İntihar Davranışının Habercisi “Psikolojik Acı”
Özet
Psikolojik acı; utanç, keder ve hüzün gibi olumsuz duygularla karakterize, alanyazında zihinsel veya duygusal acı olarak da adlandırılan ve intihar davranışının tahmin edilmesinde merkezi bir rol oynayan sarsıcı bir süreçtir. Shneidman tarafından temel psikolojik ihtiyaçların engellenmesiyle ortaya çıkan dayanılmaz bir ıstırap olarak tanımlanan bu kavram, depresyonun önemli bir parçası olmakla birlikte ondan bağımsız bir klinik yapı sergileyebilir. Geleneksel ve yeni nesil intihar teorileri incelendiğinde; psikolojik acının, intihar düşüncesi ve eylemini depresyon veya umutsuzluğa kıyasla istatistiksel olarak çok daha güçlü ve doğrudan bir şekilde öngördüğü belirlenmiştir. Türkiye'de yapılan güncel klinik çalışmalar da şizofreni, obsesif-kompulsif bozukluk ve çocukluk çağı travmaları gibi psikiyatrik tablolarda intihar riskini doğrudan tetikleyen ana unsurun psikolojik acı olduğunu ortaya koymaktadır. Bu doğrultuda, Holden veya Mee-Bunney gibi geçerliliği kanıtlanmış klinik ölçeklerin tanı süreçlerine entegre edilmesi büyük önem taşımaktadır. Sonuç olarak, klinik pratikte henüz yaygınlaşmamış olan bu ölçüm araçlarının risk değerlendirmelerine dahil edilmesi ve psikolojik acının depresyondan tamamen ayrı bir olgu olarak ele alınması, intiharı önleme ve erken müdahale stratejilerinde kritik bir optimizasyon sağlayacaktır.
Psychological pain is a distressing process characterized by negative emotions such as shame, grief, and sadness, also referred to as mental or emotional pain in literature, and plays a central role in predicting suicidal behavior. Defined by Shneidman as an unbearable suffering that arises when basic psychological needs are frustrated, this concept is a major component of depression yet can exhibit an independent clinical structure. When traditional and next-generation suicide theories are examined, it is determined that psychological pain predicts suicidal ideation and action statistically much more strongly and directly compared to depression or hopelessness. Recent clinical studies conducted in Turkey also reveal that psychological pain is the main factor directly triggering suicide risk in psychiatric conditions such as schizophrenia, obsessive-compulsive disorder, and childhood traumas. In this regard, it is of great importance to integrate validated clinical scales, such as Holden or Mee-Bunney, into diagnostic processes. Consequently, incorporating these measurement tools, which are not yet widespread in clinical practice, into risk assessments and treating psychological pain as a phenomenon entirely distinct from depression will provide a critical optimization in suicide prevention and early intervention strategies.
