Screening for psychological distress in follow-up care to identify head and neck cancer patients with untreated distress.
Krebber Anne-Marie H,Jansen Femke,Cuijpers Pim,Leemans C René,Verdonck-de Leeuw Irma M
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
PURPOSE:The purpose of the study is to investigate screening in follow-up care to identify head and neck cancer (HNC) patients with untreated psychological distress. METHODS:From November 2009 until December 2012, we investigated the use of OncoQuest (a touch screen computer system to monitor psychological distress (Hospital Anxiety and Depression Scale (HADS)) and quality of life (HRQOL; EORTC QLQ-C30 and H&N35 module) in routine follow-up care. Patients who screened positive for psychological distress (HADS-T >14, HADS-A >7, or HADS-D >7) were asked whether they received psychological or psychiatric treatment. RESULTS:During the study period of 37 months, OncoQuest was used by 720 individual HNC patients, of whom 714 had complete HADS data. Psychological distress was present in 206 patients (29 %). Of those patients who fulfilled in- and exclusion criteria (n = 137), 25 received psychological treatment (18 %). Receipt of psychological treatment was significantly related to a higher score on the HADS total scale (19.6 vs. 16.9; p = 0.019), a lower (worse) score on the EORTC QLQ-C30 scale emotional functioning (46.0 vs. 58.6; p = 0.023), a higher (worse) score on fatigue (58.2 vs. 46.4; p = 0.032), problems with sexuality (44.1 vs. 34.4; p = 0.043), oral pain (43.8 vs. 28.8; p = 0.011) and speech problems (37.0 vs. 25.3; p = 0.042). CONCLUSIONS:Screening for psychological distress via OncoQuest is beneficial because 82 % of HNC patients identified with an increased level of distress who do not yet receive mental treatment were identified. Patients who did receive treatment reported more distress and worse quality of life, which may be explained because patients with more severe problems maybe more inclined to seek help or might be detected easier by caregivers and referred to supportive care more often.
Utility of a time frame in assessing psychological pain and suicide ideation.
Meerwijk Esther L,Weiss Sandra J
BACKGROUND:Assessing psychological pain has been recommended as an integral part of a comprehensive suicide risk assessment. The Psychache Scale, an established measure of psychological pain, does not specify a time frame for when pain is experienced, which may inadvertently increase the likelihood of identifying individuals as being at elevated suicide risk when they complete the Psychache Scale based on psychological pain experienced at some undefined time in the past. METHODS:We conducted a national general population survey among United States adults to determine whether addition of a time frame to the instructions of the Psychache Scale would more accurately reflect current psychological pain and more effectively identify people with current suicide ideation. A between-subjects design was used where respondents were randomized to complete the original Psychache scale or a modified scale with time frame. Data were collected online from September 2015 to June 2016. A total of 242 respondents had complete psychological pain data: 133 completed the original Psychache Scale and 109 completed the Psychache Scale with time frame. RESULTS:Addition of a time frame did not result in differences in psychological pain scores. However, when screening for participants with current suicide ideation, 13% fewer false positives were observed with the modified scale at higher cut-off values than previously reported (38 vs. 24). The substantial increase in positive predictive value suggests that a time frame is a worthwhile addition to the Psychache Scale. DISCUSSION:We recommend using the Psychache Scale with a time frame and testing the cut-off score for suicide ideation in population samples that reflect the general population more accurately. Psychological pain cut-off scores in clinical samples have yet to be established.
Validations and psychological properties of a simplified Chinese version of pain anxiety symptoms scale (SC-PASS).
Zhou Xiao-Yi,Xu Xi-Ming,Wang Fei,Wu Sui-Yi,Yang Yi-Lin,Li Ming,Huang Jian-Ming,Wei Xian-Zhao
The Pain Anxiety Symptoms Scale (PASS) has been developed to evaluate pain anxiety, which leads to avoidance of daily activities and normal movements. However, a simplified Chinese version of PASS is still not available. Physicians are not aware of which patients are prone to anxiety, and what the risk factors are.To cross-culturally adapt the PASS into a simplified Chinese version and test the reliability and validity. Factors affecting pain anxiety were also explored.The PASS was first translated into a simplified Chinese version according to a forward-backward method. Then, validations were tested including content validity, construct validity, and reliability. Content validity was analyzed by response trend. Construct validity was analyzed by confirmatory factor analysis (CFA), exploratory factor analysis, and priori hypotheses testing. Reliability was analyzed by internal consistency and test-retest reliability. Risk factors of catastrophizing were analyzed by performing multivariate liner regression.A total of 219 patients were included in the study. The scores of items were well distributed. Both CFA and exploratory factor analysis suggested a 2nd-order, 4-factor model, accounting for 65.42% of the total variance according to principle component analysis. SC-PASS obtained good reliability with a Cronbach α = 0.92 and ICC = 0.90. College education, long pain duration, and both married and divorced status were risk factors. Factors reduced pain-related anxiety were no medication assumption, female sex, widowed status, non-Han ethnicity, and having no religious belief.The SC-PASS was applicable in Chinese patients and it was suitable for the clinical uses in mainland China.
Assessment of Psychological Pain in Clinical and Non-Clinical Samples: A Preliminary Investigation Using the Psychic Pain Scale.
Lewis Katie C,Good Evan W,Tillman Jane G,Hopwood Christopher J
Archives of suicide research : official journal of the International Academy for Suicide Research
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 = 131 adult psychiatric patients as well as = 953 undergraduate students. An initial factor analysis which replicated across both clinical and undergraduate samples identified two factors, affective deluge, and loss of control. These subscales were associated with risk factors including trauma history, severity of psychopathology, and decreased resilience, as well as a range of pathological personality traits. Findings support the utility of the PPS as a measure of psychological pain and point to future directions of empirical evaluation.
The Psychological Inflexibility in Pain Scale (PIPS) - validation, factor structure and comparison to the Chronic Pain Acceptance Questionnaire (CPAQ) and other validated measures in German chronic back pain patients.
Barke Antonia,Riecke Jenny,Rief Winfried,Glombiewski Julia A
BMC musculoskeletal disorders
BACKGROUND:Acceptance and Commitment Therapy (ACT) for pain offers an alternative to traditional Cognitive Behavioural Therapy (CBT) approaches. ACT focuses on the enhancement of 'psychological flexibility' that enables individuals to pursue their values and goals despite pain. To assess specific treatment effect or mediators and moderators of change, questionnaires measuring ACT constructs are needed. METHODS:The Psychological Inflexibility in Pain Scale (PIPS) was translated into German and completed by 182 participants with chronic back pain (70.3 % women, age 51.0 ± 10.5 years). Item analyses and a confirmatory factor analysis were computed as well as correlations with the Chronic Pain Acceptance Questionnaire (CPAQ), which measures related, but slightly different ACT-related constructs, and self-reported disability, pain intensity and further pain-related questionnaires. RESULTS:The confirmatory factor analysis reproduced the original structure with two subscales and a good fit. The internal consistencies of the subscales were Cronbach's α = .91 (Avoidance) and α = .26 (Fusion). Average item-whole correlations of the items with the respective subscales were r = .71 (Avoidance) and r = .20 (Fusion). The highest correlations were observed for Avoidance with the CPAQ (r = -.81), the Tampa Scale of Kinesiophobia (r = .58) and the Pain Catastrophizing Scale (r = .56) and for Fusion with the CPAQ subscale Pain willingness (r = -.55). The PIPS subscale Avoidance predicted pain-related disability even after controlling for catastrophizing and fear of movement. CONCLUSIONS:The PIPS subscale Avoidance may be a valuable instrument to assess treatment processes in future RCTs. The PIPS subscale Fusion seemed more problematic in the German sample with chronic back pain. More research on the comparison between PIPS and other questionnaires assessing psychological flexibility and the usefulness of the concept 'Fusion' for chronic pain are needed.
Assessment of psychological pain in suicidal veterans.
Reist Christopher,Mee Steven,Fujimoto Ken,Rajani Vivek,Bunney William E,Bunney Blynn G
Psychological pain is a relatively understudied and potentially important construct in the evaluation of suicidal risk. Psychological pain also referred to as 'mental pain' or 'psychache' can be defined as an adverse emotional reaction to a severe trauma (e.g., the loss of a child) or may be associated with an illness such as depression. When psychological pain levels reach intolerable levels, some individuals may view suicide as the only and final means of escape. To better understand psychological pain, we previously developed and validated a brief self-rating 10-item scale, Mee-Bunney Psychological Pain Assessment Scale [MBP] in depressed patients and non-psychiatric controls. Our results showed a significant increase in psychological pain in the depressed patients compared to controls. We also observed a significant linear correlation between psychological pain and suicidality in the depressed patient cohort. The current investigation extends our study of psychological pain to a diagnostically heterogeneous population of 57 US Veterans enrolled in a suicide prevention program. In addition to the MBP, we administered the Columbia Suicide Severity Rating Scale (C-SSRS), Beck Depression Inventory (BDI-II), Beck Hopelessness Scale (BHS), and the Barratt Impulsiveness Scale (BIS-11). Suicidal patients scoring above a predetermined threshold for high psychological pain also had significantly elevated scores on all the other assessments. Among all of the evaluations, psychological pain accounted for the most shared variance for suicidality (C-SSRS). Stepwise regression analyses showed that impulsiveness (BIS) and psychological pain (MBP) contributed more to suicidality than any of the other combined assessments. We followed patients for 15 months and identified a subgroup (24/57) with serious suicide events. Within this subgroup, 29% (7/24) had a serious suicidal event (determined by the lethality subscale of the C-SSRS), including one completed suicide. Our results build upon our earlier findings and recent literature supporting psychological pain as a potentially important construct. Systematically evaluating psychological pain along with additional measures of suicidality could improve risk assessment and more effectively guide clinical resource allocation toward prevention.
