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Cited by 51Suicide and Self-Harm StudiesHomicide, Infanticide, and Child AbuseChild Abuse and Trauma

The Relationship Between Mental Pain, Suicide Risk, and Childhood Traumatic Experiences: Results From a Multicenter Study

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Pompili, Maurizio, Erbuto, Denise, Innamorati, Marco, Luciano, Mario, Sampogna, Gaia, Abbate-Daga, Giovanni, Barlati, Stefano, Carmassi, Claudia +15 more·2022·The Journal of Clinical Psychiatry
DOI 10.4088/jcp.21m14176
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Abstract

Objective: Mental pain and exposure to maltreatment are significant risk factors for suicidal behavior. This study aimed to investigate whether mental pain could be associated with a recent suicide attempt and whether it could mediate the relationship between childhood traumatic experiences and suicide risk in psychiatric patients. Methods: A multicenter observational study was organized as a joint project with representatives of numerous mixed Italian academic and clinical settings. Between December 2017 and March 2020, batteries of tests were administered to patients, assessing suicidal ideation and behavior, mental pain (usual and worst mental pain in the past 15 days), depression, and childhood maltreatment. Results: A total of 2,137 psychiatric patients (1,313 women and 824 men) were included in the final sample, and 315 reported having attempted suicide in the last 3 months. Suicide attempters (compared to nonattempters) had higher odds of reporting worse mental pain (odds ratios between 1.02 and 1.17; P < .001) and suicidal intent with/without a specific plan (ORs between 11.57 and 11.77; P < .001). They also had higher odds of having a personality disorder (borderline personality disorder: ORs between 2.65 and 3.01; P < .001; other personality disorders: ORs between 1.96 and 2.28; P < .01) and major depression (ORs between 1.62 and 1.70; P < .05). Childhood trauma was associated with suicide risk directly (standardized effects between 0.06 and 0.07; P < .01) and indirectly through mental pain (usual mental pain: standardized indirect effect = 0.11, P < .001; worst mental pain in the past 15 days: standardized indirect effect = 0.12, P < .001). Conclusions: Mental pain constitutes a crucial framework for assessing the individual need for psychiatric help. Assessing mental pain allows identification of the main ingredient of suicide risk and puts the clinician in a strategic position to unlock some motives behind the wish to die. Further research is needed to learn if childhood adversities may interact with adult mental pain and thus foster suicide risk.

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  • Psychological pain mediates the relationship between childhood trauma and suicide attempt.

    “they found that psychological pain mediates the relationship between childhood trauma and suicide attempt [22].”

    From Targeting Psychological Pain After a Suicide Attempt: Scoping Review and Intervention Protocol (2026) · cites this paper as [22]

  • 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).”

    From High depression symptomatology and mental pain characterize suicidal psychiatric patients (2022) · cites this paper as [19]

  • Mental pain (usual and worst mental pain in the last 15 days) partly mediated the relationship between childhood trauma and suicide status.

    “Mental pain (usual and worst mental pain in the last 15 days) partly mediated the relationship between childhood trauma and suicide status [19].”

    From High depression symptomatology and mental pain characterize suicidal psychiatric patients (2022) · cites this paper as [19]

  • Moderated mediation models indicated that childhood trauma was directly and indirectly associated with the presence of a recent suicide attempt.

    “Moderated mediation models indicated that childhood trauma was directly and indirectly associated with the presence of a recent suicide attempt.”

    From High depression symptomatology and mental pain characterize suicidal psychiatric patients (2022) · cites this paper as [19]

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Research works printed but not linked: 47

