Mental Pain and Euthymia as Transdiagnostic Clinimetric Indices in Primary Care

Briefly, 200 patients (mean age 46.5 ± 14.5 years; 66% females) were consecutively recruited in a primary care practice in Italy from March to October 2017. The study was approved by an institutional board, and written informed consent was obtained from all patients after the procedure had been fully explained. Patients were excluded if they were < 18 or > 70 years old, had cognitive impairments, refused participation, did not give written informed consent, or had psychotic symptoms. Participants underwent three clinical interviews for assessing psychiatric and psychosomatic disorders: the Structured Clinical Interview for DSM-5 (SCID-5) [6] for obtaining psychiatric diagnoses; the Semi-Structured Interview for Diagnostic Criteria for Psychosomatic Research – revised version (SSI-DCPR-R) [7] for determining the presence of psychosomatic syndromes; and the Clinical Interview for Depression – change version (CID) [8], a dimensional observer-rated scale that provides depression and anxiety scores. All patients completed three self-rating questionnaires for the assessment of mental pain, euthymia, and psychosocial functioning: the MPQ [3], a 10-item yes/no questionnaire with a total score ranging from 0 to 10; ES [2], a 10-item yes/no questionnaire for assessing euthymia; and the PsychoSocial Index (PSI) [9], a 55item self-rating scale based on clinimetric principles that provides a comprehensive assessment of stress, psychological distress, illness behavior, well-being, and quality of life. Univariate analyses of variance using the general linear model were performed to test for associations of the MPQ and the ES with psychiatric/psychosomatic diagnoses, after controlling for sociodemographic and medical variables. Pearson product-moment correlations between the MPQ, ES, and other dimensional psychological measures were also computed. The results are expressed as means and standard deviations (SD). The significance level was set at p = 0.05, two-tailed. There were 46 patients (23%) with at least one DSM-5 diagnosis, whereas 88 patients (44%) were diagnosed with at least one DCPR-R syndrome. Concerning the MPQ, patients who received at least one DSM5 diagnosis were found to display significantly higher scores on the MPQ (mean = 3.20; SD = 2.60; F (1, 148) = 24.58; p < 0.001) than those who had neither DSM-5 nor DCPR-R diagnoses (n = 107) (mean = 1.18; SD = 1.75), particularly those reporting mood disorders (mean = 4.44; SD = 3.05; F (1, 103) = 33.02; p < 0.001). MPQ scores were also significantly higher in patients with at least one DCPR-R syndrome (mean = 2.39; SD = 2.22; F (1, 190) = 14.16; p < 0.001) than those with no diagnoses, and were particularly pronounced in patients presenting with demoralization (mean = 3.38; SD = 2.66; F (1, 128) = 24.68; p < 0.001) and irritable mood (mean = 3.09; SD = 2.68; F (1, 125) = 15.366; p < 0.001). With regard to the ES, patients who received at least one DSM5 diagnosis reported significantly lower scores (mean = 5.26; SD = 2.36; F (1, 148) = 59.851; p < 0.001) than those with no diagnoses Dear Editor, Carrozzino et al. [1] have recently conducted a clinimetric analysis of the Euthymia Scale (ES) [2], a self-rating instrument that evaluates the individual’s balance among psychic forces leading to high levels of resilience and frustration tolerance [2]. They tested two main clinimetric properties of the scale, scalability and incremental validity, and detected a two-dimensional nature of the scale (psychological flexibility and well-being) and a satisfactory incremental contribution to the prediction of well-being and neuroticism in a clinical sample [1]. We would like to add further data on the clinical utility of the ES, in association with another clinimetric index: a self-rating scale for the assessment of mental pain – the Mental Pain Questionnaire (MPQ) [3]. There have been various definitions of mental pain in the literature, and a number of self-rating questionnaires have been developed. The MPQ was developed according to clinimetric principles on the basis of the clinical characteristics outlined in the literature: feeling of mental pain, feeling of heart brokenness, sense of loss, feelings that the pain is everywhere and always with the individual, inability to understand the cause of pain, sense of emptiness, loss of meaning of life, helplessness, and suicidality as an escape from pain [3]. The MPQ showed good clinimetric properties when administered in a clinical population [4], particularly sensitivity in discriminating between patients with or without psychological distress and incremental validity. The relationship of mental pain to euthymia appears to be worthy of investigation, particularly in clinical settings, with regard to patient vulnerability, timing and modality of intervention, as well as treatment goals. The aim of the present study was to examine the psychological correlates of both mental pain and euthymia as transdiagnostic clinimetric indices in a heterogeneous clinical population in primary care, using interviews for psychiatric and psychosomatic diagnoses and other observerand self-rated instruments. A detailed description of the recruitment procedure and assessment methods used in this study has been provided elsewhere [5]. Received: June 12, 2019 Accepted after revision: June 19, 2019 Published online: July 17, 2019