A study of psychological pain in substance use disorder and its relationship to treatment outcome.
Mee Steven,Bunney Blynn G,Fujimoto Ken,Penner John,Seward Garrett,Crowfoot Keeley,Bunney William E,Reist Christopher
Substance Use Disorder (SUD) is a major public health concern affecting an estimated 22.5 million individuals in the United States. The primary aim of this study was to characterize psychological pain in a cohort of patients participating in outpatient treatment for SUD. A secondary aim was to determine the relationships between pre-treatment assessments of psychological pain, depression, anxiety and hopelessness with treatment retention time and completion rates. Data was analyzed from 289 patients enrolled in an outpatient community drug treatment clinic in Southern California, U.S. A previously determined threshold score on the Mee-Bunney Psychological Pain Assessment Scale (MBP) was utilized to group patients into high and low-moderate scoring subgroups. The higher pain group scored higher on measures of anxiety, hopelessness and depression compared to those in the low-moderate pain group. Additionally, patients scoring in the higher psychological pain group exhibited reduced retention times in treatment and more than two-fold increased odds of dropout relative to patients with lower pre-treatment levels of psychological pain. Among all assessments, the correlation between psychological pain and treatment retention time was strongest. To our knowledge, this is the first study to demonstrate that psychological pain is an important construct which correlates with relevant clinical outcomes in SUD. Furthermore, pre-treatment screening for psychological pain may help target higher-risk patients for clinical interventions aimed at improving treatment retention and completion rates.
Psychological pain and previous suicide attempts in young adults: Results with the Portuguese version of the Psychache Scale.
Campos Rui C,Holden Ronald R
Journal of clinical psychology
OBJECTIVES:In this study, we tested whether the unbearable pain scale of the Psychache Scale provides value for the statistical prediction of a previous suicide attempt; we evaluated whether psychological pain has incremental value in the statistical prediction of a previous suicide attempt relative to the reporting of having had a psychiatric diagnosis, and we established a cut-score for the Psychache Scale. METHOD:Two samples participated: a sample consisting of 1,460 young adults and a sample of 628 Portuguese community adults. RESULTS AND CONCLUSIONS:Results demonstrated that unbearable pain is not a stronger predictor of a previous suicide attempt than is the bearable pain score of the Psychache Scale; that the total score of the Psychache scale provides an additional statistically significant contribution to the statistical prediction of a previous suicide attempt relative to the reporting of having had a psychiatric diagnosis.
Psychological Inflexibility in Pain Scale: Greek adaptation, psychometric properties, and invariance testing across three pain samples.
Vasiliou Vasilis S,Michaelides Michalis P,Kasinopoulos Orestis,Karekla Maria
The success of acceptance and commitment therapy (ACT) in improving life functioning among chronic pain patients is followed by an interest in investigating mechanisms of action via which it unfolds and validating measures to assess its key constructs. The Psychological Inflexibility in Pain Scale (PIPS-II) assesses pain avoidance and fusion. This is the first study to examine the measurement models of this instrument's Greek adaptation (G-PIPS-II) in patients with different pain localizations (i.e., chronic and headache). A community heterogeneous sample of chronic pain sufferers (N = 156) and two clinical samples comprising treatment-seeking chronic pain patients (N = 149) and treatment-seeking headache patients (N = 89) were recruited from nongovernmental chronic pain support organizations and primary care centers. Exploratory and confirmatory factor analyses demonstrated an acceptable model fit of the G-PIPS-II yielding a two-factor model: avoidance (8 items) and cognitive fusion (4 items). Moderate to high correlations with theoretically related measures supported its construct validity; reliability was high for the total scale and the Avoidance subscale and medium for the Cognitive Fusion subscale. Weak measurement invariance was established across the three pain groups, suggesting that regardless of pain localization, chronic pain and headache patients understand the two latent factors in a similar way. G-PIPS-II is a psychometrically sound instrument assessing two constructs targeted for change within ACT and is deemed a conceptually meaningful scale with items having similar meanings for patients with different pain localization. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
A scale for rating the quality of psychological trials for pain.
Yates Shona L,Morley Stephen,Eccleston Christopher,de C Williams Amanda C
This paper reports the development of a scale for assessing the quality of reports of randomised controlled trials for psychological treatments. The Delphi method was used in which a panel of 15-12 experts generated statements relating to treatment and design components of trials. After three rounds, statements with high consensus agreement were reviewed by a second expert panel and rewritten as a scale. Evidence to support the reliability and validity of the scale is reported. Three expert and five novice raters assessed sets of 31 and 25 published trials to establish scale reliability (ICC ranges from 0.91 to 0.41 for experts and novices, respectively) and item reliability (Kappa and inter-rater agreement). The total scale score discriminated between trials globally judged as good and poor by experts, and trial quality was shown to be a function of year of publication. Uses for the scale are suggested.
Scale of psychological pain: Spanish adaptation of the Psychache Scale in young adults.
Ordóñez-Carrasco Jorge L,Cuadrado Guirado Isabel,Rojas Tejada Antonio
Revista de psiquiatria y salud mental
INTRODUCTION:Psychological pain is understood as an intolerable and disturbing mental state characterized by an internal experience of negative emotions. This study was aimed at making a Spanish adaptation of the Psychache Scale by Holden and colleagues in a sample of young adults. MATERIAL AND METHODS:The scale evaluates psychological pain as a subjective experience. It is composed of 13 items with a Likert-type response format. Following the guidelines of the International Tests Commission for the adaptation of the test, we obtained a version conceptually and linguistically equivalent to the original scale. Through an online questionnaire, participants completed the psychological pain scale along with other scales to measure depression (BDI-II), hopelessness (Beck's scale of hopelessness) and suicide risk (Plutchik suicide risk scale). The participants were 234 people (94 men, 137 women and three people who identified as a different sex) from 18 to 35 years old. RESULTS:The EFA showed a one-factor solution, and the FCA revealed adequate indexes of adjustment to the unifactorial model. It also showed good reliability of the test scores. The evidence of validity of the scale in relation to the other variables showed high, positive and statistically significant correlations with depression, hopelessness, suicidal ideation and suicidal risk. CONCLUSION:In summary, this Spanish adaptation of the Psychache Scale could contribute to improving the evaluation of both the patient with suicide risk and the effectiveness of psychological therapy, as well as suicidal behaviour prevention and intervention.
Psychological Characteristics in Patients with Chronic Complex Regional Pain Syndrome: Comparisons with Patients with Major Depressive Disorder and Other Types of Chronic Pain.
Park Hye Youn,Jang Ye Eun,Oh Sunghee,Lee Pyung Bok
Journal of pain research
Objective:This study investigated psychological characteristics of patients with chronic complex regional pain syndrome (CRPS) and examined relationships between psychosocial factors and pain severity. Methods:In total, 76 patients with CRPS, 95 patients with other types of chronic pain, 171 healthy controls, and 66 patients with major depressive disorder (MDD) were included. Minnesota Multiphasic Personality Inventory (MMPI-2) profiles and scores on the Beck Depression Inventory and State-Trait Anxiety Inventory were calculated. Pain intensity was measured using a visual analog scale (VAS). Results:Patients with CRPS scored higher on the Hypochondriasis (Hs), Depression (D), Hysteria (Hy), Paranoia (Pa), and Psychasthenia (Pt) scales of the MMPI-2 compared to healthy controls. The CRPS group scored lower on the D, Psychopathic deviate (Pd), Pa, Pt, Schizophrenia (Sc), and Social introversion (Si) scales compared to the MDD group. Although CRPS patients reported higher levels of pain than patients with other types of pain, the MMPI profiles of the two pain groups did not differ significantly. Linear regression analyses revealed that pain severity was significantly associated with depression and scores on the Masculinity-Femininity (Mf) scale. Conclusion:This is the first comparative study of the psychological characteristics of chronic CRPS patients, healthy controls, and patients with MDD. The neurotic profiles of CRPS patients were more psychologically adaptable than were those of patients with MDD; however, this profile was shared by both pain groups. The present findings further showed that, although pain severity was not a major contributor to depression, patients with CRPS should be evaluated for depressive symptoms.
Higher psychological pain during a major depressive episode may be a factor of vulnerability to suicidal ideation and act.
Olié Emilie,Guillaume Sébastien,Jaussent Isabelle,Courtet Philippe,Jollant Fabrice
Journal of affective disorders
BACKGROUND:It has been suggested that psychological pain ("psychache") is a key factor in the suicidal process. In addition, suicidal acts may be best understood within a stress-vulnerability model. We hypothesized that more intense psychache during a major depressive episode would be a factor of vulnerability to suicidal behavior. METHODS:Patients hospitalized for a major depressive episode, including 87 individuals with a recent history of suicidal acts, 61 individuals with a past history of suicidal acts, and 62 individuals without any suicidal history, were assessed at admission using several Visual Analog scales to measure levels of psychache, physical pain and suicidal ideation. RESULTS:Patients with a recent or past history of suicide attempts expressed significantly higher levels of current psychological pain, and a higher intensity and frequency of current suicidal ideation than patients without any history of suicidal acts. The level of current psychache was significantly and positively associated with intensity and frequency of suicidal ideation. There were no between-group differences for physical pain. LIMITATIONS:Medication status was not controlled. A lack of statistical power may have masked an association between physical pain and suicidal ideation. CONCLUSIONS:Higher psychological pain during a major depressive episode may be a factor of vulnerability to suicidal behavior, by increasing the propensity to suicidal ideation. Measuring and taking care of psychache during a depressive episode should be a major therapeutic target during crisis intervention.
