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Cited by 54Suicide and Self-Harm StudiesTreatment of Major DepressionPersonality Disorders and Psychopathology

High depression symptomatology and mental pain characterize suicidal psychiatric patients

Open access
Pompili, Maurizio, Innamorati, Marco, Erbuto, Denise, Luciano, Mario, Sampogna, Gaia, Abbate-Daga, Giovanni, Barlati, Stefano, Carmassi, Claudia +18 more·2022·European Psychiatry
DOI 10.1192/j.eurpsy.2022.2312PMC PMC9491079
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Abstract

Background: Symptoms of depression are transdiagnostic heterogenous features frequently assessed in psychiatric disorders, that impact the response to first-line treatment and are associated with higher suicide risk. This study assessed whether severe mental pain could characterize a specific phenotype of severely depressed high-risk psychiatric patients. We also aimed to analyze differences in treatments administered. Methods: 2,297 adult patients (1,404 females and 893 males; mean age = 43.25 years, SD = 15.15) treated in several Italian psychiatric departments. Patients were assessed for psychiatric diagnoses, mental pain, symptoms of depression, hopelessness, and suicide risk. Results: More than 23% of the patients reported high depression symptomatology and high mental pain (HI DEP/HI PAIN). Compared to patients with lower symptoms of depression, HI DEP/HI PAIN is more frequent among females admitted to an inpatient department and is associated with higher hopelessness and suicide risk. In addition, HI DEP/HI PAIN (compared to both patients with lower symptoms of depression and patients with higher symptoms of depression but lower mental pain) were more frequently diagnosed in patients with personality disorders and had different treatments. Conclusions: Patients reporting severe symptoms of depression and high mental pain presented a mixture of particular dangerousness (high trait hopelessness and the presence of suicide ideation with more frequency and less controllability and previous suicide behaviors). The presence of severe mental pain may act synergically in expressing a clinical phenotype that is likewise treated with a more complex therapeutic regime than that administered to those experiencing symptoms of depression without mental pain.

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Written from the paper’s full text.

TL;DR

In a large Italian multicenter psychiatric sample, more than 23% of patients had high depression symptomatology plus high mental pain (HI DEP/HI PAIN), a phenotype linked to greater hopelessness, suicide risk, and more complex treatment. HI DEP/HI PAIN patients were more often female, inpatients, diagnosed with personality disorders, and prescribed antipsychotics, mood stabilizers, and anxiolytics than depressed patients with lower mental pain.

Key findings

  • Of 2,297 patients, 535 (23.3%) were classified as HI DEP/HI PAIN, 550 as HI DEP/LO PAIN, and 1,188 as LO DEP; HI DEP/HI PAIN patients had higher mean BHS hopelessness scores (13.00 vs. 11.16 vs. 6.29) and more lifetime suicide attempts (53.3% vs. 40.7% vs. 28.2%).
  • HI DEP/HI PAIN was more frequent among females (71.0% vs. 64.4% vs. 54.7%) and inpatients (47.7% vs. 27.7% vs. 24.8%), and was associated with more personality disorder diagnoses (borderline personality disorder 16.0% vs. 7.6% vs. 5.2%).
  • In multivariate models versus LO DEP, HI DEP/HI PAIN was associated with higher BHS scores (OR = 1.27), personality disorders (OR = 1.77), death wishes (OR = 23.75), serious suicide ideation (OR = 83.72), antidepressant treatment (OR = 1.52), anxiolytic treatment (OR = 1.52), and inpatient status (OR = 2.28).
  • Compared with HI DEP/LO PAIN, HI DEP/HI PAIN patients were more frequently diagnosed with personality disorders (OR = 1.91) and more frequently treated with antipsychotics (OR = 1.58), mood stabilizers (OR = 1.53), and anxiolytics (OR = 1.34); they also reported more frequent suicide ideation (OR = 1.30), lower controllability (OR = 1.20), and pain as a reason for suicide ideation (OR = 1.30) versus LO DEP.