Referanslar
Demirkol ME, Namlı Z, Tamam L. Psikolojik Acı. Psikiyatride Guncel Yaklasimlar. 2019;11(2):205-213. doi:10.18863/pgy.444006
Shneidman ES. Perspective on suicidology: Further reflections on suicide and psychache. Suicide and Life‐Threatening Behavior. 1998;28(3):245-250. doi:10.1111/j.1943-278X.1998.tb00854.x
Verrocchio MC, Carrozzino D, Marchetti D, Andreasson K, Fulcheri M, Bech P. Mental Pain and Suicide: A Systematic Review of the Literature. Frontiers in Psychiatry. 2016;7(JUN):108. doi:10.3389/fpsyt.2016.00108
Orbach I, Mikulincer M, Sirota P, Gilboa-Schechtman E. Mental Pain: A Multidimensional Operationalization and Definition. Suicide and Life-Threatening Behaviour. 2003;33(3):219-230. doi:10.1521/suli.33.3.219.23219
Mee S, Bunney BG, Bunney WE, Hetrick W, Potkin SG, Reist C. Assessment of psychological pain in major depressive episodes. Journal of Psychiatric Research. 2011;45(11):1504-1510. doi:10.1016/j.jpsychires.2011.06.011
Holden RR, Mehta K, Cunningham EJ, McLeod LD. Development and preliminary validation of a scale of psychache. Canadian Journal of Behavioural Science. 2001;33(4):224-232. doi:10.1037/h0087144
Demirkol ME, Güleç H, Çakmak S, et al. Reliability and validity study of the Turkish version of the psychache scale. Anadolu Psikiyatr Dergisi. 2018;19(1):14–20. doi: 10.5455/apd.292935
Demirkol ME, Güleç H, Tamam L, et al. Reliability and validity of Mee-Bunney Psychological Pain Assessment Scale Turkish version. Current Psychology. 2020;39(4):1181-1188. doi:10.1007/s12144-019-00400-z
Li H, Fu R, Zou Y, Cui Y. Predictive Roles of Three-Dimensional Psychological Pain, Psychache, and Depression in Suicidal Ideation among Chinese College Students. Frontiers in Psychology. 2017;8. doi:10.3389/fpsyg.2017.01550
Malhi GS, Mann JJ. Depression. Lancet. 2018;392(10161):2299-2312. doi:10.1016/S0140-6736(18)31948-2
Conejero I, Olié E, Calati R, Ducasse D, Courtet P. Psychological Pain, Depression, and Suicide: Recent Evidences and Future Directions. Current Psychiatry Reports. 2018;20(5):33. doi:10.1007/s11920-018-0893-z
Mee S, Bunney BG, Bunney WE, Hetrick W, Potkin SG, Reist C. Assessment of psychological pain in major depressive episodes. Journal of Psychiatric Research. 2011;45(11):1504-1510. doi:10.1016/j.jpsychires.2011.06.011
Tossani E. The Concept of Mental Pain. Psychotherapy and Psychosomatics. 2013;82(2):67-73. doi:10.1159/000343003
Mee S, Bunney BG, Reist C, Potkin SG, Bunney WE. Psychological pain: A review of evidence. Journal of Psychiatric Research. 2006;40(8):680-690. doi:10.1016/j.jpsychires.2006.03.003
van Heeringen K, Van den Abbeele D, Vervaet M, Soenen L, Audenaert K. The functional neuroanatomy of mental pain in depression. Psychiatry Research: Neuroimaging. 2010;181(2):141-44.doi:10.1016/J.PSCYCHRESNS.2009.07.011
TÜİK. Nüfus ve Demografi. https://data.tuik.gov.tr/Kategori/GetKategori?p=nufus-ve-demografi-109&dil=1. Published 2021. Accessed May 20, 2021.
Ageing and health. World Health Organisation. https://www.who.int/news-room/fact-sheets/detail/ageing-and-health. Published 2018. Accessed February 25, 2020.
Turecki G, Brent DA. Suicide and suicidal behaviour. Lancet. 2016;387(10024):1227-1239. doi:10.1016/S0140-6736(15)00234-2
Arsenault-Lapierre G, Kim C, Turecki G. Psychiatric diagnoses in 3275 suicides: a meta-analysis. BMC Psychiatry. 2004;4(1):37. doi:10.1186/1471-244X-4-37
Holma KM, Haukka J, Suominen K, et al. Differences in incidence of suicide attempts between bipolar I and II disorders and major depressive disorder. Bipolar Disorders. 2014;16(6):652-661. doi:10.1111/bdi.12195
Carter G, Milner A, McGill K, Pirkis J, Kapur N, Spittal MJ. Predicting suicidal behaviours using clinical instruments: Systematic review and meta-analysis of positive predictive values for risk scales. British Journal of Psychiatry. 2017;210(6):387-395. doi:10.1192/bjp.bp.116.182717