Chronic Pain and Psychological Distress Among Older Adults: A National Longitudinal Study.
Bierman Alex,Lee Yeonjung
Research on aging
This research examines whether unobserved time-stable influences confound the association between chronic pain and psychological distress in older adults as well as how race and ethnicity combine with subjective social status (SSS) to modify the association. In a nationally representative longitudinal survey, holistically controlling for unobserved time-stable influences using fixed-effects models substantially reduces the pain-depression relationship and eliminates the overall pain-anxiety relationship. The association with depression is stronger for Black and Hispanic elders, illustrating a process of double-jeopardy. Black elders with severe pain experience lower anxiety, as do Black elders with moderate pain and low SSS, which we suggest may be due to the enervating effects of undermanaged pain. Black elders at high SSS experience greater anxiety with moderate pain. This research suggests that undermanagement of chronic pain among racial and ethnic minorities differentiates the association between pain and distress in late life and especially creates stronger associations with depression.
Cognitive Biases Toward Pain: Implications for a Neurocognitive Processing Perspective in Chronic Pain and its Interaction With Depression.
Rusu Adina C,Gajsar Hannah,Schlüter Michael-Christian,Bremer Yara-Inken
The Clinical journal of pain
OBJECTIVES:Information-processing biases such as attentional, interpretation, and memory biases are supposed to play a role in the exacerbation and maintenance of chronic pain. Current research in the area of cognitive biases shows that all these biases seem to have an influence on attention to, interpretation of, and recall of pain and can lead to maladaptive strategies and the exacerbation of pain. METHODS:We conducted a narrative literature review, considering evidence extracted from various databases including PubMed, MEDLINE, Science Direct, and ProQuest. Search terms included cognitive biases, neurocognitive processing, chronic pain, and depression. RESULTS:The literature on attentional, interpretative, and memory biases in experimental and chronic pain, as well as their neuronal underpinnings, suggests that the depression of chronic pain patients may differ from the depression of patients without pain. Depressed pain patients show a recall bias for illness-related and health-related stimuli, whereas depressed patients without pain show a bias for depression-related stimuli. In addition, research has shown that catastrophizing, helplessness/hopelessness, and thought suppression as psychological responses to pain are mediators of the relationship between chronic pain and depression. CONCLUSIONS:Current research supports the importance of individual diagnosis of chronic pain patients and their response patterns of pain, psychological processing, and information processing. This leads to the conclusion that depressed pain patients need other clinical interventions when compared with depressed patients without pain. Previous research showed that a combination of a cognitive-behavioral therapy with mindfulness meditation seems to be a promising approach.
Brain and behavior changes associated with an abbreviated 4-week mindfulness-based stress reduction course in back pain patients.
Braden B Blair,Pipe Teri B,Smith Ryan,Glaspy Tyler K,Deatherage Brandon R,Baxter Leslie C
Brain and behavior
INTRODUCTION:Mindfulness-based stress reduction (MBSR) reduces depression, anxiety, and pain for people suffering from a variety of illnesses, and there is a growing need to understand the neurobiological networks implicated in self-reported psychological change as a result of training. Combining complementary and alternative treatments such as MBSR with other therapies is helpful; however, the time commitment of the traditional 8-week course may impede accessibility. This pilot study aimed to (1) determine if an abbreviated MBSR course improves symptoms in chronic back pain patients and (2) examine the neural and behavioral correlates of MBSR treatment. METHODS:Participants were assigned to 4 weeks of weekly MBSR training (n = 12) or a control group (stress reduction reading; n = 11). Self-report ratings and task-based functional MRI were obtained prior to, and after, MBSR training, or at a yoked time point in the control group. RESULTS:While both groups showed significant improvement in total depression symptoms, only the MBSR group significantly improved in back pain and somatic-affective depression symptoms. The MBSR group also uniquely showed significant increases in regional frontal lobe hemodynamic activity associated with gaining awareness to changes in one's emotional state. CONCLUSIONS:An abbreviated MBSR course may be an effective complementary intervention that specifically improves back pain symptoms and frontal lobe regulation of emotional awareness, while the traditional 8-week course may be necessary to detect unique improvements in total anxiety and cognitive aspects of depression.
A four-year longitudinal study examining psychache and suicide ideation in elevated-risk undergraduates: A test of Shneidman's model of suicidal behavior.
Montemarano Vanessa,Troister Talia,Lambert Christine E,Holden Ronald R
Journal of clinical psychology
OBJECTIVES:Using a 4-year follow-up design, this research investigated Shneidman's model of psychache (i.e., intense mental pain/anguish) as the cause of suicide. Operationalizing suicidal manifestations using suicide ideation, we evaluated Shneidman's assertion that psychache is the prominent predictor of suicide ideation and that other suicide-related psychological variables associate with suicide ideation only through psychache. METHOD:Eighty-two undergraduates at elevated suicide risk were assessed at baseline and follow-up with measures of suicide ideation and three psychological predictors: depression, hopelessness, and psychache. RESULTS:At baseline, only psychache and neither depression nor hopelessness contributed significant, unique information to statistically predicting suicide ideation. For 4-year change in suicide ideation, only psychache and neither depression nor hopelessness provided significant, unique information. CONCLUSIONS:Results provided partial support for Shneidman's contention of the importance of psychache for suicidal behavior and that other psychological factors are only important to suicide insofar as they relate through psychache.
The role of psychological flexibility in relation to suicidal thinking in chronic pain.
McCracken L M,Patel S,Scott W
European journal of pain (London, England)
BACKGROUND:Suicidal thinking (ST) is common in people with chronic pain. It is relevant as it can be associated with suicidal attempts, and typically reflects significant suffering. While little is known about the psychological processes that contribute to ST, current psychological models, such as the Psychological Flexibility (PF) model, could help guide further investigation. This study investigates relations between ST and components of PF in chronic pain. METHODS:Participants were 424 adults attending treatment for chronic pain in the UK. Included in measures administered before treatment were standardized measures of depression, pain, pain-related interference, and measures of PF, including acceptance, cognitive defusion, committed action, and self-as-context. An item from the measure of depression was used to reflect ST. RESULTS:A large proportion of the sample reported ST, 45.7%. ST was uncorrelated with participant background characteristic, medications taken, or pain intensity. However, it was correlated with the presence of widespread pain, pain-related interference, and depression. Each component of PF was found to be significantly negatively associated with ST, as predicted. General acceptance correlated with ST at a level equal to that achieved by the depression score. In adjusted multivariate logistic regression general acceptance and committed action remained significantly uniquely associated with it. CONCLUSION:This preliminary study suggests for the first time that components of PF are associated with part of a pattern of suicidal behaviour in people with chronic pain. They may be relevant for reducing avoidance in general and providing more positive behavioural options. SIGNIFICANCE:This study provides evidence that components of psychological flexibility are associated with a reduced frequency of suicidal thinking in people with chronic pain. Treatments targeting psychological flexibility may help mitigate the impact of chronic pain on suicidal thinking.
Risking existence: The experience and handling of depression.
Bygstad-Landro Marte,Giske Tove
Journal of clinical nursing
AIMS AND OBJECTIVES:To gain insight into how people suffering from depression experience and manage life. BACKGROUND:Depression is the leading cause of incapacitation and constitutes the second largest healthcare burden worldwide, causing considerable discomfort for depression sufferers and their significant others. Depression must be understood against the backdrop of a person's context as well as biological, psychological and social factors. While various studies have been conducted on the process of depression, only a few studies have examined its existential aspects. DESIGN:A classical grounded theory methodology employing open and selective coding was used to identify the participants' main concern and the strategies they used to handle it. METHOD:Data were collected in 2015-2016 during 18 in-depth interviews with people with current or former moderate depression. The data were analysed through constant comparisons until the grounded theory emerged. RESULTS/FINDINGS:The main concern of the participants was Longing for belonging, and they handled their depression through a process named Risking existence. The process comprised four phases: (i) Ungraspable processing; (ii) Giving clues; (iii) Daring dependence; and (iv) Courage to be. The process of risking existence was accompanied from beginning to end by three essentials: to hope, to endure and shame. CONCLUSION:Working in mental health care involves encountering the pain, suffering and despair that humans endure. This challenges nurses to go beyond the symptoms and to listen for their meaning to each individual person. RELEVANCE TO CLINICAL PRACTICE:The grounded theory of risking existence provides a model by which nurses can orient themselves when working with people who are depressed. Each phase describes different strategies that patients use that can help the nurse recognise what is going on, thus enabling him or her to understand and guide his or her patients.
Impulsive choice and psychological pain in acutely suicidal depressed patients.