Methods

  • Multicenter observational study of 2,297 adult patients (1,635 outpatients and 662 inpatients; 1,404 females and 893 males; mean age = 43.25 years, SD = 15.15, range 18–95) treated in several Italian psychiatric inpatient and outpatient departments.
  • Patients were assessed for DSM-5 diagnoses via SCID-5 and administered the Physical and Psychological Pain Scale (PPPS), Beck Depression Inventory-II (BDI-II), Beck Hopelessness Scale (BHS), and Columbia Suicide Severity Rating Scale (C-SSRS).
  • Groups were defined by BDI-II score ≥20 plus PPPS worst mental pain ≥75th percentile (HI DEP/HI PAIN), BDI-II ≥20 plus PPPS <75th percentile (HI DEP/LO PAIN), or BDI-II <20 (LO DEP); analyses used ANOVAs, chi-squared tests with Bonferroni correction, multinomial regression, and a log-linear model.

Limitations

  • The paper states that many participating centers may have introduced heterogeneity in assessment and evaluation procedures, that patients had several psychiatric diagnoses making single groups difficult to characterize, that some centers did not recruit the planned number of patients, and that C-SSRS assessed suicidal intent in the past month whereas recent suicide attempts were considered within the past three months.
  • Evident from the text: the observational, cross-sectional design cannot establish causality between mental pain, depression, and suicide risk.
  • Evident from the text: findings come from psychiatric patients in Italian inpatient and outpatient departments, so generalization to other settings or populations is not established.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1192/j.eurpsy.2022.2312

Cites

Statistics

Nothing to recompute.

Claims the paper makes

0 of 43 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    In multivariate analysis, HI DEP/HI PAIN and HI DEP/LO PAIN patients had higher BDI-2 suicide risk than LO DEP patients.

    “Compared to LO DEP patients, both HI DEP/HI PAIN and HI DEP/LO PAIN patients were more frequently females, had higher BHS scores, had higher BDI-2 suicide risk, and were treated more frequently with antidepressants and anxiolytics.”
    Quote in the paperSubstantial claim
  • Findingown data

    HI DEP/HI PAIN patients were more frequently prescribed anxiolytics than HI DEP/LO PAIN and LO DEP patients.

    “Post hoc comparisons were significant (p < 0.05) with HI DEP/HI PAIN > HI DEP/LO PAIN > LO DEP for the presence of females, PDs, BHS scores, lifetime suicide attempts, BDI-2 suicide risk, recent nonsuicidal self-harm, and antipsychotic and anxiolytic treatments.”
    Quote in the paperNot a substantial claim
  • Findingown data

    HI DEP/HI PAIN patients had higher odds of death wishes than LO DEP patients (OR 23.75, 95% CI 12.32-45.78).

    “| Death wishes | | | | 8.26 | 4.26 | 15.99 | 23.75 | 12.32 | 45.78 |”
    Quote in the paperSubstantial claim
  • Findingown data

    In the study sample of 2,297 adult psychiatric patients, 535 (23.3%) had high depression symptomatology and high mental pain (HI DEP/HI PAIN).

    “More than 23% of the patients reported high depression symptomatology and high mental pain (HI DEP/HI PAIN).”
    • Also stated in: § Factors associated with HI DEP/HI PAIN · plain
      “In the past two weeks, 535 patients reported HI DEP/HI PAIN, 550 reported high depression symptomatology (BDI ≥ 20), but low psychological pain (below the 75th percentile) (HI DEP/LO PAIN), and 1,188 reported LO DEP.”
    Quote in the paperSubstantial claim
  • Findingown data

    HI DEP/HI PAIN patients were more frequently diagnosed with personality disorders than HI DEP/LO PAIN and LO DEP patients.

    “Post hoc comparisons were significant (p < 0.05) with HI DEP/HI PAIN > HI DEP/LO PAIN > LO DEP for the presence of females, PDs, BHS scores, lifetime suicide attempts, BDI-2 suicide risk, recent nonsuicidal self-harm, and antipsychotic and anxiolytic treatments.”
    Quote in the paperSubstantial claim
  • May combine two claims. 22
  • Classified as probably not a substantial claim. 33

  • May combine two claims.

    Findingown data

    In the multivariate model, groups differed for all variables except lifetime suicide attempts, recent nonsuicidal self-harm, and treatments with antipsychotics and mood stabilizers.

    “When controlling for other variables, groups differed for all the variables (excluding lifetime suicide attempts, recent nonsuicidal self-harm, and treatments with antipsychotics and mood stabilizers).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    HI DEP/HI PAIN patients differed from LO DEP group and from HI DEP/LO PAIN patients for more duration of suicide ideation.

