Hearing the Suicidal Patient's Emotional Pain

Overview

Journal Crisis

Specialty Social Sciences

Date 2017 Dec 20

PMID 29256270

Authors

Christine Dunkley

Alan Borthwick

Ruth Bartlett

Laura Dunkley

Stephen Palmer

Stefan Gleeson

David Kingdon

Affiliations

Soon will be listed here.

Abstract

Background: Escaping from emotional pain is a recognized driver in suicidal patients' desire to die. Formal scales of emotional pain are rarely used during routine contact between patients and their care team. No study has explored facilitators and inhibitors of emotional pain communication between staff and suicidal patients during regular care.

Aims: To identify factors impeding or facilitating emotional pain communication between patients at risk of suicide and mental health professionals.

Method: Nine patients with a history of a medically serious suicide attempt and 26 mental health (NHS) staff participated in individualized and focus group interviews, respectively.

Results: A typological model was created, describing how patients either speak out or inhibit communication, and professionals may hear the communication or fail to do so. Four permutations are possible: unspoken/unheard, spoken/unheard, spoken/heard, and unspoken/heard. We found 14 subthemes of impediments and facilitators, which include misaligned, alienated and, co-bearing.

Limitations: No male patients participated.

Conclusion: Numerous factors influence whether emotional pain communication is responded to, missed, or ignored. Patients may try more than one way to communicate. Some patients fear that being able to speak out results in their emotional pain being taken less seriously. Knowledge of this model should improve the care of suicidal patients.

References

Mee S, Bunney B, Reist C, Potkin S, Bunney W . Psychological pain: a review of evidence. J Psychiatr Res. 2006; 40(8):680-90. DOI: 10.1016/j.jpsychires.2006.03.003. View

Olie E, Guillaume S, Jaussent I, Courtet P, Jollant F . Higher psychological pain during a major depressive episode may be a factor of vulnerability to suicidal ideation and act. J Affect Disord. 2009; 120(1-3):226-30. DOI: 10.1016/j.jad.2009.03.013. View

Shneidman E . A bibliography of suicide notes: 1856-1979. Suicide Life Threat Behav. 1979; 9(1):57-9. View

Jobes D, Wong S, Conrad A, Drozd J, Neal-Walden T . The collaborative assessment and management of suicidality versus treatment as usual: a retrospective study with suicidal outpatients. Suicide Life Threat Behav. 2005; 35(5):483-97. DOI: 10.1521/suli.2005.35.5.483. View

Levi Y, Horesh N, Fischel T, Treves I, Or E, Apter A . Mental pain and its communication in medically serious suicide attempts: an "impossible situation". J Affect Disord. 2008; 111(2-3):244-50. DOI: 10.1016/j.jad.2008.02.022. View

Boswell J, Kraus D, Miller S, Lambert M . Implementing routine outcome monitoring in clinical practice: benefits, challenges, and solutions. Psychother Res. 2013; 25(1):6-19. DOI: 10.1080/10503307.2013.817696. View

Levi-Belz Y, Gvion Y, Horesh N, Fischel T, Treves I, Or E . Mental pain, communication difficulties, and medically serious suicide attempts: a case-control study. Arch Suicide Res. 2013; 18(1):74-87. DOI: 10.1080/13811118.2013.809041. View

Ennis L, Wykes T . Impact of patient involvement in mental health research: longitudinal study. Br J Psychiatry. 2013; 203(5):381-6. DOI: 10.1192/bjp.bp.112.119818. View

Leenaars A . Suicide across the adult life-span: an archival study. Crisis. 1989; 10(2):132-51. View

10.

Orbach I, Mikulincer M, Gilboa-Schechtman E, Sirota P . Mental pain and its relationship to suicidality and life meaning. Suicide Life Threat Behav. 2003; 33(3):231-41. DOI: 10.1521/suli.33.3.231.23213. View

11.

Canetto S, Sakinofsky I . The gender paradox in suicide. Suicide Life Threat Behav. 1998; 28(1):1-23. View

12.

Orbach I, Mikulincer M, Sirota P, Gilboa-Schechtman E . Mental pain: a multidimensional operationalization and definition. Suicide Life Threat Behav. 2003; 33(3):219-30. DOI: 10.1521/suli.33.3.219.23219. View