Cáceda Ricardo,Durand Dante,Cortes Edmi,Prendes-Alvarez Stefania,Moskovciak Tori,Harvey Philip D,Nemeroff Charles B
OBJECTIVE:Despite identification of several risk factors, suicide prediction and prevention is still a clinical challenge. Suicide can be seen as a consequence of poor decision making triggered by overwhelming psychological pain. We examined the relationship of choice impulsivity and psychological pain in depressed patients with acute suicidality. METHODS:Impulsive choice (delay discounting), psychological pain, and clinical characteristics were assessed in four groups of adults (N = 20-22): a) depressed patients within 72 hours after a suicide attempt, b) depressed patients with active suicidal ideation, c) nonsuicidal depressed patients, and d) healthy controls. RESULTS:Impulsive choice was higher in the suicide attempt (0.114 [0.027]) and ideation (0.099 [0.020]) groups compared with nonsuicidal depressed (0.079 [0.020]) and healthy (0.066 [0.019]) individuals (F(3,79) = 3.06, p = .042). Psychological pain data showed a similar profile (F(3,78) = 43.48, p < .001), with 43.4 (2.9) rating of psychological pain for the suicide attempt, 54.3 (2.2) for suicide ideation, 37.0 (3.2) for nonsuicidal depressed, and 13.7 (0.5) for healthy groups. Within the suicide attempt group, persisting suicidal ideation was associated with more severe depression (36.6 [2.9] versus 21.5 [3.1], p = .007) and choice impulsivity (0.134 [0.03] versus 0.078 [0.04], p = .015). Both measures normalized within a week: depression (29.9 [2.6] versus 14.4 [3.0], p = .006) and choice impulsivity (0.114 [0.026] versus 0.066 [0.032], p = .019). CONCLUSIONS:Transient impulsive choice abnormalities are found in a subset of those who attempt suicide. Both, suicidal ideation and behavior were associated with choice impulsivity and intense psychological pain.
A Network Analysis of the Links Between Chronic Pain Symptoms and Affective Disorder Symptoms.
Thompson Emma L,Broadbent Jaclyn,Fuller-Tyszkiewicz Matthew,Bertino Melanie D,Staiger Petra K
International journal of behavioral medicine
BACKGROUND:A range of psychological constructs, including perceived pain, self-efficacy, and pain avoidance, have been proposed to account for the comorbidity of chronic pain and affective disorder symptoms. Despite the likely inter-relation among these constructs, few studies have explored these predictors simultaneously. As such, the relative contributions of these psychological influences remain an open question. PURPOSE:The present study uses a novel, network model approach to help to identify the key psychological contributors to the pain-affective disorder link. METHOD:A cross-sectional design was implemented. The sample comprised 169 individuals with chronic pain (M 49.82; range 22-80 years; 58% female) admitted to a metropolitan chronic pain clinic in Victoria, Australia. Participants completed self-report measures of anxiety, depressive, and pain symptoms, pain self-efficacy, fear avoidance beliefs, perceived control, and pain-related disability. RESULTS:Network analysis identified self-efficacy, fear avoidance, and perceived disability as key constructs in the relationship between pain and affective disorder symptoms, albeit in different ways. While self-efficacy appeared to have direct links to other constructs in the network model, fear avoidance and perceived disability seemed to function more as mediators, linking other constructs in the model. Perceived control and anxiety were found to be less influential in the model. CONCLUSIONS:Present findings identify self-efficacy, fear avoidance, and perceived disability as plausible candidate variables to target to disrupt the link between pain experience and affective disorder symptoms. However, further testing with longitudinal designs is needed to confirm this.
[Pain and depression: cognitive and behavioural mediators of a frequent association].
Radat F,Koleck M
LITERATURE FINDINGS:The comorbidity between chronic pain and depression is high: in the general population setting, the odds ratio for suffering from one of these disorders when suffering from the other is estimated around 2.5. For chronic pain patients consulting in pain clinics, the comorbidity rate reaches one third to half of the patients. For the International Association for the Study of Pain (IASP), pain consists in an emotional as well as a sensory dimension, both of them have to be assessed systematically. Likewise, affective disorders must be systematically depicted in chronic pain patients. The reasons for such comorbidity are complex and result from the conjunction of common risk factors (environmental and genetic vulnerability factors) and of a bidirectional causality. THE TRANSACTIONAL MODEL OF STRESS AND COPING OF LAZARUS ET FOLKMAN: The appraisal stress model (Lazarus and Folkman, 1984) offers an opportunity to understand how chronic pain can cause depression. Pain is conceptualized as a chronic stress. Its appraisal in terms of loss, injustice, incomprehensibility or changes (primary appraisal), and in terms of control (secondary evaluation) determine how the subject will cope with pain. Several personality traits as optimism, hardiness or internal locus of control play a protective role on these evaluations, whereas others (neuroticism, negative affectivity or external locus of control) are risk factors for depression. Low perceived social support is also related to depression. On the contrary, self-efficiency is linked with low levels of depression. Self-management therapies focus on increase of perceived control of pain by the patient in order to improve his/her motivation to change, and to let the patient become active in the management of his/her pain. CONCLUSION:According to Lazarus and Folkman (1984), coping strategies are the constantly changing cognitive and behavioural efforts to manage specific external and/or internal demands that are appraised as taxing on or exceeding the resources of the person. Pain patients can use a wide variety of pain coping strategies: problem versus emotion focused strategies or cognitive versus behavioural strategies. Some of them are highly dysfunctional, such as catastrophizing (cognitive strategy) or avoidance (behavioural strategy). Their preferential use can lead to the development of a depressive episode. The "fear-avoidance model" (Vlayen, 2000) explains pain chronicization by a vicious circle that begins with the pain catastrophizing; this leads to fear of pain, which in turn leads to avoidance and finally to pain and depression. This is why some behavioural cognitive interventions focus on the reduction of catastrophizing and avoidance. Some functional pain coping strategies were identified: they are active strategies centred on problem resolution such as distraction, reinterpretation or ignorance of pain sensations, acceptance, and exercise and task persistence. New therapeutic interventions focus on the development of better coping strategies such as distraction, relaxation and acceptance.
Predictive Roles of Three-Dimensional Psychological Pain, Psychache, and Depression in Suicidal Ideation among Chinese College Students.
Li Huanhuan,Fu Rong,Zou Yingmin,Cui Yanyan
Frontiers in psychology
How to develop an effective screening instrument for predicting suicide risk is an important issue in suicidal research. The aim of the present research was to explore the predictive roles of three screening measures in the evaluation of preexisting suicide risk factors in a sample of undergraduate students. We assessed 1,061 students using the Beck depression and suicidal ideation scales (BDI-I) (BSI), the Psychache Scale (PAS), and the three-dimensional Psychological Pain Scale (TDPPS). Simultaneous multivariate regression analysis showed that the predictive values of pain avoidance scores and BDI scores for suicidal ideation were more significant than that of the PAS scores. Subsequently, 42 patients with major depressive disorder (MDD), 39 students with subthreshold depression (SD), and 18 healthy controls were voluntarily recruited. Students with SD were divided into high suicidal ideation (HSI-SD) and low suicidal ideation (LSI-SD) groups. Pain avoidance scores and BDI scores differed significantly among the MDD, HSI-SD, LSI-SD, and healthy control groups. Pain avoidance and BSI scores were significantly higher in the MDD and HSI-SD groups than those in the LSI-SD and healthy control groups. However, no significant difference was observed in BDI scores between the HSI-SD and LSI-SD groups. Pain avoidance and depression, rather than psychache, may be promising predictors of suicidal ideation in a Chinese young adult population.
The pain of grief: Exploring the concept of psychological pain and its relation to complicated grief, depression, and risk for suicide in bereaved adults.
Frumkin Madelyn R,Robinaugh Donald J,LeBlanc Nicole J,Ahmad Zeba,Bui Eric,Nock Matthew K,Simon Naomi M,McNally Richard J
Journal of clinical psychology
OBJECTIVE:Emotional or psychological pain is a core symptom of complicated grief (CG), yet its correlates are largely unexamined among bereaved individuals. METHOD:Bereaved adults (N = 135) completed self-reports regarding psychological pain, CG, depression, and suicidality. We assessed correlations among these variables and tested whether psychological pain was elevated among individuals with CG and individuals with current or past suicidal thoughts and behaviors. Using logistic regression, we also assessed psychological pain, depression, and CG symptom severity as predictors of suicide risk. RESULTS:Psychological pain was strongly associated with both CG and depression severity and was elevated among subjects reporting current or past suicidality. CG and depression were not statistically significant predictors of suicidal ideation after accounting for the effects of psychological pain. CONCLUSIONS:Psychological pain is strongly associated with bereavement-related psychopathology and warrants further investigation in studies examining the nature and treatment of CG.
Happiness intervention decreases pain and depression, boosts happiness among primary care patients.
Lambert D'raven Louise T,Moliver Nina,Thompson Donna
Primary health care research & development
AIM:The aim of the study was to determine whether positive psychological interventions (PPIs) in a primary health care setting would improve physical and mental health over time. BACKGROUND:Most treatments for depression focus on reducing symptoms rather than on creating positive states of mental health. Empirical studies to verify the efficacy of PPIs in primary health care are needed. METHOD:In a six-week pilot program, we invited patients in a primary health care setting with symptoms of depression to participate in groups designed to increase levels of happiness. The program involved interventions such as engaging in good deeds, writing gratitude letters, and introducing empirical research. Patients completed the SF12v2(®) at the beginning and end of the program and at three- and six-month follow-up. Measures included physical functioning, bodily pain, mental health, social functioning, and vitality. Patients also participated in focus groups to discuss their experiences. FINDINGS:Of the 124 patients who enrolled in this pilot study, 75 completed the six-week program, and 35 participated in two follow-up assessments. Among the participants who remained for all follow-up assessments, scores improved from baseline to 6-month follow-up for health, vitality, mental health, and the effects of mental and physical health on daily activities. This subset of patients reported greater energy and more daily accomplishments, along with reductions in functional limitations. Improvements in mental and physical health and functioning were shown over a six-month period. The study provides a basis for the further investigation of PPIs in creating improvements for patients with depression in primary health care.
