Conference Agenda

In suicide risk assessment, the challenge is to identify the most vulnerable individuals and the facilitating circumstances of suicide. Numerous characteristics and sometimes specific profiles have been proposed for identifying those at greatest risk of suicide. However, risk factors are not infallible predictors, and high-risk profiles can change over time and may vary depending on specific local conditions. Furthermore, the assessment of suicide risk is not always documented in routine clinical practice, and attempts to predict suicide produce many false positives and negatives. To improve the ability to assess suicide risk, recently several authors have begun to shed light on the suicide crisis.

During the emergence of suicide ideation and behavior, spikes of negative emotions and high-risk cognitions are present. Hopelessness, desperation, feelings of abandonment and disconnection from significant others, anxiety, and feelings of loneliness are activated by external pressures and stressors and fluctuate in the days and hours before a suicide attempt. These mental states are highly aversive, associated with cognitive constriction and a lower sense of control over one’s own thoughts and behaviors, and create a sense of urgency, leading the individual to think that he/she can escape from the turmoil only through death. In the last decades, various authors and theories have proposed competing models to explain emerging suicidality and the suicide crisis. Not all the models are based on extensive research that supports their predictive validity, and few studies have attempted to investigate competing models in an extended framework. The objectives of the speech were to define the construct of suicide crisis to improve suicide risk assessment, to highlight the importance of mental states in the emergence of suicide ideation and behavior, and to compare specific theories in an extended framework.

Classical suicidology has long proposed that suicidal behavior is driven by intolerable psychological anguish, often referred to as psychache. From this perspective, suicide is not primarily a movement toward death but an attempt to escape unbearable emotional suffering. When negative emotions become overwhelming and consciousness itself is experienced as distressing, individuals may wish not for death per se, but for an end to awareness while remaining alive. Suicide tends to occur when psychological pain is perceived as inescapable and intolerable.

Beyond psychiatric illness, childhood maltreatment represents a significant risk factor for suicidal behavior. This lecture examines suicidal vulnerability from both theoretical and experimental perspectives, focusing on the relationship between psychological suffering, recent suicide attempts, and early-life trauma. Data from a multicenter observational study indicate that suicide attempters are significantly more likely to report heightened psychological pain and suicidal intent, regardless of whether a specific plan is present. They also show higher rates of personality disorders and severe depressive episodes. Although childhood trauma was prevalent among psychiatric patients, its association with current mental pain scores was modest, suggesting a complex and indirect relationship between early adversity and acute psychological suffering.

Mental anguish can be further conceptualized within Panksepp’s affective neuroscience framework, which highlights the role of the opioid system in regulating emotions related to attachment, separation, and loss. Dysregulation of this system may contribute to feelings of despair and unrelieved distress. In recent years, there has been renewed interest in targeting the opioid system for the treatment of major depressive disorder and psychological pain. Antidepressant agents with partial mu-opioid receptor agonism and kappa-opioid receptor antagonism represent promising pharmacological strategies for addressing distress in vulnerable patients.

This presentation concludes by emphasizing emerging experimental evidence and the central role of clinicians in recognizing and alleviating psychological suffering among individuals at risk for suicide.

The potential link between opioid analgesics and suicidal ideation (SI) has raised increasing concern, yet global-scale evidence remains limited. In the study we will present, we investigated the association between opioid use and SI by analyzing individual case safety reports submitted to VigiBase, the World Health Organization’s international pharmacovigilance database, between 2011 and 2022. We included reports from 45 countries concerning individuals aged 15 years and older, in which SI was documented and either opioid or non-opioid analgesics were listed as suspected drugs. Non-opioid analgesics were used as comparators due to similar pain-related indications, without expected psychiatric adverse effects. Disproportionality analyses using both frequentist (reporting odds ratio, ROR) and Bayesian (information component, IC) methods revealed a strong association between opioid use and SI (ROR: 2.26 [95% CI: 1.97–2.60]; IC: 1.52 [0.44–2.60]). This association was consistent across time periods and global regions, and remained robust when cases involving combinations with non-opioid analgesics were excluded. Buprenorphine and fentanyl were the opioids most strongly associated with SI. Notably, most reported SI cases involved a single opioid prescribed for acute pain, suggesting that even short-term exposure may contribute to suicidal thoughts. In contrast, non-opioid analgesics showed no significant association with SI, reinforcing a specific signal linked to opioid pharmacology. These findings highlight a possible interaction between physical pain, opioid effects on psychological pain regulation, and the emergence of suicidality. Given the consistent signal across diverse populations, and the frequency of use in non-psychiatric settings, this study supports the need for systematic assessment of suicidal ideation prior to and during opioid treatment. Pharmacovigilance databases offer a valuable resource for detecting early psychiatric safety signals and should be more widely integrated into risk evaluation frameworks in both research and clinical practice.

Suicidal vulnerability involves the convergence of psychological pain, social disconnection, altered bodily perception, and neurobiological dysfunction. Social touch—especially affective CT-optimal touch—is a key regulator of affiliation, emotional soothing, and safety signaling. It engages brain regions implicated in suicide risk, including the insula and orbitofrontal cortex, and interacts with endogenous opioid pathways. Clinically, disturbances in how patients perceive bodily and social cues may contribute to crisis escalation and impaired emotion regulation.

Recent findings exploring touch perception in individuals with a history of suicide attempt offer an unexpected clinical insight: the pleasantness of affective social touch appears preserved, whereas non-affective touch is perceived as more pleasant compared with controls. This pattern suggests not a deficit in social reward, but a shift in the evaluation of bodily signals, consistent with emerging evidence of interoceptive dysregulation in suicidal states. Such alterations may influence how patients experience threat, comfort, or connection, contributing to psychological pain and difficulties in interpersonal functioning.

These observations support the hypothesis that tactile processing, interoception, and opioid modulation form a clinically relevant pathway in suicidal vulnerability. Ongoing work examines how tactile stimulation influences opioid-related biological responses, with the aim of clarifying whether these mechanisms differ according to suicidal history.

Understanding how patients process touch and bodily cues may ultimately help refine suicide risk assessment and inspire therapeutic approaches focused on restoring bodily grounding, affiliative signals, and emotional relief.