    “HI DEP/HI PAIN patients differed from the LO DEP group and from HI DEP/LO PAIN patients for the presence of more severe suicide ideation and for the existence of higher frequency, more duration, less controllability, fewer deterrents, and for having higher pain as a reason for suicide ideation than other groups.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    HI DEP/HI PAIN patients differed from LO DEP group and from HI DEP/LO PAIN patients for fewer deterrents.

    “HI DEP/HI PAIN patients differed from the LO DEP group and from HI DEP/LO PAIN patients for the presence of more severe suicide ideation and for the existence of higher frequency, more duration, less controllability, fewer deterrents, and for having higher pain as a reason for suicide ideation than other groups.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Current suicide ideation was reported with more frequency and less controllability in HI DEP/HI PAIN patients than other patients.

    “Current suicide ideation was reported with more frequency and less controllability, and lifetime suicide attempts were more frequent than other patients.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    HI DEP/HI PAIN patients differed from LO DEP group and from HI DEP/LO PAIN patients for the presence of more severe suicide ideation.

    “HI DEP/HI PAIN patients differed from the LO DEP group and from HI DEP/LO PAIN patients for the presence of more severe suicide ideation and for the existence of higher frequency, more duration, less controllability, fewer deterrents, and for having higher pain as a reason for suicide ideation than other groups.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    HI DEP/HI PAIN patients differed from LO DEP group and from HI DEP/LO PAIN patients for less controllability of suicide ideation.

    “HI DEP/HI PAIN patients differed from the LO DEP group and from HI DEP/LO PAIN patients for the presence of more severe suicide ideation and for the existence of higher frequency, more duration, less controllability, fewer deterrents, and for having higher pain as a reason for suicide ideation than other groups.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    DEP/PAIN groups significantly differed in the presence of suicide ideation and characteristics of the ideation (frequency, duration, controllability, presence of deterrents, and pain as reason for suicide ideation) (p < 0.05).

    “DEP/PAIN groups significantly (p < 0.05) differed in the presence of suicide ideation and characteristics of the ideation (frequency, duration, controllability, the presence of deterrents, and pain as reason for suicide ideation)”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    Patients reporting severe symptoms of depression and high mental pain presented a mixture of particular dangerousness: high trait hopelessness and presence of suicide ideation with more frequency and less controllability and previous suicide behaviors.

    “Patients reporting severe symptoms of depression and high mental pain presented a mixture of particular dangerousness (high trait hopelessness and the presence of suicide ideation with more frequency and less controllability and previous suicide behaviors).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Heterogeneity and comorbidity of depression symptoms impact the response to first-line treatment and contribute to higher suicide risk.

    “Heterogeneity and comorbidity of depression symptoms impact the response to first-line treatment [1–4], contributing to higher suicide risk.”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [1] McQuaid RJ. Transdiagnostic biomarker approaches to mental health disorders: consideration of symptom complexity, comorbidity and context. Brain Behav Immun Health. 2021; 16: 100303. 34589795 PMC8474161 source

      Not checked in the free run.

    • cites [2] Saveanu R, Etkin A, Duchemin AM, Goldstein-Piekarski A, Gyurak A, Debattista C, et al. The international study to predict optimized treatment in depression (iSPOT-D): outcomes from the acute phase of antidepressant treatment. J Psychiatr Res. 2015; 61: 1– 12. 25586212 source

      Not checked in the free run.

    • cites [3] Serafini G, Parisi VM, Aguglia A, Amerio A, Sampogna G, Fiorillo A, et al. A specific inflammatory profile underlying suicide risk? Systematic review of the main literature findings. Int J Environ Res Public Health. 2020; 17(7): 2393. PMC7177217 32244611 source

      Not checked in the free run.

    • cites [4] Miller AH. Beyond depression: the expanding role of inflammation in psychiatric disorders. World Psychiatry. 2020; 19(1): 108–9. doi: 10.1002/wps.20723. 31922681 PMC6953590 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The study was conducted ethically following the Declaration of Helsinki and with written informed consent.

    “The study was conducted ethically following the World Medical Association Declaration of Helsinki. Patients participated voluntarily and provided written informed consent following review and approval of each participating center’s research ethics review board, ensuring that data would be reported anonymously and in aggregate form.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Cronbach's alpha in the present sample was 0.91 for physical pain and 0.92 for mental pain dimensions of the PPPS.

    “Cronbach’s alpha values in the present sample were 0.91 and 0.92, respectively, for physical and mental pain dimensions.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Psychiatric diagnoses were assessed according to DSM-5 criteria using the Structured Clinical Interview 5th Edition (SCID-5).