The importance of unresolved fatigue in depression: costs and comorbidities.
Robinson Rebecca L,Stephenson Judith J,Dennehy Ellen B,Grabner Michael,Faries Douglas,Palli Swetha Rao,Swindle Ralph W
OBJECTIVE:To assess the cost outcomes of patients with a history of depression and clinically significant fatigue. METHODS:Adults with ≥ 2 claims with depression diagnosis codes identified from the HealthCore Integrated Research Database were invited to participate in this study linking survey data with retrospective claims data (12-mo presurvey and postsurvey periods). Patient surveys included measures for depression (Quick Inventory of Depressive Symptomatology), fatigue (Fatigue Associated with Depression Questionnaire), anxiety (7-item Generalized Anxiety Disorder scale), sleep difficulty (Athens Insomnia Scale), and pain (Brief Pain Inventory). After adjusting for demographic and clinical characteristics using propensity scores, postsurvey costs were compared between patients with and without fatigue using nonparametric bootstrapping methods. RESULTS:Of the 1982 patients who had completed the survey and had complete claims data, 653 patients had significant levels of fatigue. Patients with fatigue reported significantly higher scores, indicating greater severity, on measures of depression, pain, sleep difficulty, and anxiety (all p < 0.05). These patients also had higher levels of overall medication use and were more likely to have lower measures of socioeconomic status than patients without significant levels of fatigue (all p < 0.05). Mean annual total costs were greater for patients with fatigue than those without fatigue ($14,462 vs $9971, respectively, p < 0.001). These cost differences remained statistically significant after adjusting for clinical and demographic differences. CONCLUSIONS:Clinically significant fatigue appears to add to the economic burden of depression. This reinforces the need for aggressive treatment of all symptoms and further examination of the variability of this relationship as patients approach remission.
A 13-year prospective cohort study on the effects of aging and frailty on the depression-pain relationship in older adults.
Sanders Joost B,Comijs Hannie C,Bremmer Marijke A,Deeg Dorly J H,Beekman Aartjan T F
International journal of geriatric psychiatry
OBJECTIVES:The primary aim of the study is to investigate the effect of age and aging on the association between pain and depression over 13 years. We hypothesized that (1) this association would become stronger with age and frailty and that (2) this association is mainly driven by somatic and psychological factors. METHODS:Data were derived from the Longitudinal Aging Study Amsterdam, a prospective population-based cohort study with four follow-up measurements over 13 years, consisting of 1528 respondents (mean age 67.9 ± 8.1). Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale; pain was measured with an adapted version of the Nottingham Health Profile. Follow-up time and age were used as proxy variables for aging and gait speed as frailty marker. Cognition, mastery and neuroticism were measured using the mini mental state examination, the Pearlin Mastery Scale and the Dutch Personality Questionnaire respectively. RESULTS:Linear mixed models showed that pain and depressive symptoms were associated over the 13-year follow-up: b = 0.095, p < 0.001. Neither aging nor frailty changed this association. Measured somatic and psychological characteristics explained 40% of the covariance between pain and depressive symptoms over time. DISCUSSION:When dealing with people suffering from pain and depression, interventions should be similar for all aged people, encompassing both somatic and psychological factors, irrespective of age or frailty status.
A visual analog scale to measure psychological and physical pain: A preliminary validation of the PPP-VAS in two independent samples of depressed patients.
Jollant Fabrice,Voegeli Géraldine,Kordsmeier Nolan C,Carbajal Jessica M,Richard-Devantoy Stéphane,Turecki Gustavo,Cáceda Ricardo
Progress in neuro-psychopharmacology & biological psychiatry
OBJECTIVE:Psychological pain lies at the heart of human experience. However, it may also be abnormally intense and/or prolonged in pathological states, with negative outcomes. A simple and reliable measure of psychological pain for clinical use would be useful. In this study, we present a preliminary validation of a simple visual analog scale jointly measuring psychological and physical pain. METHODS:Two samples of adult (non elderly) depressed patients and healthy controls were independently recruited in two locations in Canada and the USA (N = 46/48 and 200/20, respectively). Six dimensions were successively scored on a paper visual analog scale measuring current, mean and worst pain over the last 15 days, for physical then psychological pain. RESULTS:All physical and psychological pain dimensions discriminated depressed from non-depressed subjects. Among depressed patients, psychological pain scores were higher than physical pain scores for a given period of assessment. Moreover, correlations between dimensions from the same pain category (physical or psychological) were higher than between different pain categories. Psychological pain was mainly correlated with depression and hopelessness scales while physical pain was mainly correlated with anxiety scales. Secondary analyses showed that psychological (and some physical) pain measures were correlated with suicidal ideas in one location, but no difference in pain scores was found between patients with vs. without a history of suicidal acts in both samples. Childhood trauma positively correlated with several pain dimensions. CONCLUSION:The PPP-VAS appears to be a valid tool in terms of discriminative capacities and convergent-divergent validities. Validation in different samples, including adolescents and elderly, and in various psychiatric and medical conditions will have to be conducted, in addition to the assessment of concurrent and predictive validities, and the confirmation of sensitivity to change. The role of psychological pain in the suicidal process needs to be further elucidated.
Decision-making in major depressive disorder: Subjective complaint, objective performance, and discrepancy between both.
Baeza-Velasco Carolina,Guillaume Sébastien,Olié Emilie,Alacreu-Crespo Adrian,Cazals Aurélie,Courtet Philippe
Journal of affective disorders
BACKGROUND:Studies comparing objective and subjective cognition in major depressive disorder (MDD) are scarce, and available data concern different cognitive functions but not decision-making specifically. This cross-sectional study aimed to explore objective (O-DMI) and subjective decision-making impairment (S-DMI) as well as the discrepancy between both in people with MDD. Secondly, we assessed the association between S-DMI and O-DMI. Finally, we explored sociodemographic, clinical, and psychosocial factors related to decision-making impairment status. METHOD:One hundred and nine people with MDD were assessed with the Iowa Gambling Task to identify "O-DMI". The item 9 of the Beck Depression Inventory was used to compose the variable "S-DMI". Psychiatric history, medication adherence, childhood trauma, physical and psychological pain, and negative life experiences were also collected. RESULTS:Forty-six percent of participants have O-DMI and 65.1% S-DMI. From 49.5% showing a discrepancy between both, 68,6% have positive discrepancy and 31,4% negative (i.e. under and overestimation respectively). O-DMI and S-DMI were not associated. Binary logistic regressions showed that the number of negative life events in the past 6 months was predictor of O-DMI, while depression severity and medication adherence predicted S-DMI. Finally, medication adherence and depression severity predicted the type of discrepancy. LIMITATIONS:The variable S-DMI was obtained through a single item. CONCLUSION:These results confirm the lack of association between objective and subjective measures of cognition in MDD, and for the first-time concerning decision-making. This suggest that both assessments should be done in order to have a deeper knowledge of the cognitive functioning of each patient.
Is there a role of depressive symptoms in the fear-avoidance model? A structural equation approach.
Seekatz Bettina,Meng Karin,Bengel Juergen,Faller Hermann
Psychology, health & medicine
The fear-avoidance (FA) model has gained widespread acceptance as a conceptual framework for investigating psychological factors such as FA beliefs and avoidance behavior, which contribute to chronic back pain and reduced functioning. Depressive symptoms are supposed to be related to FA beliefs and to foster avoidance behavior. This study aims to investigate the multivariate assumptions of the FA model with a focus on the role of depressive symptoms. A total of N = 360 patients with chronic nonspecific low back pain at admission of inpatient orthopedic rehabilitation participated in the survey. Measures included a numeric pain rating scale, Fear-Avoidance Beliefs Questionnaire, Pain Anxiety Symptoms Scale, Hannover Functional Ability Questionnaire and Patient Health Questionnaire. Using structural equation modeling (SEM), we construed a basic FA model and subsequently extended it by adding symptoms of depression as a covariate. The results of SEM indicated a good model fit for a basic FA model (χ²(263) = 431.069, p < .001, RMSEA = .042, CFI = .964, WRMR = .986). They confirmed the hypothesized relations and supported single mediations of the relationship between pain and functioning by FA beliefs and avoidance behavior. A second model including symptoms of depression as additional covariate (χ²(511) = 722.761, p < .001, RMSEA = .034, CFI = .956, WRMR = .949) showed a high impact of depressive symptoms on all FA model variables leading to a decrease of the FA mediations. The findings provide empirical support for the multivariate FA model and underline the importance of considering depressive symptoms in a multiple-target approach to understand the mechanisms of chronic pain.
Psychological pain and reduced resting-state heart rate variability in adults with a history of depression.
Meerwijk Esther L,Chesla Catherine A,Weiss Sandra J
Psychological pain is a prominent symptom in people who experience depression, but its relation with physiological measures has not been explored. This study compared two measures of psychological pain, the Orbach & Mikulincer Mental Pain (OMMP) questionnaire and the Psychache Scale, for their relationship with resting-state heart rate variability (HRV) in 35 adults with a history of depression. Low-frequency HRV decreased significantly with increasing psychological pain, particularly in participants who did not use antidepressants, while the beat-to-beat fractal dimension decreased in participants who did use antidepressants. Neither heart rate nor high-frequency HRV was associated with psychological pain. These results suggest a state of arousal characterized by increased sympathetic activity. Results also indicate that the OMMP may be a more accurate measure of autonomic arousal associated with current psychological pain than the Psychache Scale.