  1. Shneidman ES. Suicide as psychache. J Nerv Ment Dis. 1993;181(3):145-147.
  2. Ducasse D, Holden RR, Boyer L, et al. Psychological pain in suicidality: a meta- analysis. J Clin Psychiatry. 2018;79(3):16r10732. P u b M e d 3. Pompili M, Lester D, Leenaars AA, et al. Psychache and suicide: a preliminary investigation. Suicide Life Threat Behav. 2008;38(1):116-121.
  3. P u M e d C r o s s R e f 4. Verrocchio MC, Carrozzino D, Marchetti D, et al. Mental pain and suicide: a systematic review of the literature. Front Psychiatry. 2016;7:108. u b M e d C r o s s R e f 5. Li X, You J, Ren Y, et al. A longitudinal study testing the role of psychache in the association between emotional abuse and suicidal ideation. J Clin Psychol. 2019;75(12):2284-2292. · DOI · Paper page
  4. P u b M e d C r o s s R e f 6. Edwards VJ, Holden GW, Felitti VJ, et al. Relationship between multiple forms of childhood maltreatment and adult mental health in community respondents: results from the adverse childhood experiences study. Am J Psychiatry. 2003;160(8):1453-1460. · DOI
  5. P u b M e d C r o s s R e f 7. Widom CS, DuMont K, Czaja SJ. A prospective investigation of major depressive disorder and comorbidity in abused and neglected children grown up. Arch Gen Psychiatry. 2007;64(1):49-56. · DOI · Paper page
  6. P u b M e d C r o s s R e f 8. Phillips NK, Hammen CL, Brennan PA, et al. Early adversity and the prospective prediction of depressive and anxiety disorders in adolescents. J Abnorm Child Psychol. 2005;33(1):13-24. · DOI · Paper page
  7. P u b M e d C r o s s R e f 9. Li M, D'Arcy C, Meng X. Maltreatment in childhood substantially increases the risk of adult depression and anxiety in prospective cohort studies: systematic review, meta- analysis, and proportional attributable fractions. Psychol Med. 2016;46(4):717-730. · DOI · Paper page
  8. P u b M e d C r o s s R e f 10. Nanni V, Uher R, Danese A. Childhood maltreatment predicts unfavorable course of illness and treatment outcome in depression: a meta-analysis. Am J Psychiatry. 2012;169(2):141-151. · DOI · Paper page
  9. P u b M e d C r o s s R e f 11. Carr CP, Martins CM, Stingel AM, et al. The role of early life stress in adult psychiatric disorders: a systematic review according to childhood trauma subtypes. J Nerv Ment Dis. 2013;201(12):1007-1020. · DOI · Paper page
  10. P u b M e d C r o s s R e f 12. Richard-Devantoy S, Bertrand JA, Béziat S, et al. Psychological pain and depression: it's hard to speak when it hurts. Int J Psychiatry Clin Pract. 2021;25(2):180-186. · DOI · Paper page
  11. P u b M e d C r o s s R e f 13. Green JG, McLaughlin KA, Berglund PA, et al. Childhood adversities and adult psychiatric disorders in the National Comorbidity Survey Replication I: associations with first onset of DSM-IV disorders. Arch Gen Psychiatry. 2010;67(2):113-123. · DOI
  12. P u b M e d C r o s s R e f 14. Pompili M, Innamorati M, Venturni P, et al. Child episode may be a factor of vulnerability to suicidal ideation and act. J Affect Disord. 2010;120(1-3):226-230. · DOI · Paper page
  13. Alacreu-Crespo A, Cazals A, Courtet P, et al. Brief assessment of psychological pain to predict suicidal events at one year in depressed patients. Psychother Psychosom. 2020;89(5):320-323.
  14. P u b M e d C r o s s R e f 30. Alacreu-Crespo A, Olié E, Seneque M, et al. Decision-making skills moderate the relationship between psychological and physical pain with suicidal behavior in depressed patients. Psychother Psychosom. 2019;88(3):190-191. · DOI · Paper page
  15. P u b M e d C r o s s R e f 31. Cáceda R, Durand D, Cortes E, et al. Impulsive choice and psychological pain in acutely suicidal depressed patients. Psychosom Med. 2014;76(6):445-451. · DOI · Paper page
  16. P u b M e d C r o s s R e f 32. Zatti C, Rosa V, Barros A, et al. Childhood trauma and suicide attempt: a meta-analysis of longitudinal studies from the last decade. Psychiatry Res. 2017;256:353-358. · DOI · Paper page
  17. P u b M e d C r o s s R e f 33. Demirkol ME, Uğur K, Tamam L. The mediating effects of psychache and dissociation in the relationship between childhood trauma and suicide attempts. Anadolu Psikiyatri Derg. 2020;21(0):453-460. C r o s s R e f · DOI
  18. Zarrati I, Bermas H, Sabet M. The relationship between childhood trauma and suicide ideation: mediating role of mental pain. Ann Mil Health Sci Res. 2019;17(1):e89266. C r o s s R e f 35. Walker RL, Joiner TE Jr, Rudd MD. The course of post-crisis suicidal symptoms: how and for whom is suicide "cathartic"? Suicide Life Threat Behav. 2001;31(2):144-152. · DOI
  19. P u b M e d C r o s s R e f 36. van Praag H, Plutchik R. An empirical study on the "cathartic effect" of attempted suicide. Psychiatry Res. 1985;16(2):123-130. · DOI
  20. P u b M e d C r o s s R e f 37. Pompili M, Innamorati M, Del Casale A, et al. No cathartic effect in suicide attempters admitted to the emergency department. J Psychiatr Pract. 2009;15(6):433-441. · DOI
  21. P u b M e d C r o s s R e f 38. Haglund A, Lysell H, Larsson H, et al. Suicide immediately after discharge from psychiatric inpatient care: a cohort study of nearly 2.9 million discharges. J Clin Psychiatry. 2019;80(2):18m12172. P u b M e d C r o s s R e f 39. Angst J, Angst F, Stassen HH. Suicide risk in patients with major depressive disorder. J Clin Psychiatry. 1999;60(suppl 2):57-62, discussion 75-76, 113-116. · DOI · Paper page
