Physical pain, depression symptoms, suicidal acts all indicators of psychological pain
Psychological pain is linked with levels of physical pain and recent suicidal acts, as well as depression symptom severity, according to a French study published in the Journal of Clinical Psychiatry.
“Due to the close relationship between psychological pain and suicidal behavior, it is important to identify the clinical factors that contribute to psychological pain in high-risk populations in order to better define the concept of psychological pain and to develop targeted interventions,” Adrian Alacreu-Crespo, PhD, of the Institute of Functional Genomics at Universite de Montpellier in France, and colleagues wrote.
Alacreu-Crespo and colleagues sought to fill gaps in knowledge regarding the impact of psychological pain on mental health to better understand suicide and related behaviors in patients diagnosed with mood disorders.
The study included a total of 371 patients (259 women) aged 18 to 71 years who were admitted for a major depressive episode according to DSM-IV criteria between 2010 and 2017 to the department of psychiatric emergency and acute care at the Academic Hospital in Montpellier.
Participants were split into three groups: those who attempted suicide within the previous 7 days (n = 178), those who had attempted suicide at least once in their lifetime (n = 101) and those who had not attempted suicide at the time of enrollment (n = 93). During the initial assessment, current psychopathology, medication, personality traits (impulsivity, anxiety, hopelessness) and childhood trauma were examined. Both at study inception and a 1-year follow-up, depressive symptomatology as well as psychological and physical pain recorded in the previous 15 days were assessed.
Results showed, at study initiation, the highest recorded psychological pain was found in those who had recently attempted suicide as opposed to those who had attempted suicide in the past (OR = 1.18; 95% CI, 1.04–1.35) and those who had not attempted suicide (OR = 1.32; 95% CI, 1.16–1.5). When assessing symptoms through the multivariate model, depression severity (OR = 1.11; 95% CI,1.08–1.16) and worst physical pain (OR = 2.53; 95% CI, 1.28–5.02) predicted high levels of psychological pain. Conversely, bipolar disorder (OR = 0.54; 95% CI, 0.29–0.98) predicted lower levels of psychological pain.
At the 1-year follow-up, alterations in maximal psychological pain were predicted by changes in depressive symptomatology (beta = 0.46; P<.001) and maximal physical pain (beta = 0.42; P < .003).
Data additionally revealed that, among depressive symptoms, guilt, lack of initiative and loss of appetite were better indicators of maximal psychological pain, both at the beginning of the study and the follow-up (all, P < .05).
“Clinicians should pay special attention to patients who report high levels of physical pain or have severe depressive symptoms,” Alacreu-Crespo and colleagues wrote. “The protective effect of lifetime bipolar disorder might be partly explained by the associated pharmacologic treatments.”