    “Patients were assessed for psychiatric diagnoses according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria, the Structured Clinical Interview 5th Edition (SCID—DSM-5) [20], via psychiatric interviews and the administration of psychometric instruments.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20] First MB, Williams JBW, Karg RS, Spitzer RL. Structured clinical interview for DSM-5—Research version (SCID-5 for DSM-5, research version; SCID-5-RV). Arlington, VA: American Psychiatric Association; 2015.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Patients with MDD and suicidal ideation have significantly worse quality of life, high healthcare resource use, and greater productivity loss and activity impediment than patients without suicidal ideation and the general population.

    “A recent study showed that patients with MDD and suicidal ideation (vs. patients without suicidal ideation and the general population) had significantly worse quality of life, high healthcare resource use, and greater productivity loss and activity impediment [17].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [17] Jaffe DH, Rive B, Denee TR. The burden of suicidal ideation across Europe: a cross-sectional survey in five countries. Neuropsychiatr Dis Treat. 2019; 15: 2257–71. 31496708 PMC6689539 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The severity of depressive symptoms in major depressive disorder is associated with an increased risk of an MDD-related hospital encounter in the short term.

    “Additionally, the severity of depressive symptoms in major depressive disorder (MDD) was reported to be associated with an increased risk of an MDD-related hospital encounter in the short term [16].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [16] Voelker J, Wang K, Tang W, He J, Daly E, Pericone CD, et al. Association of depression symptom severity with short-term risk of an initial hospital encounter in adults with major depressive disorder. BMC Psychiatry. 2021; 21(1): 257. 34001045 PMC8130130 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Mental pain was measured using the Physical and Psychological Pain Scale (PPPS).

    “the Physical and Psychological Pain Scale (PPPS) [21]”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [21] Olie E, Guillaume S, Jaussent I, Courtet P, Jollant F. Higher psychological pain during a major depressive episode may be a factor of vulnerability to suicidal ideation and act. J Affect Disord. 2010; 120(1–3): 226–30. 19394086 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The BDI-II item 9 has been considered an efficient screening tool for suicide risk in clinical settings.

    “A single item assesses suicide ideation (item no. 9) and has been considered an efficient screening tool for suicide risk in clinical settings [27].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [27] Green KL, Brown GK, Jager-Hyman S, Cha J, Steer RA, Beck AT. The predictive validity of the Beck Depression Inventory suicide item. J Clin Psychiatry. 2015; 76(12): 1683–6. 26717528 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Cronbach's alpha in the present sample was 0.89 for the BHS.

    “Cronbach’s alpha in the present sample was 0.89.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Bonferroni correction was used to correct for multitesting.

    “Bonferroni correction was used to correct for multitesting, and measures of effect sizes were reported.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Hopelessness was measured using the Beck Hopelessness Scale (BHS).

    “the Beck Hopelessness Scale (BHS) [23]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [23] Beck AT, Weissman A, Lester D, Trexler L. The measurement of pessimism: the hopelessness scale. J Consult Clin Psychol. 1974; 42(6): 861–5. 4436473

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Mental pain is associated with change in brain areas involved in emotional processing in depressed patients.

    “In this study, mental pain was associated with change in brain areas involved in emotional processing [18].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [18] van Heeringen K, Van den Abbeele D, Vervaet M, Soenen L, Audenaert K. The functional neuroanatomy of mental pain in depression. Psychiatry Res. 2010; 181(2): 141–4. 20074915 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Suicide risk was measured using the Columbia Suicide Severity Rating Scale (C-SSRS).

    “the Columbia Suicide Severity Rating Scale (C-SSRS) [24]”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [24] Posner K, Brown GK, Stanley B, Brent DA, Yershova KV, Oquendo MA, et al. The Columbia-suicide severity rating scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults. Am J Psychiatry. 2011; 168(12): 1266–77. 22193671 PMC3893686 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A BHS score of 9 or higher could detect patients at risk for suicide.

    “A score of 9 or higher could detect patients at risk for suicide [31, 35].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [31] Beck AT, Brown G, Berchick RJ, Stewart BL, Steer RA. Relationship between hopelessness and ultimate suicide: a replication with psychiatric outpatients. Am J Psychiatry. 1990; 147(2): 190–5. 2278535 source

      Not checked in the free run.

