title: Mental Pain and Suicide: A Systematic Review of the Literature.
abstract: BACKGROUND
  Mental pain, defined as a subjective experience characterized by perception of strong negative feelings and changes in the self and its function, is no less real than other types of grief. Mental pain has been considered to be a distinct entity from depression. We have performed a systematic review analyzing the relationship between mental pain and suicide by providing a qualitative data synthesis of the studies.
  
  
  METHODS
  We have conducted, in accordance with PRISMA guidelines, a systematic search for the literature in PubMed, Web Of Science, and Scopus. Search terms were "mental pain" "OR" "psychological pain" OR "psychache" combined with the Boolean "AND" operator with "suicid*." In addition, a manual search of the literature, only including the term "psychache," was performed on Google Scholar for further studies not yet identified.
  
  
  RESULTS
  Initial search identified 1450 citations. A total of 42 research reports met the predefined inclusion criteria and were analyzed. Mental pain was found to be a significant predictive factor of suicide risk, even in the absence of a diagnosed mental disorder. Specifically, mental pain is a stronger factor of vulnerability of suicidal ideation than depression.
  
  
  CONCLUSIONS
  Mental pain is a core clinical factor for understanding suicide, both in the context of mood disorders and independently from depression. Health care professionals need to be aware of the higher suicidal risk in patients reporting mental pain. In this regard, psychological assessment should include a clinimetric evaluation of mental pain in order to further detect its contribution to suicidal tendency.
authors.affiliation: Department of Psychological, Health, and Territorial Sciences, G. d'Annunzio University , Chieti , Italy.
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Verrocchio
authors.affiliation: Department of Psychological, Health, and Territorial Sciences, G. d'Annunzio University, Chieti, Italy; Psychiatric Research Unit, Mental Health Centre North Zealand, Copenhagen University Hospital, Hillerød, Denmark.
authors.forename: Danilo
authors.initials: D
authors.lastname: Carrozzino
authors.affiliation: Department of Psychological, Health, and Territorial Sciences, G. d'Annunzio University , Chieti , Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Marchetti
authors.affiliation: Psychiatric Research Unit, Mental Health Centre North Zealand, Copenhagen University Hospital , Hillerød , Denmark.
authors.forename: Kate
authors.initials: K
authors.lastname: Andreasson
authors.affiliation: Department of Psychological, Health, and Territorial Sciences, G. d'Annunzio University , Chieti , Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Fulcheri
authors.affiliation: Psychiatric Research Unit, Mental Health Centre North Zealand, Copenhagen University Hospital , Hillerød , Denmark.
authors.forename: Per
authors.initials: P
authors.lastname: Bech
keywords: mental pain; psychache; psychological pain; suicidal behavior; suicidal ideation; suicide attempt