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Patient-reported outcomes (PROs) refer to any report coming directly from patients about how they function or feel in relation to a health condition or its therapy. PROs have been applied in medicine for the assessment of the impact of clinical phenomena. Self-report scales and procedures for assessing physical pain in adults have been developed and used in clinical trials. However, insufficient attention has been dedicated to the assessment of mental pain. The aim of this paper is to outline the implications that assessment of mental pain may entail in psychiatry and medicine, with particular reference to a clinimetric index. A simple 10-item self-rating questionnaire, the Mental Pain Questionnaire (MPQ), encompasses the specific clinical features of mental pain and shows good clinimetric properties (i.e., sensitivity, discriminant and incremental validity). The preliminary data suggest that the MPQ may qualify as a PRO measure to be included in clinical trials. Assessment of mental pain may have important clinical implications in intervention research, both in psychopharmacology and psychotherapy. The transdiagnostic features of mental pain are supported by its association with a number of psychiatric disorders, such as depression, anxiety, eating disorders, as well as borderline personality disorder. Further, addressing mental pain may be an important pathway to prevent and diminish the opioid epidemic. The data summarized here indicate that mental pain can be incorporated into current psychiatric assessment and included as a PRO measure in treatment outcome studies.
The first part of my work comprises empirical findings and theoretical foundations on stress in its historical development and socio-emotional and behavioural factors.
The first study of my dissertation focuses on the relationship between perceived stress in adolescence, the context variables of perceived helpfulness and competition and socio-emotional and behavioural strengths and difficulties (i.e., emotional problems, symptoms of hyperactivity, problems with peers, prosocial behaviour and conduct problems) from early to middle adolescence. I postulated a moderation or mediation of the effect of perceived stress on socio-emotional and behavioural strengths and difficulties through the two context variables. My hypotheses were tested using a latent moderating structural equation model (moderation analysis) and a multi-group structural equation model taking into account the gender and age of the students (mediation analysis). The theoretical basis of my first study is the transactional stress model by Lazarus and Folkman (1984).
The second study of my dissertation is dedicated to the question whether perceived stress is a moderator in the relationship between depressive symptoms in early adolescence and socio-emotional and behavioural strengths and difficulties in middle adolescence. Based on the cognitive vulnerability-transactional stress theory of Hankin and Abramson (2001), which assumes reciprocal and dynamic relationships between the individual and the environment, I investigated this question and tested the relationships using a latent moderating structural equation model.
The third study of my dissertation is based on Bronfenbrenner’s socio-ecological model (1975). Using a cross-lagged panel design, I investigate the within time and longitudinal relationships between variables of emotional (in-)stability (i.e., depressive symptoms, perceived stress and loneliness) and socio-environmental factors (i.e., sense of belonging, student-student and teacher-student-relationship) from early to middle adolescence.
At the end of my work there is a summary of all results, a discussion and an outlook for future research.