Assessment of psychological pain in major depressive episodes.
Mee Steven,Bunney Blynn G,Bunney William E,Hetrick William,Potkin Steven G,Reist Christopher
Journal of psychiatric research
Severe psychological or mental pain is defined as an experience of unbearable torment which can be associated with a psychiatric illness (e.g., major depressive disorder) or a tragic loss such as the death of a child. A brief self-rating scale (Mee-Bunney Psychological Pain Assessment Scale [MBPPAS]) was developed to assess the intensity of psychological pain. The scale was used to measure psychological pain in 73 major depressive episode (MDE) patients and 96 non-psychiatric controls. In addition to the MBPPAS, all subjects completed four additional instruments: Suicidal Behavior Questionnaire (SBQ), Beck Depression Inventory (BDI), Beck Hopelessness Scale (BHS), and the Brief Pain Inventory (BPI). Known-groups, content and convergent validity, and internal reliability of the scale were established. MDE and control subjects were ranked according to MBPPAS scores. A threshold was set at 32 representing 0.5 SD above the mean for MDEs. MDE subjects above the threshold of 32 had significantly higher SBQ scores than those below. A significant linear correlation between psychological pain and SBQ suicidality scores was observed. This is the first study to contrast psychological pain in controls and patients with MDE. Our results suggest that psychological pain is a useful and unique construct in patients with MDE that can be reliably assessed and may aid in the evaluation of suicidal risk.
Alexithymia and depression in the recovery of chronic pain patients: a follow-up study.
Saariaho Anita S,Saariaho Tom H,Mattila Aino K,Ohtonen Pasi,Joukamaa Matti I,Karukivi Max
Nordic journal of psychiatry
BACKGROUND:Childhood adversities and emotional dysregulation are connected with chronic pain, alexithymia, and depression. Longitudinal studies exploring the impact of their co-occurrence on the pain situation are rare. AIMS:The influence of alexithymia, depression, baseline pain situation, and treatment options on the course of chronic pain in a clinical sample was studied. METHODS:The baseline data was collected from chronic pain patients (n = 154) before their first pain clinic visit, and the follow-up data after 1 year by self-report questionnaires. Study variables consisted of pain intensity, pain disability, alexithymia (TAS-20), depression (BDI-II), and treatment interventions. Statistical analyses were performed to find out differences between baseline and follow-up, as well as between alexithymic and non-alexithymic patients, and to estimate the effect of the treatment provided. RESULTS:At follow-up, the majority of the patients had pain intensity and disability severe enough to disrupt with their daily living. None of treatment interventions was related to better outcome. Alexithymic patients reported more pain disability and depression at both baseline and at follow-up. The effect of alexithymia on pain disability was mediated by depression. The use of opioids was connected to alexithymia and depressiveness. Alexithymia and depression made a substantial contribution to poorer outcome. CONCLUSIONS:Severe pain intensity and disability with depression and alexithymia predicted difficulties in achieving improvement. Depression and alexithymia probably impair compliance with treatment and adherence to interventions. Their co-occurrence with a more severe pain situation and with the use of opioids indicates psychological problems underlying the pain experience.
Idiographic measurement of depressive thinking: development and preliminary validation of the Sentence Completion Test for Chronic Pain (SCP).
Rusu Adina C,Hallner Dirk
Scandinavian journal of pain
Background and aims Depression is a common feature of chronic pain, but there is only limited research into the content and frequency of depressed cognitions in pain patients. This study describes the development of the Sentence Completion Test for Chronic Pain (SCP), an idiographic measure for assessing depressive thinking in chronic pain patients. The sentence completion task requires participants to finish incomplete sentences using their own words to a set of predefined stems that include negative, positive and neutral valenced self-referenced words. In addition, the stems include past, future and world stems, which reflect the theoretical negative triad typical to depression. Complete responses are coded by valence (negative, positive and neutral), pain and health-related content. Methods A total of 89 participants were included in this study. Forty seven adult out-patients formed the depressed pain group and were compared to a non-clinical control sample of 42 healthy control participants. This study comprised several phases: (1) theory-driven generation of coding rules; (2) the development of a coding manual by a panel of experts (3) comparing reliability of coding by expert raters without the use of the coding manual and with the use of the coding manual; (4) preliminary analyses of the construct validity of the SCP. The internal consistency of the SCP was tested using the Kuder-Richardson coefficient (KR-20). Inter-rater agreement was assessed by intra-class correlations (ICC). The content and construct validity of the SCP was investigated by correlation coefficients between SCP negative completions, the Hospital Anxiety and Depression Scale (HADS) depression scores and the number of symptoms on the Structured Clinical Interview for DSM-IV-TR (SCID). Results As predicted for content validity, the number of SCP negative statements was significantly greater in the depressed pain group and this group also produced significantly fewer positive statements, compared to the healthy control group. The number of negative pain completions and negative health completions was significantly greater in the depressed pain group. As expected, in the depressed pain group, the correlation between SCP negatives and the HADS Depression score was r=0.60 and the correlation between SCP negatives and the number of symptoms on the SCID was r=0.56. Conclusions The SCP demonstrated good content validity, internal consistency and inter-rater reliability. Implications Uses for this measure, such as complementing questionnaire measures by an idiographic assessment of depressive thinking and generating hypotheses about key problems within a cognitive-behavioural case-formulation, are suggested.
Clarifying the role of psychological pain in the risks of suicidal ideation and suicidal acts among patients with major depressive episodes.
Li Huanhuan,Xie Weizhen,Luo Xinwei,Fu Rong,Shi Chuan,Ying Xiangyu,Wang Ning,Yin Qifeng,Wang Xiang
Suicide & life-threatening behavior
The role of psychological pain in the risk of suicide was explored using a three-dimensional psychological pain model (pain arousal, painful feelings, pain avoidance). The sample consisted of 111 outpatients with major depressive episodes, including 28 individuals with suicidal histories. They completed the Chinese version of the Beck Scale for Suicide Ideation (BSI), the Beck Depression Inventory (BDI), the Psychache Scale, and the three-dimensional Psychological Pain Scale (TDPPS). A structured clinical interview was conducted to assess the history of suicidal acts. Significant correlations were found among BDI, BSI, and TDPPS scores (p < .01). Stepwise regression analyses showed that only pain avoidance scores significantly predicted suicide ideation at one's worst point (β = .79, p < .001) and suicidal acts (β = .46, p < .001). Pain avoidance was also a better predictor of current suicidal ideation (β = .37, p = .001) than were BDI scores (β = .31, p < .01). Increased levels of pain avoidance during a major depressive episode may be a dominant component of the motivation for suicide. Future clinical assessments for populations at high risk of suicide should include measures of psychological pain to reduce the incidence of suicide.
Projective Technique Testing Approach to the Understanding of Psychological Pain in Suicidal and Non-Suicidal Psychiatric Inpatients.
Berardelli Isabella,Sarubbi Salvatore,Spagnoli Alessandra,Fina Chiara,Rogante Elena,Erbuto Denise,Innamorati Marco,Lester David,Pompili Maurizio
International journal of environmental research and public health
Psychological pain is a core clinical factor for understanding suicide, independently from depression. The aim of this study is to assess the role of psychological pain on suicide risk and to evaluate the relationship between psychache and different psychiatric disorders. We conducted the present cross-sectional study on 291 inpatients with a diagnosis of major depressive disorder, bipolar disorder, and schizophrenia. We administered Shneidman's Psychological Pain Assessment Scale (PPAS) for the assessment of mental pain and the Mini International Neuropsychiatric Interview (MINI) for the assessment of suicide risk. There was a significant association between current psychache and worst-ever psychache and suicide risk in inpatients affected by a depressive disorder, bipolar disorder and schizophrenia. Furthermore, we found a significant difference in current psychache between inpatients with major depressive disorder and inpatients with schizophrenia and in worst-ever psychache between inpatients with bipolar disorder and inpatients with schizophrenia, with lower scores in inpatients with schizophrenia. The assessment of psychache appears to be useful for predicting suicidal risk and should be used routinely for identifying and treating suicide risk in clinical practice.
[Depression, anxiety and stress scales: DASS--A screening procedure not only for pain patients].
Nilges P,Essau C
Schmerz (Berlin, Germany)
BACKGROUND:The assessment of mental distress is a central aspect in pain research and treatment. Particularly for depression the comorbidity with pain poses methodological and conceptual challenges. This study examined the psychometric properties of the short version of the depression, anxiety and stress scale (DASS), used in both pain research and treatment and constructed to overcome the particular problems by omitting somatic items and concentrating on the psychological core aspects of depression, anxiety and stress. METHOD:The psychometric properties of the DASS-21 were compared between patients with pain and various people without any pain problems (N = 950). The DASS has three subscales, depression, anxiety and stress, each with seven items. The construct validity of the DASS was examined using the hospital anxiety and depression scale (HADS) for anxiety and depression and the general depression scale (Allgemeine Depressionsskala, ADS) for depression. The sensitivity and specificity for depression were determined against a structured interview for diagnostic and statistical manual of mental disorders (DSM-IV) and compared with the Center for Epidemiological Studies depression scale (CESD) and HADS in pain patients. RESULTS:Cronbach's alpha of the DASS for the depression subscale was at least 0.91, while the anxiety and stress subscales had Cronbach alphas of 0.78-0.82 and 0.81-0.89, respectively. Although the depression subscale has only 7 items, it is just as reliable as the ADS with 21 items. It also has a better sensitivity and specificity than the HADS in identifying clinical patients with depression. DISCUSSION:The DASS is a reliable questionnaire, free to use and brief to administer; therefore, it is an alternative to the previously used instruments for the screening of depression. Furthermore, the subscale stress measures irritability and tension, which are important aspects of pain experience but underused in assessment procedures for the diagnosis and treatment evaluation of patients with pain.
