Mental pain and its communication in medically serious suicide attempts: An "impossible situation"

Background: The study of near-fatal suicide attempters may provide insight into the minds of suicidal subjects. Our aim is to test the hypothesis that mental pain is a general risk factor for suicidal behavior and communication difficulties are a particular risk factor for medically serious suicidal behavior. Methods: Thirty five subjects who made medically serious suicide attempts were compared with 67 medically not serious suicide attempters and 71 healthy controls. All were interviewed with the SCID-I and completed questionnaires covering mental pain, communication difficulties and seriousness of suicide attempt. Result: Variables from the mental pain domain (e.g. depression) predicted the presence of suicidal behavior, and variables from the communication difficulties domain (e.g., self-disclosure) predicted the lethality and seriousness of the suicide attempts. Limitations: Relatively small number of patients with medically serious suicide attempt and the relatively large number of questionnaires which may to some extent have diminished informant reliability. Conclusions: Problems with sharing of feelings with others are an important risk factor for near-lethal suicide, over and above the contribution of psychiatric illness and mental pain, including depression and hopelessness.