McGirr A, Renaud J, Bureau A, Seguin M, Lesage A, Turecki G. Impulsive-aggressive behaviours and completed suicide across the life cycle: A predisposition for younger age of suicide. Psychological Medicine. 2008;38(3):407-417. doi:10.1017/S0033291707001419
Hofstra E, van Nieuwenhuizen C, Bakker M, et al. Effectiveness of suicide prevention interventions: A systematic review and meta-analysis. General Hospital Psychiatry. 2020;63:127-140. doi:10.1016/j.genhosppsych.2019.04.011
Zalsman G, Hawton K, Wasserman D, et al. Suicide prevention strategies revisited: 10-year systematic review. The Lancet Psychiatry. 2016;3(7):646-659. doi:10.1016/S2215-0366(16)30030-X
Fox KR, Huang X, Guzmán EM, et al. Interventions for suicide and self-injury: A meta-analysis of randomized controlled trials across nearly 50 years of research. Psychological Bulletin. 2020;146(12):1117-1145. doi:10.1037/bul0000305
Klonsky ED, May AM, Saffer BY. Suicide, Suicide Attempts, and Suicidal Ideation. Annual Review of Clinical Psychology. 2016;12(December):307-330. doi:10.1146/annurev-clinpsy-021815-093204
David Klonsky E, May AM. The three-step theory (3ST): A new theory of suicide rooted in the “ideation-to-action” framework. International Journal of Cognitive Therapy. 2015;8(2):114-129. doi:10.1521/ijct.2015.8.2.114
Mento C, Silvestri MC, Muscatello MRA, et al. Psychological pain and risk of suicide in adolescence. International Journal of Adolescent Medicine and Health. April 2020. doi:10.1515/ijamh-2019-0270
Troister T, Holden RR. Comparing psychache, depression, and hopelessness in their associations with suicidality: A test of Shneidman’s theory of suicide. Personality and Individual Differences. 2010;49(7):689-693. doi:10.1016/j.paid.2010.06.006
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.” Journal of Affective Disorders. 2008;111(2-3):244-250. doi:10.1016/j.jad.2008.02.022
Campos RC, Holden RR, Laranjeira P, et al. Self-report depressive symptoms do not directly predict suicidality in nonclinical individuals: Contributions toward a more psychosocial approach to suicide risk. Death Studies. 2016;40(6):335-349. doi:10.1080/07481187.2016.1150920
Ducasse D, Holden RR, Boyer L, et al. Psychological Pain in Suicidality: A Meta-Analysis. The Journal of Clinical Psychiatry. 2018;79(3):16r10732. doi:10.4088/JCP.16r10732
Montemarano V, Troister T, Lambert CE, Holden RR. A four-year longitudinal study examining psychache and suicide ideation in elevated-risk undergraduates: A test of Shneidman’s model of suicidal behavior. Journal of Clinical Psychology. 2018;74(10):1820-1832. doi:10.1002/jclp.22639
Patterson AA, Holden RR. Psychache and Suicide Ideation among Men Who Are Homeless: A Test of Shneidman’s Model. Suicide and Life-Threatening Behaviour. 2012;42(2):147-156. doi:10.1111/j.1943-278X.2011.00078.x
Demirkol ME, Tamam L, Namli Z, et al. Association of Psychache and Alexithymia With Suicide in Patients With Schizophrenia. Journal of Nervous and Mental Diseases. 2019;207(8):668–74. doi:10.1097/NMD.0000000000001023
Uğur K, Demirkol ME, Tamam L. The Mediating Roles of Psychological Pain and Dream Anxiety in the Relationship between Sleep Disturbance and Suicide. Archives of Suicide Research. 2021;25(3):512–28. doi.org/10.1080/13811118.2020.1740124
Demirkol ME, Namlı Z, Davul ÖE, et al. Psychache and suicidal history in patients with obsessive-compulsive disorder. Neuropsychiatric Disease and Treatment. 2019;15:3531–9. doi: 10.2147/NDT.S237369
Demirkol ME, Uğur K, Tamam L. The mediating effects of psychache and dissociation in the relationship between childhood trauma and suicide attempts. Anadolu Psikiyatri Dergisi. 2020;21(5):453–60. doi:10.5455/apd.82990