Physical, lifestyle, psychological, and social determinants of pain intensity, pain disability, and the number of pain locations in depressed older adults.
Hanssen Denise J C,Naarding Paul,Collard Rose M,Comijs Hannie C,Oude Voshaar Richard C
Late-life depression and pain more often co-occur than can be explained by chance. Determinants of pain in late-life depression are unknown, even though knowledge on possible determinants of pain in depression is important for clinical practice. Therefore, the objectives of the present study were 1) to describe pain characteristics of depressed older adults and a nondepressed comparison group, and 2) to explore physical, lifestyle, psychological, and social determinants of acute and chronic pain intensity, disability, and multisite pain in depressed older adults. Data from the Netherlands Study of Depression in Older Persons cohort, consisting of 378 depressed persons, diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, 4th edition criteria, and 132 nondepressed persons aged 60 years and older, were used in a cross-sectional design. Pain characteristics were measured by the Chronic Graded Pain Scale. Multiple linear regression analyses were performed to explore the contribution of physical, lifestyle, psychological, and social determinants to outcomes pain intensity, disability, and the number of pain locations. Depressed older adults more often reported chronic pain and experienced their pain as more intense and disabling compared to nondepressed older adults. Adjusted for demographic, physical, and lifestyle characteristics, multinomial logistic regression analyses showed increased odds ratios (OR) for depression in acute pain (OR 3.010; P=0.005) and chronic pain (OR 4.544, P<0.001). In addition, linear regression analyses showed that acute and chronic pain intensity, disability, and multisite pain were associated with several biopsychosocial determinants, of which anxiety was most pronounced. Further research could focus on the temporal relationship between anxiety, late-life depression, and pain.
Pain and depression: an integrative review of neurobiological and psychological factors.
Goesling Jenna,Clauw Daniel J,Hassett Afton L
Current psychiatry reports
The comorbidity of pain and depression has been well established in the literature and is associated with a greater burden to the individual and society than either condition alone. The relationship between pain and depression is quite complex and multiple factors must be considered when trying to disentangle the pain-depression link including shared neurobiology, precipitating environmental factors and cognitive influences. This article aims to provide an overview of the leading neurobiological and psychosocial theories that have advanced our understanding of the link between pain and depression. To this end we describe the shared neurobiological mechanisms in the brain thought to explain the overlap and consider psychological processes and how they inform a cognitive behavioral model. The article also provides an overview of the evidence based treatment for comorbid pain and depression.
From stress to inflammation and major depressive disorder: a social signal transduction theory of depression.
Slavich George M,Irwin Michael R
Major life stressors, especially those involving interpersonal stress and social rejection, are among the strongest proximal risk factors for depression. In this review, we propose a biologically plausible, multilevel theory that describes neural, physiologic, molecular, and genomic mechanisms that link experiences of social-environmental stress with internal biological processes that drive depression pathogenesis. Central to this social signal transduction theory of depression is the hypothesis that experiences of social threat and adversity up-regulate components of the immune system involved in inflammation. The key mediators of this response, called proinflammatory cytokines, can in turn elicit profound changes in behavior, which include the initiation of depressive symptoms such as sad mood, anhedonia, fatigue, psychomotor retardation, and social-behavioral withdrawal. This highly conserved biological response to adversity is critical for survival during times of actual physical threat or injury. However, this response can also be activated by modern-day social, symbolic, or imagined threats, leading to an increasingly proinflammatory phenotype that may be a key phenomenon driving depression pathogenesis and recurrence, as well as the overlap of depression with several somatic conditions including asthma, rheumatoid arthritis, chronic pain, metabolic syndrome, cardiovascular disease, obesity, and neurodegeneration. Insights from this theory may thus shed light on several important questions including how depression develops, why it frequently recurs, why it is strongly predicted by early life stress, and why it often co-occurs with symptoms of anxiety and with certain physical disease conditions. This work may also suggest new opportunities for preventing and treating depression by targeting inflammation.
Residual symptoms in patients with partial versus complete remission of a major depressive disorder episode: patterns of painful physical symptoms in depression.
Harada Eiji,Satoi Yoichi,Kikuchi Toshiaki,Watanabe Koichiro,Alev Levent,Mimura Masaru
Neuropsychiatric disease and treatment
OBJECTIVE:The patterns of residual painful physical symptoms (PPS) and emotional symptoms among patients with partial remission (PR) or complete remission (CR) of a major depressive disorder (MDD) episode were compared. METHODS:This is a multicenter, cross-sectional, observational study. Patients who had originally been diagnosed with MDD, were treated with an antidepressant for 12 weeks for that episode, and achieved either PR or CR at study entry were enrolled in the study. Using the 17-item Hamilton Rating Scale for Depression (HAM-D17), PR was defined as a score of ≥8 and ≤18 and CR as a score of ≤7. Residual symptoms were assessed using the Brief Pain Inventory-Short Form (BPI-SF) and the HAM-D17. RESULTS:A total of 323 patients (CR =158, PR =165) were included in the study. Patients in the PR group had a higher mean (standard deviation) score in the HAM-D17 than those in the CR group (11.8 [3.1] and 4.4 [2.0], respectively). BPI-SF results showed that "at least moderate PPS" (score ≥3 on BPI-SF question 5) was significantly more prevalent among patients with PR than those with CR (37.0% vs 16.5%, respectively; odds ratio =3.04; P<0.001). Presence of pain (any severity) was also more prevalent among patients with PR than those with CR (54.5% vs 35.4%, respectively). The HAM-D17 results for individual items indicated that impaired work and activities, depressed mood, psychological and somatic anxiety, and general somatic symptoms were observed in at least 75% of patients with PR. CONCLUSION:PR was associated with a higher prevalence of at least moderate PPS. Other residual symptoms commonly observed in patients with PR included typical core emotional symptoms (eg, loss of interest, depressed mood, and psychological anxiety). These results underline the importance of PPS, because PPS is clinically relevant for the patients but difficult to assess with the commonly used depression evaluation scale.
Anhedonia and pain avoidance in the suicidal mind: behavioral evidence for motivational manifestations of suicidal ideation in patients with major depressive disorder.
Xie Weizhen,Li Huanhuan,Luo Xinwei,Fu Rong,Ying Xiangyu,Wang Ning,Yin Qifeng,Zou Yingmin,Cui Yanyan,Wang Xiang,Shi Chuan
Journal of clinical psychology
OBJECTIVES:Psychological pain may be helpful in conceptualizing suicidal behavior, in that high motivation to avoid pain combined with painful feelings may contribute to an increased risk of suicide. However, no experimental study has tested this hypothesis. The aim of the present study is to provide empirical evidence for the relationship between anhedonia, pain avoidance motivation, and suicidal ideation. METHOD:The sample comprised 40 depressed outpatients and 20 healthy control subjects. All participants completed the Beck Scale for Suicide Ideation (BSS), Beck Depression Inventory, Psychache Scale, Three-Dimensional Psychological Pain Scale, the monetary incentive delay (MID), and affective incentive delay (AID) tasks. Based on BSS scores, clinical participants were divided into high suicidal ideation (HSI) and low suicidal ideation (LSI) groups. RESULTS:In the AID task, the HSI group had longer response times (RTs) under the reward condition than those under the punishment condition (p = .002). The LSI and control groups had shorter RTs under the reward condition compared with those under the neural condition (p <.001 and p = .008, respectively). The LSI group also had shorter RTs under the reward condition than under the punishment condition (p = .003). Pain arousal (r = -.33, p <.01) and BSS scores were significantly negatively correlated with differences in RTs between neutral and reward conditions. Pain avoidance (r = .35, p <.01) and BSS scores were positively correlated with differences in RTs between neutral and punishment conditions. CONCLUSIONS:The AID task was more sensitive than the MID task for the detection of participants' motivation in approaching hedonic experiences and avoiding pain. A suicidal mindset is manifested as decreased motivation to experience hedonia and increased motivation to avoid pain, which could be strong predictors of suicidal behavior.
Pain and Depression: A Systematic Review.
IsHak Waguih William,Wen Raymond Y,Naghdechi Lancer,Vanle Brigitte,Dang Jonathan,Knosp Michelle,Dascal Julieta,Marcia Lobsang,Gohar Yasmine,Eskander Lidia,Yadegar Justin,Hanna Sophia,Sadek Antonious,Aguilar-Hernandez Leslie,Danovitch Itai,Louy Charles
Harvard review of psychiatry
BACKGROUND:Pain comorbid with depression is frequently encountered in clinical settings and often leads to significant impaired functioning. Given the complexity of comorbidities, it is important to address both pain and depressive symptoms when evaluating treatment options. AIM:To review studies addressing pain comorbid with depression, and to report the impact of current treatments. METHOD:A systematic search of the literature databases was conducted according to predefined criteria. Two authors independently conducted a focused analysis of the full-text articles and reached a consensus on 28 articles to be included in this review. RESULTS:Overall, studies suggested that pain and depression are highly intertwined and may co-exacerbate physical and psychological symptoms. These symptoms could lead to poor physical functional outcomes and longer duration of symptoms. An important biochemical basis for pain and depression focuses on serotonergic and norepinephrine systems, which is evident in the pain-ameliorating properties of serotonergic and norepinephrine antidepressants. Alternative pharmacotherapies such as ketamine and cannabinoids appear to be safe and effective options for improving depressive symptoms and ameliorating pain. In addition, cognitive-behavioral therapy may be a promising tool in the management of chronic pain and depression. CONCLUSION:The majority of the literature indicates that patients with pain and depression experience reduced physical, mental, and social functioning as opposed to patients with only depression or only pain. In addition, ketamine, psychotropic, and cognitive-behavioral therapies present promising options for treating both pain and depression.