  22. P u b M e d C r o s s R e f 41. Angst J, Hengartner MP, Gamma A, et al. Mortality of 403 patients with mood disorders 48 to 52 years after their psychiatric hospitalisation. Eur Arch Psychiatry Clin Neurosci. 2013;263(5):425-434. · DOI · Paper page
  23. P u b M e d C r o s s R e f 42. Harris EC, Barraclough B. Suicide as an outcome for mental disorders: a meta- analysis. Br J Psychiatry. 1997;170(3):205-228. · DOI
  24. P u b M e d C r o s s R e f 43. Orbach I. Taking an inside view: stories of pain. In: Michel K, Jobes DA, eds. Building a Therapeutic Alliance With the Suicidal Patient. American Psychological Association; 2011:111-128. · DOI · Paper page
  25. Conejero I, Olié E, Calati R, et al. Psychological pain, depression, and suicide: recent evidences and future directions. Curr Psychiatry Rep. 2018;20(5):33. P u b M e d C r o s s R e f 45. Sörberg Wallin A, Zeebari Z, Lager A, et al. Suicide attempt predicted by academic performance and childhood IQ: a cohort study of 26 000 children. Acta Psychiatr Scand. 2018;137(4):277-286. · DOI · Paper page
  26. P u b M e d C r o s s R e f 46. Phillips JA, Hempstead K. Differences in US suicide rates by educational attainment, 2000-2014. Am J Prev Med. 2017;53(4):e123- e130. · DOI · Paper page
  27. P u b M e d C r o s s R e f 47. Innamorati M, Pompili M, Di Vittorio C, et al. Suicide in the old elderly: results from one Italian county. Am J Geriatr Psychiatry. 2014;22(11):1158-1167. · DOI
  28. P u b M e d C r o s s R e f 48. Schneider B, Lukaschek K, Baumert J, et al. Living alone, obesity, and smoking increase risk for suicide independently of depressive mood findings from the population-based MONICA/KORA Augsburg cohort study. J Affect Disord. 2014;152-154:416-421. · DOI
  29. P u b M e d C r o s s R e f 49. Shaw RJ, Cullen B, Graham N, et al. Living alone, loneliness and lack of emotional support as predictors of suicide and self- harm: a nine-year follow up of the UK Biobank cohort. J Affect Disord. 2021;279:316-323. · DOI
  30. P u b M e d C r o s s R e f 50. Ng TP, Jin A, Feng L, et al. Mortality of older persons living alone: Singapore Longitudinal Ageing Studies. BMC Geriatr. 2015;15(1):126. · DOI
  31. P u b M e d C r o s s R e f 51. McQuaid RJ, Cox SML, Ogunlana A, et al. The burden of loneliness: implications of the social determinants of health during COVID-19. Psychiatry Res. 2021;296:113648. · DOI
  32. P u b M e d C r o s s R e f 52. Montalbani B, Bargagna P, Mastrangelo M, et al. The COVID-19 outbreak and subjects with mental disorders who presented to an Italian psychiatric emergency department. J Nerv Ment Dis. 2021;209(4):246-250. · DOI
  33. P u b M e d abuse as a risk factor for suicide in life: a selective overview. Minerva Psichiatr. 2011;52:61-69.
  34. P u b M e d C r o s s R e f 16. Bryan CJ, McNaugton-Cassill M, Osman A, et al. The associations of physical and sexual assault with suicide risk in nonclinical military and undergraduate samples. Suicide Life Threat Behav. 2013;43(2):223-234. · DOI
  35. P u b M e d C r o s s R e f 17. Fergusson DM, McLeod GF, Horwood LJ. Childhood sexual abuse and adult developmental outcomes: findings from a 30-year longitudinal study in New Zealand. Child Abuse Negl. 2013;37(9):664-674. · DOI
  36. P u b M e d C r o s s R e f 18. Mann JJ, Bortinger J, Oquendo MA, et al. Family history of suicidal behavior and mood disorders in probands with mood disorders. Am J Psychiatry. 2005;162(9):1672-1679. · DOI · Paper page
  37. P u b M e d C r o s s R e f 19. Zouk H, Tousignant M, Seguin M, et al. Characterization of impulsivity in suicide completers: clinical, behavioral and psychosocial dimensions. J Affect Disord. 2006;92(2-3):195-204. · DOI
  38. P u b M e d C r o s s R e f 20. Silverman MM, Berman AL, Sanddal ND, et al. Rebuilding the tower of Babel: a revised nomenclature for the study of suicide and suicidal behaviors. Part 1: Background, rationale, and methodology. Suicide Life Threat Behav. 2007;37(3):248-263. · DOI
  39. P u b M e d C r o s s R e f 21. Silverman MM, Berman AL, Sanddal ND, et al. Rebuilding the tower of Babel: a revised nomenclature for the study of suicide and suicidal behaviors. part 2: suicide-related ideations, communications, and behaviors. Suicide Life Threat Behav. 2007;37(3):264-277. · DOI · Paper page
  40. P u b M e d C r o s s R e f 22. American Psychiatric Association DSM-5 Task Force. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. American Psychiatric Association; 2013. · DOI · Paper page
  41. Posner K, Brown GK, Stanley B, 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):1266-1277.
  42. Orbach I, Mikulincer M, Sirota P, et al. Mental pain: a multidimensional operationalization and definition. Suicide Life Threat Behav. 2003;33(3):219-230.
  43. Posner K, Brown GK, Stanley B, 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;168:1266-77.
  44. Bernstein DP, Stein JA, Newcomb MD, et al. Development and validation of a brief screening version of the Childhood Trauma Questionnaire. Child Abuse Negl. 2003;27:169-90.
  45. Innamorati M, Erbuto D, Venturini P, et al. Factorial validity of the Childhood Trauma Questionnaire in Italian psychiatric patients. Psychiatry Res. 2016;245:297- 302.
  46. Orbach I, Mikulincer M, Sirota P, et al. Mental pain: a multidimensional operationalization and definition. Suicide Life Threat Behav. 2003;33:219-30.
  47. Olié E, Guillaume S, Jaussent I, et al. Higher psychological pain during a major depressive episode may be a factor of vulnerability to suicidal ideation and act. J It is illegal to post this copyrighted PDF on any website. ♦ © 2022 Copyright Physicians Postgraduate Press, Inc.

