The interpersonal-psychological theory of suicide and the role of psychological pain during the COVID-19 pandemic: A network analysis

Introduction Among the most investigated theories explaining suicidal behavior there are the interpersonal-psychological theory of suicide (IPTS) by Thomas E. Joiner and the one focused on the construct of psychological pain (or psychache, or mental pain). Objective Since it remains unclear whether these two different theories correlate with each other in the explanation of suicidal risk, we […]

Assessment of psychological pain in clinical and non-clinical samples: A preliminary investigation using the psychic pain scale

Psychological pain is an important contributing factor to suicide risk. The present study examined the psychometric properties of the Psychic Pain Scale (PPS), a new measure assessing unbearable negative affect as described in Maltsberger’s theory of suicidality. The PPS was administered to n = 131 adult psychiatric patients as well as n = 953 undergraduate students. An initial factor analysis which […]

The mediating roles of psychological pain and dream anxiety in the relationship between sleep disturbance and suicide

Suicide is a significant public health problem worldwide, and sleep disturbances have negative effects on mental health and suicidality. Several psychological concepts may mediate the relationship between sleep disturbances and suicide. We aimed to investigate the mediating roles of psychological pain and dream anxiety in this relationship. This cross-sectional study included 150 depressive patients with […]

Exposure to suicide in the family and suicidal ideation in Portugal during the Covid-19 pandemic: The mediating role of unbearable psychache

Objectives: This study tested the mediation effects of two facets of psychache – bearable and unbearable – in the relationship between exposure to suicide in the family and suicidal ideation in Portugal during the Covid-19 pandemic. Methods: Two hundred and forty-four adults aged between 19 and 64 participated. Two groups were defined: one exposed to suicide in […]

Prefrontal activity during experimental ostracism and daily psychache in suicide attempters

Background Suicidal behaviors can result from a complex interaction between social stressors and individual vulnerability. Evidence suggests a specific neural processing of social cues in suicide attempters without knowledge of how it relates to real-world experiences. Objective To investigate the association between brain activity during experimental social exclusion (measured by functional MRI) and psychological pain in […]

The serious suicide attempts approach for understanding suicide: Review of the psychological evidence

The study of survivors of a serious suicide attempt (SSA)––an attempt that would have been fatal had it not been for the provision of rapid and effective emergency treatment––can help researchers understand the suicidal mind. Serious suicide attempters are epidemiologically very similar to those who died by suicide, and thus can serve as valid proxies for studying […]

Understanding the transition from suicidal desire to planning and preparation: Correlates of suicide risk within a psychiatric inpatient sample of ideators and attempters

Background: There is a clear need to better understand the trajectory from suicidal ideation to enactment of lethal suicidal behavior. Identification of factors that promote desire and the transition to intent and behavior is critical for the advancement of theory, risk formulation, and prevention. Method: In this cross sectional study, correlates of suicide risk were examined at […]

Psychache, unmet interpersonal needs, childhood trauma and suicide ideation in young adults

This 5-month, 2-wave study evaluated the mediating effects of psychache and unmet interpersonal needs on the relationship between childhood trauma and suicide ideation in 208 young adults, controlling for depression. Path analysis demonstrated that changes in depression, perceived burdensomeness, and thwarted belongingness mediated the relationship between childhood trauma and changes in positive suicide ideation, and […]

A brief measure of unbearable psychache

Objective Psychache has been proposed to cause suicide when it becomes unbearable. However, existing measures of psychache do not directly target unbearable psychache. Thus, the purpose of the current study was to provide initial validation for a brief measure of unbearable psychache. Method Three items were selected to create the Unbearable Psychache Scale (UP3). Psychometric […]

Tolerance for psychological pain and capability for suicide: Contributions to suicidal ideation and behavior

