D., Gentili, F., Innamorati, M., Lester, D., Tatarelli, R., Martelletti, P., & Pompili, M. (2008) · The Journal of Headache and Pain · doi:10.1007/s10194-008-0072-4 · Cited by 38
Morals, Suicide, and Psychiatry: A View from Japan
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Family Dynamics, Hopelessness and Psychiatric Disturbance in Parasuicidal Adolescents
Pillay, A. L., & Wassenaar, D. R. (1997) · Australian & New Zealand Journal of Psychiatry · doi:10.3109/00048679709073825 · Cited by 37
Suicide attempts in the county of Basel: results from the WHO/EURO Multicentre Study on Suicidal Behaviour
Muheim, F., Eichhorn, M., Berger, P., Czernin, S., Stoppe, G., Keck, M., & Riecher‐Rössler, A. (2013) · Swiss Medical Weekly · doi:10.4414/smw.2013.13759 · Cited by 45
Suicide, Stigma, and Utilizing Social Media Platforms to Gauge Public Perceptions
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“The view of suicide as being an “escape” is somewhat neutral, a theory which can be ascribed to Shneidman (36) who described the “psychache””
Background
The Effects of Suicide on the Private Practitioner: A Professional and Personal Perspective
Fox, R., & Cooper, M. (1998) · Clinical Social Work Journal · doi:10.1023/a:1022866917611 · Cited by 37
Suicidal Ideation, Suicidal Plan and Suicidal Attempts Among Those with Major Depressive Disorder
Subramaniam, M., Abdin, E., Seow, E., Picco, L., Vaingankar, J. A., & Chong, S. A. (2014) · Annals of the Academy of Medicine Singapore · doi:10.47102/annals-acadmedsg.v43n8p412 · Cited by 35
ROC analysis of three‐dimensional psychological pain in suicide ideation and suicide attempt among patients with major depressive disorder
Sun, X., Li, H., Song, W., Jiang, S., Shen, C., & Wang, X. (2019) · Journal of Clinical Psychology · doi:10.1002/jclp.22870 · Cited by 37
Some Controversies in Suicidology: Toward a Mentalistic Discipline
Shneidman, E. S. (1993) · Suicide and Life-Threatening Behavior · doi:10.1111/j.1943-278x.1993.tb00199.x · Cited by 35
Self-citation
Suicide Ideation Is Related to Therapeutic Alliance in a Brief Therapy for Attempted Suicide
Gysin-Maillart, A., Soravia, L. M., Gemperli, A., & Michel, K. (2016) · Archives of Suicide Research · doi:10.1080/13811118.2016.1162242 · Cited by 37
“Clinicians tend to see suicide as a symptom of mental disorder (Jobes, 2000), while for the suicidal individual the central issue is the very personal experience of pain, anguish, hopelessness, and loss of self-esteem (Maltsberger, 2004; Shneidman, 1993).”
Background
Clinical Trial Feasibility Studies of the Collaborative Assessment and Management of Suicidality
Jobes, D. A., Comtois, K. A., Brenner, L. A., & Gutierrez, P. M. (2011) · Wiley eBooks · doi:10.1002/9781119998556.ch22 · Cited by 33
Mediators in the association between affective temperaments and suicide risk among psychiatric inpatients
Erbuto, D., Innamorati, M., Lamis, D. A., Berardelli, I., Forte, A., De Pisa, E., Migliorati, M., Serafini, G., Gonda, X., Rihmer, Z., et al. (2018) · Psychiatry · doi:10.1080/00332747.2018.1480251 · Cited by 32
“It refers to the hurt, anguish, or ache that takes hold in the mind; the pain of excessively felt shame, guilt, fear, anxiety, loneliness, or angst, and the dread of growing old or of dying badly (Pompili, Iliceto, Lester, et al., 2009; Shneidman, 1993).”
Background
Being bullied, psychological pain and suicidal ideation among Chinese adolescents: A moderated mediation model
Bao, J., Li, H., Song, W., & Jiang, S. (2020) · Children and Youth Services Review · doi:10.1016/j.childyouth.2020.104744 · Cited by 33
From motivation, decision-making to action: An fMRI study on suicidal behavior in patients with major depressive disorder
Ji, X., Zhao, J., Li, H., Pizzagalli, D. A., Law, S., Lin, P., Fan, L., Zhang, P., Fang, S., Wang, X., et al. (2021) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2021.05.007 · Cited by 35
“…having higher TDPPS total and pain avoidant scores than the NS group fit with Shneidman’s well-accepted psychache theory that emphasizes ending intolerable, and perceivedto-be otherwise unavoidable, psychological pain is a suicide driver (Shneidman, 1993; Olie et al., 2010; Reisch et al., 2010).”