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Authors
Pompili, M., Erbuto, D., Innamorati, M., Luciano, M., Sampogna, G., Abbate-Daga, G., Barlati, S., Carmassi, C., Castellini, G., Fazio, P. D., Lorenzo, G. D., Nicola, M. D., Ferrari, S., Gramaglia, C., Nanni, M. G., Pasquini, M., Pinna, F., Poloni, N., Serafini, G., Signorelli, M., 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)
  • Magna Graecia University (IT)
  • University of Rome Tor Vergata (IT)
  • Università Cattolica del Sacro Cuore (IT)
  • Università degli Studi del Piemonte Orientale “Amedeo Avogadro” (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 Foggia (IT)
  • Marche Polytechnic University (IT)
Corresponding author
Pompili, Maurizio
ORCID
Venue
The Journal of Clinical Psychiatry
Publisher
Physicians Postgraduate Press, Inc
Published
2022-06-15
Volume
83
Issue
4
ISSN
  • 0160-6689 (ISSN-L)
  • 1555-2101
DOI
10.4088/jcp.21m14176
OpenAlex
W4282581833
Cited by
51
References
0
Citations by year
2026: 9 · 2025: 16 · 2024: 9 · 2023: 13 · 2022: 4
FWCI
9.59
Type
journal article
Language
en
Open access
Locations
  • The Journal of Clinical Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Cineca Institutional Research Information System (Tor Vergata University) (submittedVersion)
  • Florence Research (University of Florence) (submittedVersion)
  • IrInSubria (University of Insubria) (submittedVersion)
  • Institutional Research Information System (Università degli Studi di Brescia) (submittedVersion)
  • UNICA IRIS Institutional Research Information System (University of Cagliari) (submittedVersion)
  • Archivio Istituzionale della Ricerca - Università degli Studi della Campania "Luigi Vanvitelli" (submittedVersion)
  • IRIS UNIMORE (University of Modena and Reggio Emilia) (submittedVersion, cc-by)
  • IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
  • Institutional Research Information System University of Turin (University of Turin) (submittedVersion)
  • CINECA IRIS Institutial Research Information System (University of Genoa) (submittedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
  • Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
Keywords
psychological suffering, suicide risk, suicide attempts, childhood trauma, child abuse, suicidal ideation, suicidal intent, depression, personality disorders, borderline personality disorder, mediation, psychiatric patients
MeSH terms
Adult, Borderline Personality Disorder, Major Depressive Disorder, Depressive Disorder, Major, Disease Susceptibility, Female, Humans, Male, Pain, Risk Factors, Suicide, Attempted, Suicidal Ideation

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