    • cites [35] Grano N, Oksanen J, Kallionpaa S, Roine M. Specificity and sensitivity of the Beck Hopelessness Scale for suicidal ideation among adolescents entering early intervention service. Nord J Psychiatry. 2017; 71(1): 72–6. 27626513 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Depressive symptoms were measured using the Beck Depression Inventory-II (BDI-II).

    “the Beck Depression Inventory-II (BDI-II) [22]”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [22] Beck AT, Steer RA, Brown GK. Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation; 1996.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The BHS has good psychometric properties and satisfactory ability in predicting subsequent suicide behavior, and general health and social functioning.

    “Several international studies reported good psychometric properties of the BHS and suggested satisfactory ability in predicting subsequent suicide behavior, and general health and social functioning [30–34].”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [30] Innamorati M, Lester D, Balsamo M, Erbuto D, Ricci F, Amore M, et al. Factor validity of the Beck Hopelessness Scale in Italian medical patients. J Psychopathol Behav Assess. 2014; 36: 300–7. source

      Not checked in the free run.

    • cites [31] Beck AT, Brown G, Berchick RJ, Stewart BL, Steer RA. Relationship between hopelessness and ultimate suicide: a replication with psychiatric outpatients. Am J Psychiatry. 1990; 147(2): 190–5. 2278535 source

      Not checked in the free run.

    • cites [32] Pompili M, Innamorati M, Gonda X, Serafini G, Sarno S, Erbuto D, et al. Affective temperaments and hopelessness as predictors of health and social functioning in mood disorder patients: a prospective follow-up study. J Affect Disord. 2013; 150(2): 216–22. 23684516 source

      Not checked in the free run.

    • cites [33] Beck AT, Brown G, Steer RA. Prediction of eventual suicide in psychiatric inpatients by clinical ratings of hopelessness. J Consult Clin Psychol. 1989; 57(2): 309–10. 2708621 source

      Not checked in the free run.

    • cites [34] Beck AT. Hopelessness as a predictor of eventual suicide. Ann N Y Acad Sci. 1986; 487: 90–6. 3471167 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Depressive symptoms encompass diagnoses and may play a central role in major psychiatric disorders to recognize more vulnerable subpopulations.

    “Depressive symptoms encompass diagnoses and may play a central role in major psychiatric disorders to recognize more vulnerable subpopulations [13–15].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [13] Upthegrove R, Marwaha S, Birchwood M. Depression and schizophrenia: cause, consequence, or trans-diagnostic issue? Schizophr Bull. 2017; 43(2): 240–4. 27421793 PMC5605248 source

      Not checked in the free run.

    • cites [14] Maj M, Stein DJ, Parker G, Zimmerman M, Fava GA, De Hert M, et al. The clinical characterization of the adult patient with depression aimed at personalization of management. World Psychiatry. 2020; 19(3): 269–93. 32931110 PMC7491646 source

      Not checked in the free run.

    • cites [15] Reynolds CF. Optimizing personalized management of depression: the importance of real-world contexts and the need for a new convergence paradigm in mental health. World Psychiatry. 2020; 19(3): 266–8. 32931119 PMC7491608 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The study was approved by the Internal Review Board of Sant'Andrea Hospital and local review boards.

    “The project was first submitted to the Internal Review Board of Sant’Andrea Hospital (RIF.CE: 4646_2017) as part of the Sapienza University of Rome, the study’s coordinator. The protocol was then submitted to the internal review boards of the participating centers by local investigators.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    A web-based system with codes and anonymous labels and a guided digital procedure was used to minimize data entry errors.

    “A web-based system with codes and anonymous labels was devised for this study. Each center entered all data via a guided digital procedure to minimize data entry errors.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The C-SSRS is a rating scale evaluating suicidal ideation in individuals aged 12 years and older.

    “It is a rating scale evaluating suicidal ideation in individuals aged 12 years and older [24].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [24] Posner K, Brown GK, Stanley B, Brent DA, Yershova KV, Oquendo MA, et al. The Columbia-suicide severity rating scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults. Am J Psychiatry. 2011; 168(12): 1266–77. 22193671 PMC3893686 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Cronbach's alpha in the present sample was 0.94 for the BDI-II.

    “Cronbach’s alpha in the present sample was 0.94.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Suicide risk is particularly high during hospitalization and at discharge.

