The interplay between childhood trauma, hopelessness, depressive symptoms, and mental pain in a large sample of patients with severe mental disorders: A network analysis

Background: Mental pain represents a significant risk factor for suicidal behavior in severe mental disorders. The present study aims to investigate the interplay between childhood traumatic experiences, hopelessness, depressive symptoms and mental pain, using a network analysis approach in a large transdiagnostic sample of participants living in the community. Methods: The present investigation was conducted using data gathered in a multicentric observational cross-section study organized as a joint project, including different Italian research and clinical settings. Considering the assessment tools adopted in the study, 12 different variables were included as nodes in the EBICglasso network analysis. Stability of the edges and of centrality indices were assessed using bootstrap procedures, considering case-dropping and node-dropping procedures. Results: A total of 2147 participants were included in the analysis. Mental pain represents a central feature in a complex network of relationships, including traumatic experiences, hopelessness, and depressive symptoms. More in deatail, mental pain and, to a lesser extent, affective and cognitive depressive symptoms emerged as the most central and influential nodes of the network, highlighting the strong link existing between these aspects and their importance in the lives of people with mental disorders. Conclusions: Results confirm the importance of mental pain as a transdiagnostic feature, requiring careful assessment and consideration in all patients, beyond the diagnostic categories and regardless of suicide risk. Assessing and managing the presence and severity of mental pain should be taken into account in clinical practice, in the perspective of providing significant clinical benefits, as well as relevant research insight.