Mental Pain and Suicide: A Systematic Review of the Literature
Open accessAbstract
BACKGROUND: Mental pain, defined as a subjective experience characterized by perception of strong negative feelings and changes in the self and its function, is no less real than other types of grief. Mental pain has been considered to be a distinct entity from depression. We have performed a systematic review analyzing the relationship between mental pain and suicide by providing a qualitative data synthesis of the studies. METHODS: We have conducted, in accordance with PRISMA guidelines, a systematic search for the literature in PubMed, Web Of Science, and Scopus. Search terms were "mental pain" "OR" "psychological pain" OR "psychache" combined with the Boolean "AND" operator with "suicid*." In addition, a manual search of the literature, only including the term "psychache," was performed on Google Scholar for further studies not yet identified. RESULTS: Initial search identified 1450 citations. A total of 42 research reports met the predefined inclusion criteria and were analyzed. Mental pain was found to be a significant predictive factor of suicide risk, even in the absence of a diagnosed mental disorder. Specifically, mental pain is a stronger factor of vulnerability of suicidal ideation than depression. CONCLUSION: Mental pain is a core clinical factor for understanding suicide, both in the context of mood disorders and independently from depression. Health care professionals need to be aware of the higher suicidal risk in patients reporting mental pain. In this regard, psychological assessment should include a clinimetric evaluation of mental pain in order to further detect its contribution to suicidal tendency.
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Regardless of which risk factors are present, for many individuals who consider suicide, it is a response to physical or psychological pain and distress, accompanied with an unmet need to escape.
“Regardless of which risk factors are present, for many individuals who consider suicide, it is a response to physical or psychological pain and distress, accompanied with an unmet need to escape (Williams, 2014; Calati et al., 2015; Verrocchio et al., 2016).”
From The Psychological Pathway to Suicide Attempts: A Strategy of Control Without Awareness (2021) · cites this paper as Verrocchio et al., 2016
The Introduction describes psychological pain as a mediator of other suicide risk factors, and the Discussion says people may seek to escape unbearable mental pain when basic psychological needs are unmet. These passages support the psychological-pain and escape elements, but the paper does not establish physical pain as an alternative basis for the claim. (LLM, conf=0.84)
Experimental — accuracy not yet measuredExperiencing intolerable levels of psychological pain is associated with increased suicide risk in both clinical and non-clinical populations.
“Experiencing intolerable levels of psychological pain has been associated with increased suicide risk [12] in both clinical and non-clinical populations [13].”
From Targeting Psychological Pain After a Suicide Attempt: Scoping Review and Intervention Protocol (2026) · cites this paper as [13]
Psychological pain is associated with suicidality, independently of underlying mental disorders.
“Moreover, psychological pain is associated with suicidality, independently of underlying mental disorders.13,14”
From “Nothing Hurts Less Than Being Dead”: Psychological Pain in Case Descriptions of Psychiatric Euthanasia and Assisted Suicide from the Netherlands: « Rien ne fait moins mal qu’être mort »: La douleur psychologique dans les descriptions de cas d’euthanasie et de suicide assisté psychiatrique aux Pays-Bas (2020) · cites this paper as [14]
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“Regardless of which risk factors are present, for many individuals who consider suicide, it is a response to physical or psychological pain and distress, accompanied with an unmet need to escape (Williams, 2014; Calati et al., 2015; Verrocchio et al., 2016).”
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- Authors
- Verrocchio, M. C., Carrozzino, D., Marchetti, D., Andreasson, K., Fulcheri, M., & Bech, P.
- Affiliations
- University of Chieti-Pescara (IT)
- Copenhagen University Hospital (DK)
- Corresponding author
- Verrocchio, Maria Cristina
- ORCID
- Venue
- Frontiers in Psychiatry
- Publisher
- Frontiers Media SA
- Published
- 2016-06-20
- Volume
- 7
- Pages
- 108-108
- ISSN
- 1664-0640 (ISSN-L)
- PMC
- PMC4913233
- OpenAlex
- W2471867149
- Cited by
- 297
- References
- 57
- Citations by year
- 2026: 19 · 2025: 46 · 2024: 26 · 2023: 26 · 2022: 27 · 2021: 30 · 2020: 28 · 2019: 27 · 2018: 41 · 2017: 19 · 2016: 6 · 2014: 1
- FWCI
- 4.60
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Frontiers in Psychiatry (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, cc-by)
- Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion, cc-by)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Psychology › Clinical Psychology › Grief, Bereavement, and Mental Health
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Keywords
- psychological suffering, emotional pain, suicide, suicidal ideation, suicide risk, depression, mood disorders, psychological assessment
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