Resting-state EEG delta power is associated with psychological pain in adults with a history of depression.
Meerwijk Esther L,Ford Judith M,Weiss Sandra J
Psychological pain is a prominent symptom of clinical depression. We asked if frontal alpha asymmetry, frontal EEG power, and frontal fractal dimension asymmetry predicted psychological pain in adults with a history of depression. Resting-state frontal EEG (F3/F4) was recorded while participants (N=35) sat upright with their eyes closed. Frontal delta power predicted psychological pain while controlling for depressive symptoms, with participants who exhibited less power experiencing greater psychological pain. Frontal fractal dimension asymmetry, a nonlinear measure of complexity, also predicted psychological pain, such that greater left than right complexity was associated with greater psychological pain. Frontal alpha asymmetry did not contribute unique variance to any regression model of psychological pain. As resting-state delta power is associated with the brain's default mode network, results suggest that the default mode network was less activated during high psychological pain. Findings are consistent with a state of arousal associated with psychological pain.
Unexplained Painful Physical Symptoms in Patients with Major Depressive Disorder: Prevalence, Pathophysiology and Management.
Jaracz Jan,Gattner Karolina,Jaracz Krystyna,Górna Krystyna
Patients with major depression often report pain. In this article, we review the current literature regarding the prevalence and consequences, as well as the pathophysiology, of unexplained painful physical symptoms (UPPS) in patients with major depressive disorder (MDD). UPPS are experienced by approximately two-thirds of depressed patients. The presence of UPPS makes a correct diagnosis of depression more difficult. Moreover, UPPS are a predictor of a poor response to treatment and a more chronic course of depression. Pain, in the course of depression, also has a negative impact on functioning and quality of life. Frequent comorbidity of depression and UPPS has inspired the formulation of an hypothesis regarding a shared neurobiological mechanism of both conditions. Evidence from neuroimaging studies has shown that frontal-limbic dysfunction in depression may explain abnormal pain processing, leading to the presence of UPPS. Increased levels of proinflamatory cytokines and substance P in patients with MDD may also clarify the pathophysiology of UPPS. Finally, dysfunction of the descending serotonergic and noradrenergic pathways that normally suppress ascending sensations has been proposed as a core mechanism of UPPS. Psychological factors such as catastrophizing also play a role in both depression and chronic pain. Therefore, pharmacological treatment and/or cognitive therapy are recommended in the treatment of depression with UPPS. Some data suggest that serotonin and noradrenaline reuptake inhibitors (SNRIs) are more effective than selective serotonin reuptake inhibitors (SSRIs) in the alleviation of depression and UPPS. However, the pooled analysis of eight randomised clinical trials showed similar efficacy of duloxetine (an SNRI) and paroxetine (an SSRI) in reducing UPPS in depression. Further integrative studies examining genetic factors (e.g. polymorphisms of genes for interleukins, serotonin transporter and receptors), molecular factors (e.g. cytokines, substance P) and neuroimaging findings (e.g. functional studies during painful stimulation) might provide further explanation of the pathophysiology of UPPS in MDD and therefore facilitate the development of more effective methods of treatment.
ROC analysis of three-dimensional psychological pain in suicide ideation and suicide attempt among patients with major depressive disorder.
Sun Xuemei,Li Huanhuan,Song Wei,Jiang Songyuan,Shen Chengfeng,Wang Xiang
Journal of clinical psychology
OBJECTIVE:To identify the predictive ability of the three-dimensional psychological pain scale (TDPPS) on suicide risk among MDD patients as compared to impulsivity, depression, hopelessness, psychache and acquired capability for suicide, and to determine the cut-off point of TDPPS in the identification of those at risk for suicide. METHOD:The sample comprised 137 depressed outpatients who were divided into subjects with a history of suicidal attempt (SA, N = 31) and those without such history (NSA, N = 106). All participants completed the questionnaires to evaluate interested variables. Broad sociodemographic and clinical variables were analyzed by using hierarchical and logistic regression analysis and Receiver Operating Characteristic curve analysis. RESULTS:TDPPS, especially pain avoidance subscale displayed superior performance in accurately identifying suicide attempt compared with other measurements. The appropriate cut-off point was 58 for the TDPPS. CONCLUSIONS:TDPPS may be an effective screening scale for detecting depressed patients at high suicidal risk.
Effect of Affective Reward on Cognitive Event-related Potentials and its Relationship with Psychological Pain and Suicide Risk among Patients with Major Depressive Disorder.
Song Wei,Li Huanhuan,Guo Ting,Jiang Songyuan,Wang Xiang
Suicide & life-threatening behavior
OBJECTIVE:The present study aimed to explore the electrophysiological correlates involved in three-dimensional psychological pain and their relationship with suicide in patients with major depressive disorder. METHOD:The sample comprised 23 and nine patients with major depressive disorder with high and low risk for suicide, respectively, and 24 healthy controls. All participants completed the measurements and performed an event-related potential-based analogue of the affective incentive delay task. The event-related potential components previously associated with motivationally salient cue (contingent negative variation, P2, and cue-P3), target (target-P3), and feedback (reward vs. punishment, feedback-related negativity, and feedback-P3) stimuli were examined. RESULTS:All inventory scores differed significantly among the high-risk, low-risk, and healthy control groups. During the expectant phase, the main effect of group and interaction between group and condition was significant in the average amplitudes of the cue-P2 component. During the feedback phase, the feedback-P3 elicited by positive feedback had a significant main effect of group and of the interaction between group and condition. Specifically, the feedback-P3 elicited by negative feedback in the punitive condition showed significant positive correlations with the total and subscale scores on the Three-Dimensional Psychological Pain Scale. CONCLUSIONS:Feedback-P3 may be an electrobiological component underlying the processing of psychological pain in suicidality.
Stress, sex hormones, inflammation, and major depressive disorder: Extending Social Signal Transduction Theory of Depression to account for sex differences in mood disorders.
Slavich George M,Sacher Julia
Social Signal Transduction Theory of Depression is a biologically plausible, multi-level theory that describes neural, physiologic, molecular, and genomic mechanisms that link experiences of social-environmental adversity with internal biological processes that drive depression pathogenesis, maintenance, and recurrence. Central to this theory is the hypothesis that interpersonal stressors involving social threat (e.g., social conflict, evaluation, rejection, isolation, and exclusion) upregulate inflammatory processes that can induce several depressive symptoms, including sad mood, anhedonia, fatigue, psychomotor retardation, and social-behavioral withdrawal. The original article describing this formulation (Psychol Bull 140:774-815, 2014) addressed critical questions involving depression onset and recurrence, as well as why depression is strongly predicted by early life stress and comorbid with anxiety disorders and certain physical disease conditions, such as asthma, rheumatoid arthritis, chronic pain, and cardiovascular disease. Here, we extend the theory to help explain sex differences in depression prevalence, which is a defining feature of this disorder. Central to this extension is research demonstrating that ovarian hormone fluctuations modulate women's susceptibility to stress, brain structure and function, and inflammatory activity and reactivity. These effects are evident at multiple levels and are highly context-dependent, varying as a function of several factors including sex, age, reproductive state, endogenous versus exogenous hormones, and hormone administration mode and dose. Together, these effects help explain why women are at greater risk for developing inflammation-related depressed mood and other neuropsychiatric, neurodevelopmental, and neurodegenerative disorders during the reproductive years, especially for those already at heightened risk for depression or in the midst of a hormonal transition period.
Efficacy of psychological pain theory-based cognitive therapy in suicidal patients with major depressive disorder: A pilot study.
Zou Yingmin,Li Huanhuan,Shi Chuan,Lin Yixuan,Zhou Hanyu,Zhang Jiaqi
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 Inventory, Three-Dimensional Psychological Pain Scale (TDPPS), and Problem Solving Inventory(PSI), and Automatic Thoughts Questionnaire (ATQ). All measures differed significantly between depressed patients and healthy controls. Then clinical participants were assigned randomly to the PPTBCT (n=19) and control (n=13) groups. During the 8-week intervention, scores related to depression, suicidal ideation, psychological pain, and automatic thoughts were decreased in both groups at the post-intervention and 4-week follow-up time points, compared with pre-intervention scores. BSI scores remained low at follow up and did not differ significantly from post-intervention scores in the PPTBCT group, but were significantly higher at follow up than at post-intervention in the control group. PPTBCT may effectively reduce suicide risk in patients with major depressive disorder, although the effects of its application need to be confirmed.
Psychological Pain, Depression, and Suicide: Recent Evidences and Future Directions.
Conejero Ismael,Olié Emilie,Calati Raffaella,Ducasse Déborah,Courtet Philippe
Current psychiatry reports
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. RECENT FINDINGS: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.