Assessing mental pain as a predictive factor of suicide risk in a clinical sample of patients with psychiatric disorders

Summary. Background. Mental pain (psychache) is a key risk factor for suicide, surpassing traditional constructs like depression and anxiety. While its correlation with suicidal ideation is well-established, few studies have evaluated its predictive value for actual suicide attempts in clinical populations. This study aimed to evaluate whether mental pain predicts short-term suicide attempts in a clinical sample, and to assess its potential role as a screening tool in suicide prevention. Methods. A longitudinal study on 179 psychiatric outpatients recruited at the University Hospital of Varese between 2020 and 2022. At baseline, participants completed the Psychache Scale (PAS), Beck Hopelessness Scale (BHS), Beck Depression Inventory-II (BDI-II), and Columbia Suicide Severity Scale (C-SSRS), among others. Sociodemographic, clinical, and laboratory data were also collected. Suicide attempts were tracked over a 12-month follow-up. Binary logistic regression was used to identify predictors of suicide attempts. Results. Twenty-six patients attempted suicide during follow-up, with 24 cases occurring within the first 6 months. Higher scores on the PAS, BHS, BDI-II, and Columbia Severity Rating Scale (C-SSRS) were significantly associated with increased suicide risk. In logistic regression, the PAS emerged as an independent predictor: each point increase corresponded to a 3.8% rise in suicide attempt probability (p=0.015). The BDI-II showed the strongest model fit (R2=0.169). Unemployment and history of substance abuse were also significantly associated with increased risk. No significant associations were found with routine laboratory parameters. Conclusions. The PAS, alongside the BDI-II, BHS, and C-SSRS scales may serve as an effective tool for early suicide risk detection, especially in psychiatric and primary care settings. Mental pain appears to be a relevant short-term risk indicator, highlighting the need for targeted screening and prevention strategies. Further research should explore its application in general healthcare to enhance suicide prevention efforts.