    “Findings have shown that suicide risk is particularly high during hospitalization and at discharge [37].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [37] Forte A, Buscajoni A, Fiorillo A, Pompili M, Baldessarini RJ. Suicidal risk following hospital discharge: a review. Harv Rev Psychiatry. 2019; 27(4): 209–16. 31274577 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Contrasting results have been reported, with a higher risk in male patients.

    “However, contrasting results have been reported, with a higher risk in male patients [41].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [41] Large M, Sharma S, Cannon E, Ryan C, Nielssen O. Risk factors for suicide within a year of discharge from psychiatric hospital: a systematic meta-analysis. Aust N Z J Psychiatry. 2011; 45(8): 619–28. 21740345 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Such possible implications of psychopharmacology in psychiatric patients experiencing mental pain have been reported as central to implementing patient-reported outcomes.

    “Such possible implications of psychopharmacology in psychiatric patients experiencing mental pain have been reported as central to implementing patient-reported outcomes; any report comes directly from patients about how they function or feel concerning a health condition or therapy [49].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [49] Fava GA, Tomba E, Brakemeier EL, Carrozzino D, Cosci F, Eory A, et al. Mental pain as a transdiagnostic patient-reported outcome measure. Psychother Psychosom. 2019; 88(6): 341–9. 31665739 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In a study of 12 countries, females had higher suicide rates during and after hospitalization.

    “The authors reported a similar gender gap in suicide risk, with females having higher suicide rates during and after hospitalization [40].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [40] Listabarth S, Vyssoki B, Glahn A, Gmeiner A, Pruckner N, Vyssoki S, et al. The effect of sex on suicide risk during and after psychiatric inpatient care in 12 countries-an ecological study. Eur Psychiatry. 2020; 63(1): e85. 32892754 PMC7576527 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    According to Zou et al., the higher risk of suicide in patients with severe mental pain could be explained by a specific component of mental pain, pain avoidance, and the behavioral tendency to escape from psychological pain through suicide.

    “According to Zou et al. [42], the higher risk of suicide in patients with severe mental pain could be explained by a specific component of mental pain, pain avoidance, and the behavioral tendency to escape from psychological pain through suicide [43].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [42] Zou Y, Li H, Shi C, Lin Y, Zhou H, Zhang J. Efficacy of psychological pain theory-based cognitive therapy in suicidal patients with major depressive disorder: a pilot study. Psychiatry Res. 2017; 249: 23–9. 28063394 source

      Not checked in the free run.

    • cites [43] Li H, Xie W, Luo X, Fu R, Shi C, Ying X, et al. Clarifying the role of psychological pain in the risks of suicidal ideation and suicidal acts among patients with major depressive episodes. Suicide Life Threat Behav. 2014; 44(1): 78– 88. 24106764 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In Italy, validation studies on the BHS in medical patients, university students, and psychiatric inpatients demonstrated satisfactory psychometric properties.

    “In Italy, validation studies have been conducted on samples of medical patients, university students, and psychiatric inpatients and have demonstrated satisfactory psychometric properties [30].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [30] Innamorati M, Lester D, Balsamo M, Erbuto D, Ricci F, Amore M, et al. Factor validity of the Beck Hopelessness Scale in Italian medical patients. J Psychopathol Behav Assess. 2014; 36: 300–7. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    The opportunity to identify the presence of mental pain comorbid with depressive symptoms may help recognize poor future expectations, which is a well-known proxy for completed suicide.

    “The opportunity to identify the presence of mental pain comorbid with depressive symptoms may help recognize poor future expectations, which is a well-known proxy for completed suicide [39].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [39] Beck AT, Steer RA, Kovacs M, Garrison B. Hopelessness and eventual suicide: a 10-year prospective study of patients hospitalized with suicidal ideation. Am J Psychiatry. 1985; 142(5): 559–63. 3985195 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    Mental pain is highly prevalent in depressed psychiatric patients, especially in inpatient settings.

    “Thus, mental pain is highly prevalent in depressed psychiatric patients, especially in inpatient settings.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    The many centers participating in this research may point to heterogeneity of assessment and evaluation procedures through psychometric instruments.

    “First, the many centers participating in this research may point to the heterogeneity of assessment and evaluation procedures through psychometric instruments.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Patients had several psychiatric diagnoses, making it difficult to characterize single groups.

    “Second, patients had several psychiatric diagnoses, making it difficult to characterize single groups.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In a previous article, recent suicide attempters (compared to nonattempters) had a more severe childhood physical, sexual, and emotional abuse history but not emotional and physical neglect.