Among people with suicide ideation most do not attempt suicide or die by suicide. In this online study of adult US Facebook users (n=219), we examined capability for suicide, operationalized as fearlessness about death, and tolerance for psychological pain as potential variables that may explain why some people move from suicide ideation to suicidal behavior. […]

Reexamining the mental pain-suicidality link in adolescence: The role of tolerance for mental pain

Objective In this study, we reexamine the mental pain–suicidality link in adolescence, by focusing on mental pain tolerance as a critical factor in explaining youth suicidal behavior. Method In a series of three studies, participants completed measures of mental pain (tolerance and intensity), emotional regulation, depression, and suicidality. Study 1 included a nonclinical sample of […]

Hearing the suicidal patient’s emotional pain: A typological model to improve communication

Background: Escaping from emotional pain is a recognized driver in suicidal patients’ desire to die. Formal scales of emotional pain are rarely used during routine contact between patients and their care team. No study has explored facilitators and inhibitors of emotional pain communication between staff and suicidal patients during regular care. Aims: To identify factors impeding or […]

When the pain becomes unbearable: Case-control study of mental pain characteristics among medically serious suicide attempters

The unbearable mental pain experience is recognized as a key antecedent of suicidal behavior. We aimed to examine the precise nature of the mental pain among medically serious suicide attempters (MSSAs), a population closely resembling those who died by suicide. We evaluated various factors of mental pain from the Orbach and Mikulincer Mental Pain Scale, […]

Efficacy of psychological pain theory-based cognitive therapy in suicidal patients with major depressive disorders: A pilot study

The present study aimed to explore the effects of psychological pain theory–based cognitive therapy (PPTBCT) on suicide among depressed patients, compared with a control group who received usual psychological care (UPC). The sample consisted of 32 depressed patients and 32 healthy control subjects. All participants completed the Beck Scale for Suicide Ideation (BSI), Beck Depression […]

Predictive value of psychological characteristics and suicide history on medical lethality of suicide attempts: A follow-up study of hospitalized patients.

This study examined the role of mental pain, communication difficulties, and suicide history in predicting the medical severity of follow-up suicide attempts. Methods The cohort included 153 consecutive psychiatric in-patients who participated in earlier studies 1-9 years previously. Fifty-three had a history of a medically serious suicide attempt (MSSA), 64 had a history of a […]

Sources of psychological pain and suicidal thoughts among homeless adults.

Homeless adults experience problems in multiple areas of their lives. It was hypothesized that adults who were troubled by problems in more areas of their lives would be more likely to report suicidal thoughts. The sample included 457 homeless men and women who resided in three emergency shelters. The number of sources of psychological pain, […]

A five-month longitudinal study of psychache and suicide ideation: Replication in general and high-risk university students.

Shneidman’s (1993) model of psychache as the cause of suicide was evaluated in a 5-month longitudinal study of psychological pain and suicide ideation. Replicating across general (N = 683) and high-risk undergraduates (N = 262), psychache was significantly associated with suicide ideation, and change in psychache was significantly associated with change in suicide ideation.

Clarifying the role of psychological pain in the risks of suicidal ideation and suicidal acts among patients with major depressive episodes.


Mental pain, communication difficulties, and medically serious suicide attempts: A case-control study.

Medical severe suicide attempts (MSSA) are epidemiologically very similar to individuals who complete suicide. Mental pain variants (e.g., hopelessness), facets of communication difficulties (e.g., self-disclosure), as well as socio-demographic and clinical characteristics were assessed. The MSSA had significantly higher communication difficulties than the other 3 groups. Moreover, the interaction between mental pain and communication difficulties […]

Reliability and validation of the Hebrew version of the Reasons for Attempting Suicide Questionnaire (RASQ-H) and its importance for mental pain.

This study evaluated the Hebrew Reasons for Attempting Suicide Questionnaire (RASQ-H) and its application for suicidality, and mental pain and its tolerance. The sample comprised 97 participants who were inpatient suicide attempters, inpatient nonattempters, or nonpatient controls.