Background
The Subjective Experience of Problem Irresolvability and Suicidal Behavior: Dynamics and Measurement
Orbach, I., Mikulincer, M., Blumenson, R., Mester, R., & Stein, D. J. (1999) · Suicide and Life-Threatening Behavior · doi:10.1111/j.1943-278x.1999.tb01053.x · Cited by 34
Young men's experiences of living with substance abuse and suicidal behaviour: Between death as an escape from pain and the hope of a life
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“Several theoretical models have been developed to understand suicide, including the cognitive model of suicidal behavior (Wenzel & Beck, 2008), psychache (Shneidman, 1993), and many others (Mann et al., 1999; Rosenberg, 1999; Smith & Cukrowicz, 2010).”
Background
A longitudinal study testing the role of psychache in the association between emotional abuse and suicidal ideation
Li, X., You, J., Ren, Y., Zhou, J., Sun, R., Liu, X., & Leung, F. Y. K. (2019) · Journal of Clinical Psychology · doi:10.1002/jclp.22847 · Cited by 32
The Development-Based Taxonomy of Stressors and Traumas: An Initial Empirical Validation
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Sources of Psychological Pain and Suicidal Thoughts Among Homeless Adults
Coohey, C., Easton, S. D., Kong, J., & Bockenstedt, J. K. W. (2014) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.12126 · Cited by 30
Lifetime mental disorders and suicidal behaviour in South Africa
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Clues to Suicide, Reconsidered
Shneidman, E. S. (1994) · Suicide and Life-Threatening Behavior · doi:10.1111/j.1943-278x.1994.tb00818.x · Cited by 31
Self-citation
Using Large Language Models to Understand Suicidality in a Social Media–Based Taxonomy of Mental Health Disorders: Linguistic Analysis of Reddit Posts
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“…desperation—having a deep sense of despair, feeling overwhelmed, and lacking the ability to improve current conditions—is consistent with psychache [24] and the recently proposed diagnostic criteria for acute suicide conditions (eg, suicide crisis syndrome [25]), each of which cite despair as a…”
Background
Test of a clinical model of poor physical health and suicide: The role of depression, psychosocial stress, interpersonal conflict, and panic
Black, J., Bond, M. A., Hawkins, R. C., & Black, E. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.05.079 · Cited by 33
¿Están los grandes repetidores adictos a los comportamientos suicidas?
Blasco-Fontecilla, H., Artieda-Urrutia, P., Berenguer-Elias, N., García-Vega, J. M., Fernández-Rodríguez, M. A. T., Rodriguez-Lomas, C., Gonzalez-Villalobos, I., Cuadrado, L. M. I., & de León, J. (2014) · Adicciones · doi:10.20882/adicciones.38 · Cited by 30
An Empirical Study of Seriously Disturbed Suicidal Patients
Fowler, J. C., Hilsenroth, M. J., & Piers, C. (2001) · Journal of the American Psychoanalytic Association · doi:10.1177/00030651010490010901 · Cited by 28
Worldviews and Individual Vulnerability to Suicide: The Role of Social Axioms
Lam, B. C. P., Bond, M. H., Chen, S. X., & Wu, W. C. H. (2010) · European Journal of Personality · doi:10.1002/per.762 · Cited by 30
Seasonal variation and meteotropism in suicide: clinical relevance of findings and implications for research
Preti, A. (2002) · Acta Neuropsychiatrica · doi:10.1034/j.1601-5215.2002.140103.x · Cited by 30
Attitudes Toward Suicide: Past, Present and Future
Stillion, J. M., & Stillion, B. D. (1999) · OMEGA - Journal of Death and Dying · doi:10.2190/0t85-b3h5-jg6t-qfxg · Cited by 30
Rational Suicide in Elderly Adults: A Clinician's Perspective
Balasubramaniam, M. (2018) · Journal of the American Geriatrics Society · doi:10.1111/jgs.15263 · Cited by 29
Assessing psychache as a suicide risk variable: Data with the Portuguese version of the psychache scale
Campos, R. C., Holden, R. R., & Gomes, M. (2018) · Death Studies · doi:10.1080/07481187.2018.1493002 · Cited by 29
“One of the most compelling psychological perspectives of suicide is that of Shneidman (1993).”
