Psychological Pain, Depression, and Suicide: Recent Evidences and Future Directions
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Purpose of Review
The definition of psychological pain is complex. It is a lasting unpleasant and unsustainable feeling characterized by a perception of inability or deficiency of the self, as well as frustrated psychological needs and social disconnection. The aim of our review was to summarize the most recent and updated findings supporting the role of psychological pain in the pathophysiology of depression and suicidal behavior. We also explored the relationship between psychological and physical pain in depression and suicide.
Psychological pain is a prominent dimension of depressive disorder and has been associated with higher risk of suicidal ideation and suicidal behavior. Sensitivity to psychological and physical pain is increased in depression. Conversely, higher tolerance to physical pain is associated with suicidal behavior.
A better understanding of the pathophysiology of pain processing in depression and suicide offers new therapeutic options for the treatment of depression through the use of analgesic drugs.
KeywordsPsychological pain Physical pain Depression Mood disorders Suicidal ideation Suicidal behavior
Compliance with Ethical Standards
Conflict of Interest
Ismael Conejero, Emilie Olié, Déborah Ducasse, and Philippe Courtet declare no conflict of interest.
Raffaella Calati has received a grant from the FondaMental Foundation, Créteil, France (2015–2016).
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 2.American Psychiatric Association, American Psychiatric Association, editors. Diagnostic and statistical manual of mental disorders: DSM-5. 5th ed. Washington, D.C: American Psychiatric Association; 2013.Google Scholar
- 3.Why people die by suicide — Thomas Joiner | Harvard University Press.Google Scholar
- 9.Pain terms: a list with definitions and notes on usage. Recommended by the IASP Subcommittee on Taxonomy. Pain. 1979;6:249. https://www.iasp-pain.org/Taxonomy.
- 18.•• Meerwijk EL, Chesla CA, Weiss SJ. Psychological pain and reduced resting-state heart rate variability in adults with a history of depression. Psychophysiology. 2014;51:247–56. This study compares measures of psychological pain for their relationship with resting-state heart rate variability in 35 adults with a history of depression. CrossRefPubMedGoogle Scholar
- 19.•• Meerwijk EL, Ford JM, Weiss SJ. Resting-state EEG Delta power is associated with psychological pain in adults with a history of depression. Biol Psychol. 2015;105:106–14. This study links deactivation of default mode network with high psychological pain in depressed adults. CrossRefPubMedGoogle Scholar
- 21.•• Ducasse D, Holden RR, Boyer L, Artéro S, Calati R, Guillaume S, et al. Psychological pain in suicidality: a meta-analysis. J Clin Psychiatry. 2017; Available from: http://www.psychiatrist.com/JCP/article/Pages/2017/v78n08/16r10732.aspx. Access date: November 7, 2017. This meta-analysis shows that psychological pain is associated with suicidal ideation and acts.
- 22.Verrocchio MC, Carrozzino D, Marchetti D, Andreasson K, Fulcheri M, Bech P. Mental pain and suicide: a systematic review of the literature. Front Psychiatry. 2016;7:108.Google Scholar
- 23.Levi-Belz Y, Gvion Y, Grisaru S, Apter A. When the pain becomes unbearable: case-control study of mental pain characteristics among medically serious suicide attempters. Arch Suicide Res Off J Int Acad Suicide Res. 2017:1–14.Google Scholar
- 25.• Campos RC, Holden RR, Santos S. Exposure to suicide in the family: suicide risk and psychache in individuals who have lost a family member by suicide. 2018;74:407–17 This study reports an interaction between exposure to suicide of a family member and psychological, and that it potentiates the risk for suicidal behavior. Google Scholar
- 30.•• Chu C, Buchman-Schmitt JM, Stanley IH, Hom MA, Tucker RP, Hagan CR, et al. The interpersonal theory of suicide: a systematic review and meta-analysis of a decade of cross-national research. Psychol Bull. 2017;143:1313–45. Based on the interpersonal theory of suicide, this meta-analysis of 122 published and unpublished studies shows that the interaction between perceived burdensomeness and thwarted belongingness is significantly associated with suicidal ideation. CrossRefPubMedGoogle Scholar
- 33.•• Jollant F, Near J, Turecki G, Richard-Devantoy S. Spectroscopy markers of suicidal risk and mental pain in depressed patients. Prog Neuropsychopharmacol Biol Psychiatry. 2016 This study shows that spectroscopy brain markers are associated with psychological pain. Google Scholar
- 39.Linehan M. Cognitive-behavioral treatment of borderline personality disorder. Guilford Press; 1993. Available from: https://www.guilford.com/books/Cognitive-Behavioral-Treatment-of-Borderline-Personality-Disorder/Marsha-Linehan/9780898621839.
- 45.Rathod H, Ram D, Sundarmurthy H, Rathod S, John D. Headache disability, suicidality and pain catastrophization - are they related. J Clin Diagn Res JCDR. 2016;10:VC01–4.Google Scholar
- 49.• Cáceda R, Kordsmeier NC, Golden E, Gibbs HM, Delgado PL. Differential processing of physical and psychological pain during acute suicidality. Psychother Psychosom. 2017;86:116–8. This study showed that modifications of pain thresholds and psychological pain after a suicide attempt are time-related. CrossRefPubMedGoogle Scholar
- 54.•• Calati R, Bensassi I, Courtet P. The link between dissociation and both suicide attempts and non-suicidal self-injury: meta-analyses. Psychiatry Res. 2017;251:103–14. This meta-analysis found a link between the level of dissociation and suicidal behavior and non-suicidal self-injury in psychiatric patients.CrossRefPubMedGoogle Scholar
- 62.Fertuck EA, Karan E, Stanley B. The specificity of mental pain in borderline personality disorder compared to depressive disorders and healthy controls. Borderline Personal Disord Emot Dysregul. 2016;3.Google Scholar
- 73.•• Yovell Y, Bar G, Mashiah M, Baruch Y, Briskman I, Asherov J, et al. Ultra-low-dose buprenorphine as a time-limited treatment for severe suicidal ideation: a randomized controlled trial. Am J Psychiatry. 2015;173:491–8. This double-blind controlled trial shows an efficacy of low dose buprenorphine for the treatment of suicidal ideation. CrossRefPubMedGoogle Scholar