Mental Pain, Communication Difficulties, and Medically Serious Suicide Attempts: A Case-Control Study

Abstract

Medical severe suicide attempts (MSSA) are epidemiologically very similar to individuals who complete suicide. Thus the investigation of individuals who have made MSSAs may add to our understanding of the risk factors for completed suicide. The aim of this study was to assess the role of mental pain and communication difficulties in MSSA. A total of 336 subjects were divided into 4 groups: 78 meeting criteria for MSSA compared with116 subjects who made a medically non-serious suicide attempt (MNSSA), 47 psychiatric controls with no history of suicidal behavior, and 95 healthy controls. Mental pain variants (e.g., hopelessness), facets of communication difficulties (e.g., self-disclosure), as well as socio-demographic and clinical characteristics were assessed. The MSSA had significantly higher communication difficulties than the other 3 groups. Moreover, the interaction between mental pain and communication difficulties explained some of the variance in suicide lethality, above and beyond the contribution of each component alone. This report underlines the importance of mental pain for suicide attempts in general while difficulties in communication abilities play a critical role in differentiating MSSA from MNSSA. The co-existence of unbearable mental pain with difficulties in communication significantly enhances the risk for more lethal forms of suicidal behavior.

Keywords:

• medical lethality
• mental pain
• schizoid tendencies
• self-disclosure

Acknowledgments

We would like to thank the hospital and the mental health services staff at the participating hospitals for their assistance in running the interviews.

Notes

Note.

*Rated on 5-point scale.

Note. MPS = Mental Pain Scale; BDI = Beck Depression Inventory; BHS = Beck Hopelessness Scale; LES = Life Events Scale; SDQ = Self-Disclosure Questionnaire; ULS = UCLA Loneliness Scale.

^a Significant differences in means on Scheffe post hoc test (     p<.05).

^b Significant differences in means on Scheffe post hoc test (     p<.05).

^c Significant differences in means on Scheffe post hoc test (     p<.05).

Note. MPS = Mental Pain Scale; BDI = Beck Depression Inventory; BHS = Beck Hopelessness Scale; LES = Life Events Scale; SDQ = Self-Disclosure Questionnaire; ULS = UCLA Loneliness Scale.

*P < .05;.

**P < .01;.

***P < .001.

Additional information

Notes on contributors

Yossi Levi-Belz

Yossi Levi-Belz, Department of Behavioral Sciences, Ruppin Academic Center, Emek Hefer, Israel and The Feinberg Child Study Center, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Yari Gvion

Yari Gvion, Department of Clinical Psychology, Bar Ilan University, Ramat Gan, Israel.

Netta Horesh

Netta Horesh, Department of Clinical Psychology, Bar Ilan University, Ramat Gan, Israel.

Tsvi Fischel

Tsvi Fischel, Geha Psychiatric Hospital, Petah Tiqva, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Ilan Treves

Ilan Treves, Shalvata Mental Health Center, Hod Hasharon, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Evgenia Or

Evgenia Or, Lev Hasharon Psychiatric Hospital, Pardesia, Tel Aviv, Israel.

Orit Stein-Reisner

Orit Stein-Reisner, Lev Hasharon Psychiatric Hospital, Pardesia, Tel Aviv, Israel.

Mark Weiser

Mark Weiser, Psychiatric Ambulatory Services, Sheba Medical Center, Tel Hashomer, Israel.

Haim Shem David

Haim Shem David, Psychiatric Ambulatory Services, Sheba Medical Center, Tel Hashomer, Israel.

Alan Apter

Alan Apter, the Feinberg Child Study Center, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.