    “In a previous article, we reported that recent suicide attempters (compared to nonattempters) had a more severe childhood physical, sexual, and emotional abuse history but not emotional and physical neglect (for this dimension, we have to consider that reliability was insufficient).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [19] Pompili M, Erbuto D, Innamorati M, Luciano M, Sampogna G, Abbate-Daga G, et al. The relationship between mental pain, suicide, and childhood traumatic experiences: results from a multicenter study. J Clin Psychiatry. 2022; 83: 21m14176. 35704708 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    There are limitations concerning the instruments used to assess the patients (C-SSRS assessed suicidal intent in past month, whereas recent suicide attempts were considered in past three months, which could set the two measures at different times).

    “Finally, there are also limitations concerning the instruments used to assess the patients (such as C-SSRS that assessed suicidal intent in the past month, whereas recent suicide attempts were considered to be in the past three months, which could set the two measures at different times).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationcitation

    The present report adds consistent emphasis on the need to explore patients' perspectives through an empathic understanding of their sufferance as part of the clinical picture.

    “The present report adds consistent emphasis on the need to explore patients’ perspectives through an empathic understanding of their sufferance as part of the clinical picture [51–53].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [51] Fava GA, Guidi J. The pursuit of euthymia. World Psychiatry. 2020; 19(1): 40– 50. 31922678 PMC7254162 source

      Not checked in the free run.

    • cites [52] Hayes SC. Constructing a liberated and modern mind: six pathways from pathology to euthymia. World Psychiatry. 2020; 19(1): 51–2. 31922691 PMC6953575 source

      Not checked in the free run.

    • cites [53] MacLeod A. Euthymia: why it really does matter. World Psychiatry. 2020; 19(1): 1– 2. 31922672 PMC6953547 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Mental pain features are crucial for the early detection of suicide risk.

    “Mental pain features are also crucial for the early detection of suicide risk [50].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [50] Erbuto D, Innamorati M, Lamis DA, Berardelli I, Forte A, De Pisa E, et al. Mediators in the association between affective temperaments and suicide risk among psychiatric inpatients. Psychiatry. 2018; 81(3): 240–57. 30183526 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Some centers did not manage to recruit the number of patients set at the beginning of the study, influencing heterogeneity and representativeness of the final sample.

    “Furthermore, some centers did not manage to recruit the number of patients set at the beginning of the study, thus influencing the heterogeneity and representativeness of the final sample.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Fava et al. pointed to the transdiagnostic features of mental pain, as such features are traceable to several psychiatric disorders.

    “In addition, Fava et al. [49] pointed to the transdiagnostic features of mental pain, as such features are traceable to several psychiatric disorders, such as depression, anxiety, eating disorders, and borderline personality disorder.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [49] Fava GA, Tomba E, Brakemeier EL, Carrozzino D, Cosci F, Eory A, et al. Mental pain as a transdiagnostic patient-reported outcome measure. Psychother Psychosom. 2019; 88(6): 341–9. 31665739 source

      Not checked in the free run.

45 of 45

  • The authors state this as an assumption.

    Mental pain as a form of inner turmoil may require sedative, tranquilizing, and mood-modulation agents to relieve patients’ suffering.

    “It seems reasonable to assume that mental pain as a form of inner turmoil may require sedative, tranquilizing, and mood-modulation agents to relieve patients’ suffering [44–48].”
1 of 1

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Higher levels of psychological pain have been reported more frequently among younger populations, women, and those who are divorced, widowed, or unemployed.

    “Additionally, higher levels of psychological pain have been reported more frequently among younger populations [21,23], women, and those who are divorced, widowed, or unemployed [23].”

    From Targeting Psychological Pain After a Suicide Attempt: Scoping Review and Intervention Protocol (2026) · cites this paper as [23]

    In Results, Table 1, the high-depression/high-pain group has a higher proportion of women and descriptively includes more divorced or widowed and unemployed patients, with a slightly lower mean age. The Results text says only the sex difference remained significant after correction for multiple testing; age, marital status, and employment did not. The findings also concern suicidal psychiatric patients grouped by both depression symptoms and psychological pain, not younger populations generally. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Anxiolytic percentages exceed the reported total

    Major

    The three group percentages imply about 1,245 patients treated with anxiolytics, rather than the reported 1,053.

  • Antipsychotic percentages exceed the reported total

    Major

    The three group percentages imply about 1,229 patients treated with antipsychotics, rather than the reported 1,050.