BackgroundMethodInfluential
PROTECT: Relational safety based suicide prevention training frameworks
Ray, M. K., Wyder, M., Crompton, D., Kousoulis, A. A., Arensman, E., Hafizi, S., Bortel, T. V. V., & Lombardo, C. (2019) · International Journal of Mental Health Nursing · doi:10.1111/inm.12685 · Cited by 29
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“Shneidman (1993) introduced the concept “psychache” to describe an introspective experience with overwhelming feelings of “guilt, shame, humiliation or loneliness or fear or angst or dread of growing old or dying badly [10] (p.”
Background
Emotions and Suicidal Ideation among Depressed Women with Childhood Sexual Abuse Histories
You, S., Talbot, N. L., He, H., & Conner, K. R. (2012) · Suicide and Life-Threatening Behavior · doi:10.1111/j.1943-278x.2012.00086.x · Cited by 28
Suicide and Reputation Damage
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Content Analysis of Suicide Notes as a Test of the Motivational Component of the Existential‐Constructivist Model of Suicide
Rogers, J. R., Bromley, J. L., McNally, C. J., & Lester, D. (2007) · Journal of Counseling & Development · doi:10.1002/j.1556-6678.2007.tb00461.x · Cited by 28
When the Pain Becomes Unbearable: Case-Control Study of Mental Pain Characteristics Among Medically Serious Suicide Attempters
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“Baumeister (1990) had already suggested that mental pain induces mental constriction and tunnel vision, leading individuals to perceive suicide as the only solution to an unbearable state of being (Baumeister, 1990; Orbach, 2001; Shneidman, 1993).”
Background
Association of comorbidity of mood and anxiety disorders with suicidal behaviors
Wang, X., Liu, Z., Li, Y., Li, G., & Huang, Y. (2017) · Journal of Affective Disorders · doi:10.1016/j.jad.2017.11.006 · Cited by 28
How meaningful is meaning-making?
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Clinical model for suicide risk assessment
Kral, M. J., & Sakinofsky, I. (1994) · Death Studies · doi:10.1080/07481189408252680 · Cited by 28
Perspectives on the insidious nature of pain metaphor: we literally need to change our metaphors
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“Shneidman (61) devised the neologism “ psychache ” to describe unbearable psychological anguish, soreness, hurt, “ pain ” and aching and theorized that unresolved psychache due to an unful ﬁ lled psychological need caused suicide.”
Background
Risk for Suicide Among Treatment Seeking Adolescents: The Role of Positive and Negative Affect Intensity
Rojas, S. M., Leen‐Feldner, E. W., Blumenthal, H., Lewis, S. F., & Feldner, M. T. (2014) · Cognitive Therapy and Research · doi:10.1007/s10608-014-9650-8 · Cited by 30

Authors: SHNEIDMAN, E. S.
Affiliations: University of California, Los Angeles (US)
Corresponding author: SHNEIDMAN, EDWIN S.
Venue: The Journal of Nervous and Mental Disease
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 1993-03
Volume: 181
Issue: 3
Pages: 145-147
ISSN: 0022-3018 (ISSN-L)
DOI: 10.1097/00005053-199303000-00001
OpenAlex: W2224716391
Cited by: 775
References: 0
Citations by year: 2026: 39 · 2025: 84 · 2024: 58 · 2023: 43 · 2022: 50 · 2021: 49 · 2020: 59 · 2019: 42 · 2018: 32 · 2017: 38 · 2016: 34 · 2015: 25 · 2014: 31 · 2013: 22 · 2012: 20
Type: journal article
Language: en
Open access: closed
Locations: The Journal of Nervous and Mental Disease (publishedVersion)
PubMed (publishedVersion)
Topics: Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Disorders
Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
Keywords: suicide, emotional pain, psychological suffering
MeSH terms: Depressive Disorder, Frustration, Happiness, Humans, Models, Psychological, Pain, Personality, Q-Sort, Stress, Psychological, Suicide

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