Clarifying the Role of Psychological Pain in the Risks of Suicidal Ideation and Suicidal Acts among Patients with Major Depressive Episodes

The role of psychological pain in the risk of suicide was explored using a three‐dimensional psychological pain model (pain arousal, painful feelings, pain avoidance). The sample consisted of 111 outpatients with major depressive episodes, including 28 individuals with suicidal histories. They completed the Chinese version of the Beck Scale for Suicide Ideation (BSI), the Beck Depression Inventory (BDI), the Psychache Scale, and the three‐dimensional Psychological Pain Scale (TDPPS). A structured clinical interview was conducted to assess the history of suicidal acts. Significant correlations were found among BDI, BSI, and TDPPS scores (p < .01). Stepwise regression analyses showed that only pain avoidance scores significantly predicted suicide ideation at one's worst point (β = .79, p < .001) and suicidal acts (β = .46, p < .001). Pain avoidance was also a better predictor of current suicidal ideation (β = .37, p = .001) than were BDI scores (β = .31, p < .01). Increased levels of pain avoidance during a major depressive episode may be a dominant component of the motivation for suicide. Future clinical assessments for populations at high risk of suicide should include measures of psychological pain to reduce the incidence of suicide.     

From religious emotions to affects: historical and theoretical reflections on injury to feeling,self and religion

ABSTRACT

Images of angry Muslims have become a common sight in repeated controversies problematising the compatibility of Islam and freedom of speech. To explain such outrage, it is often put forward that Muslims reacted to the disrespect and violation of their ‘religious feelings’. In this paper, we challenge the trope of hurt religious feelings in the explanation of unrest. Referring to the writings of Schleiermacher, James and Taylor, the discussion traces how religion and feeling have become inextricably intertwined, located within the individual self and institutionalised as a dominant interpretation of religion. We introduce affect as a conceptual alternative to such understandings, which allows us to analyse the emphasis on Muslim emotionality as a relationship between Muslim and secular bodies, hence no longer reduced to the interiority of Muslim subjects. We will illustrate the potential of an affect-based approach discussing Muslim feelings’ vital role in the construction of European democracies.     

Adult Parent–Child Relationships: Relationship Quality, Support, and Reciprocity

A partir du modèle de la solidarité intergénérationnelle de Bengston ( Bengston & Roberts, 1991 ), on a étudié, chez 265 femmes entre deux âges vivant en Allemagne, les interrelations entre leurs valeurs familiales, leur perception de qualité de la relation avec leurs parents, le soutien qu’elles disent leur apporter et recevoir de leur part, ainsi que leur appréhension de l’entraide entre les générations. On s’est aussi demandé si l’aide apporté aux parents et la réciprocité perçu étaient en rapport avec la charge que les filles ressentaient suite au soutien accordé. Les données des diverses rubriques, fournies par les sujets, ont été traitées avec des analyses de régression logistiques multiple et multinomiale. Les analyses ont débouché sur des liaisons positives entre les valeurs familiales, la qualité des relations et le soutien aux parents. La réciprocité perçue était reliée aux aides mutuelles entre les générations et un soutien déséquilibré avait des effets négatifs sur la qualité de la relation. La charge ressentie pouvait ­être prédite à partir de la réciprocité perçue et de l’importance de l’aide. Cependant, sont apparus des modèles corrélationnels spécifiques dépendant à la fois du type d’aide et du niveau d’importance relatif du père et de la mère. Les résultats sont discutés dans le contexte du sens de la réciprocité et des obligations familiales dans une culture occidentale. In accordance with Bengtson's model of intergenerational solidarity (e.g. Bengtson & Roberts, 1991 ), the interrelations between adult daughters’ family values, their perception of the relationship quality with their parents, the support they reported to give to and to receive from their parents, and their perception of reciprocity in intergenerational support exchange were investigated for N= 265 middle‐aged women in Germany. It was also asked whether the support given to parents and perceived reciprocity are related to daughters’ felt burden as a result of their support. Cross‐sectional, self‐report data were examined with multiple and multinomial logistic regression analyses. The analyses revealed positive relations between family values, relationship quality, and support to parents. Perceived reciprocity was associated with the exchange of intergenerational support, and imbalance in support had negative effects on the relationship quality. Felt burden was predicted by the extent of support and the perceived reciprocity. However, specific correlational patterns depending on the kind of support as well as differences in the importance of mother and father occurred. The findings are discussed against the background of the meaning of family obligations and reciprocity in a Western culture.     

The Building of Epistemic Trust: An Adoptive Family’s Experience of Mentalization-Based Therapy

ABSTRACT

Recently, theorists have posited the development of epistemic trust – the trust in others as reliable sources of information – as an essential aspect of the therapeutic relationship and a mechanism of therapeutic change. Epistemic trust is likely to be disrupted in adoptive children and families and Mentalization Based Treatment (MBT) aims to explicitly promote its development. Therefore, this study aims to investigate how epistemic mistrust is addressed and how epistemic trust is established within the MBT framework. This single-case, exploratory study reports data from in-depth interviews with one adoptive family, which were analyzed qualitatively using Interpretative Phenomenological Analysis. Two superordinate themes are reported: pre-therapy factors contributing to epistemic mistrust and factors contributing to the development of epistemic trust. The findings highlight two critical elements in establishing epistemic trust: the use of certain clinical skills that help build a secure base within therapy and the possibility of trust being transferred from and to other professionals/systems beyond therapy. Hence, this study informs a deeper understanding of how epistemic trust may be built in therapeutic work with adopted children and identifies possible clinical approaches that may be used by clinicians working with this client group.     

A Five‐Month Longitudinal Study of Psychache and Suicide Ideation: Replication in General and High‐Risk University Students

Shneidman's (1993) model of psychache as the cause of suicide was evaluated in a 5‐month longitudinal study of psychological pain and suicide ideation. Replicating across general (N = 683) and high‐risk undergraduates (N = 262), psychache was significantly associated with suicide ideation, and change in psychache was significantly associated with change in suicide ideation. For general suicide ideation and suicide preparation, these significant results were maintained even when depression and hopelessness were statistically controlled. This research is a unique contribution being the first large‐sample longitudinal study that evaluates and supports Shneidman's psychache causal model of suicidality in general and high‐risk groups.     

Patterns of Presentation for Attempted Suicide: Analysis of a Cohort of Individuals Who Subsequently Died by Suicide

All suicides and related prior attempts occurring in Northern Ireland over two years were analyzed, focusing on number and timing of attempts, method, and mental health diagnoses. Cases were derived from coroner's records, with 90% subsequently linked to associated general practice records. Of those included, 45% recorded at least one prior attempt (with 59% switching from less to more lethal methods between attempt and suicide). Compared with those recording one attempt, those with 2+  attempts were more likely to have used less lethal methods at the suicide (OR = 2.77: 95% CI = 1.06, 7.23); and those using less lethal methods at the attempts were more likely to persist with these into the suicide (OR = 3.21: 0.79, 13.07). Finally, those with preexisting mental problems were more likely to use less lethal methods in the suicide: severe mental illness (OR = 7.88: 1.58, 39.43); common mental problems (OR = 3.68: 0.83, 16.30); and alcohol/drugs related (OR = 2.02: 0.41, 9.95). This analysis uses readily available data to highlight the persisting use of less lethal methods by visible and vulnerable attempters who eventually complete their suicide. Further analysis of such conditions could allow more effective prevention strategies to be developed.