  • Mood-stabilizer percentages exceed the reported total

    Minor

    The three group percentages imply about 1,014 patients treated with mood stabilizers, rather than the reported 847.

  • Inpatient group percentages exceed the reported total

    Minor

    Applying the three group percentages to their reported group sizes gives about 702 inpatients, exceeding the stated whole-sample count of 662. Rounding cannot account for the difference.

  • Personality-disorder 'none' percentages exceed the reported count

    Minor

    The three group percentages imply about 1,769 patients in the 'none' category, exceeding its reported count of 1,688.

5 of 5

The citation lists haven’t been fetched yet

References 49 · Cited by 54

Research works printed but not linked: 4

  1. Beck, 1996, Manual for the Beck Depression Inventory-II
  2. Beck, 1993, Manual for the Beck Hopelessness Scale
  3. Pompili, 2008, Beck Hopelessness Scale: Manuale
  4. First, 2015, Structured clinical interview for DSM-5—Research version (SCID-5 for DSM-5, research version; SCID-5-RV)

Authors
Pompili, M., Innamorati, M., Erbuto, D., Luciano, M., Sampogna, G., Abbate-Daga, G., Barlati, S., Carmassi, C., Castellini, G., De Fazio, P., Di Lorenzo, G., Di Nicola, M., Ferrari, S., Goracci, A., Gramaglia, C., Martinotti, G., Nanni, M. G., Pasquini, M., Pinna, F., Poloni, N., Serafini, G., Signorelli, M., Tortorella, A., Ventriglio, A., Volpe, U., & Fiorillo, A.
Affiliations
  • Azienda Ospedaliera Sant'Andrea (IT)
  • European University of Rome (IT)
  • University of Campania "Luigi Vanvitelli" (IT)
  • Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia (IT)
  • University of Pisa (IT)
  • University of Florence (IT)
  • University of Siena (IT)
  • Università degli Studi del Piemonte Orientale “Amedeo Avogadro” (IT)
  • University of Chieti-Pescara (IT)
  • University of Ferrara (IT)
  • Sapienza University of Rome (IT)
  • University of Cagliari (IT)
  • University of Insubria (IT)
  • University of Genoa (IT)
  • University of Catania (IT)
  • University of Perugia (IT)
  • University of Foggia (IT)
  • Marche Polytechnic University (IT)
Corresponding author
Pompili, Maurizio
ORCID
Venue
European Psychiatry
Publisher
Royal College of Psychiatrists
Published
2022
Volume
65
Issue
1
Pages
e54-e54
ISSN
  • 0924-9338 (ISSN-L)
  • 1778-3585
DOI
10.1192/j.eurpsy.2022.2312
PMC
PMC9491079
OpenAlex
W4293776637
Semantic Scholar
02555c188de2629e5019acd10a7cc720da93e899
Cited by
54
References
49
Citations by year
2026: 9 · 2025: 16 · 2024: 13 · 2023: 12 · 2022: 3
FWCI
10.05
Type
journal article
Language
en
Open access
Licence
Locations
  • European Psychiatry (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • IRIS UNIMORE (University of Modena and Reggio Emilia) (submittedVersion, cc-by-nc-nd)
  • IRIS Research product catalog (Sapienza University of Rome) (submittedVersion, cc-by)
  • Institutional Research Information System University of Turin (University of Turin) (submittedVersion, other-oa)
  • CINECA IRIS Institutial Research Information System (University of Genoa) (submittedVersion, other-oa)
  • Cineca Institutional Research Information System (Tor Vergata University) (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
  • Florence Research (University of Florence) (submittedVersion)
  • IrInSubria (University of Insubria) (submittedVersion, cc-by)
  • Institutional Research Information System (Università degli Studi di Brescia) (submittedVersion)
  • UNICA IRIS Institutional Research Information System (University of Cagliari) (submittedVersion, cc-by)
  • Archivio Istituzionale della Ricerca - Università degli Studi della Campania "Luigi Vanvitelli" (submittedVersion)
  • Institutional Research Information System University of Ferrara (University of Ferrara) (submittedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
Keywords
depression, psychological suffering, suicide risk, hopelessness, suicidal ideation, personality disorders, psychiatric inpatients, clinical phenotype, suicide prevention, treatment complexity, sex differences
MeSH terms
Affect, Mental Disorders, Depression, Female, Humans, Italy, Male, Risk Factors, Suicidal Ideation

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Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

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