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      Hearing the Suicidal Patient's Emotional Pain : A Typological Model to Improve Communication


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          Abstract. Background: Escaping from emotional pain is a recognized driver in suicidal patients' desire to die. Formal scales of emotional pain are rarely used during routine contact between patients and their care team. No study has explored facilitators and inhibitors of emotional pain communication between staff and suicidal patients during regular care. Aims: To identify factors impeding or facilitating emotional pain communication between patients at risk of suicide and mental health professionals. Method: Nine patients with a history of a medically serious suicide attempt and 26 mental health (NHS) staff participated in individualized and focus group interviews, respectively. Results: A typological model was created, describing how patients either speak out or inhibit communication, and professionals may hear the communication or fail to do so. Four permutations are possible: unspoken/unheard, spoken/unheard, spoken/heard, and unspoken/heard. We found 14 subthemes of impediments and facilitators, which include misaligned, alienated and, co-bearing. Limitations: No male patients participated. Conclusion: Numerous factors influence whether emotional pain communication is responded to, missed, or ignored. Patients may try more than one way to communicate. Some patients fear that being able to speak out results in their emotional pain being taken less seriously. Knowledge of this model should improve the care of suicidal patients.

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          Most cited references17

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          The gender paradox in suicide.

          In most Western countries females have higher rates of suicidal ideation and behavior than males, yet mortality from suicide is typically lower for females than for males. This article explores the gender paradox of suicidal behavior, examines its validity, and critically examines some of the explanations, concluding that the gender paradox of suicidal behavior is a real phenomenon and not a mere artifact of data collection. At the same time, the gender paradox in suicide is a more culture-bound phenomenon than has been traditionally assumed; cultural expectations about gender and suicidal behavior strongly determine its existence. Evidence from the United States and Canada suggests that the gender gap may be more prominent in communities where different suicidal behaviors are expected of females and males. These divergent expectations may affect the scenarios chosen by females and males, once suicide becomes a possibility, as well as the interpretations of those who are charged with determining whether a particular behavior is suicidal (e.g., coroners). The realization that cultural influences play an important role in the gender paradox of suicidal behaviors holds important implications for research and for public policy.
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            Development and preliminary validation of a scale of psychache.

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              Mental pain: a multidimensional operationalization and definition.

              An operationalization of mental pain is presented in three studies. The first study describes the operationalization of mental pain and the factor structure of the items produced by a content analysis of self-reports yielding a scale with nine factors: the experience of irreversibility, loss of control, narcissistic wounds, emotional flooding, freezing, estrangement, confusion, social distancing, and emptiness. Study 2 tested the relationship between mental pain and depression and anxiety in a normal population. Study 3 focused on the relationship between mental pain and coping. Mental pain is conceptualized as a perception of negative changes in the self and its functions that are accompanied by negative feelings. It is suggested that it can be meaningfully applied to the study of different mental states, life conditions, and transitions in life.

                Author and article information

                Hogrefe Publishing
                December 19, 2017
                : 39
                : 4
                : 267-274
                [ 1 ]Faculty of Health Sciences, University of Southampton, UK
                [ 2 ]Institute of Environmental Science and Research, Wellington, New Zealand
                [ 3 ]Centre for Stress Management, London, UK
                [ 4 ]Leadership, Education and Training Department, Southern Health NHS Foundation Trust, Hampshire, UK
                [ 5 ]Faculty of Medicine, University of Southampton, UK
                Author notes
                Christine Dunkley, 28 Stourvale Gardens Chandler's Ford, Eastleigh, Hants, SO53 3NE, UK, christine.dunkley@ 123456grayrock.co.uk
                © 2017 Hogrefe Publishing

                Distributed under the Hogrefe OpenMind License (https://doi.org/10.1027/a000001)

                : July 24, 2016
                : June 2, 2017
                : June 12, 2017
                Research Trends

                Clinical Psychology & Psychiatry
                suicide,emotional pain,communication,risk,qualitative
                Clinical Psychology & Psychiatry
                suicide, emotional pain, communication, risk, qualitative


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