Article Text

Download PDFPDF
How to measure mental pain: a systematic review assessing measures of mental pain
  1. Camille Charvet1,
  2. Isabelle Boutron2,3,
  3. Yannick Morvan4,5,
  4. Catherine Le Berre2,3,
  5. Suzanne Touboul6,
  6. Raphaël Gaillard7,
  7. Eiko Fried8,
  8. Astrid Chevance2,3
  1. 1 Medical School, Sorbonne Université, FR-75006, Paris, France
  2. 2 CRESS U1153, Université Paris-Cité, Inserm, FR-75006, Paris, France
  3. 3 Service d'épidémologie clinique, APHP, GHU Cochin-Hôtel Dieu, FR-75005, Paris, France
  4. 4 CESP, Inserm, Maison de Solenn, FR-75005, Paris, France
  5. 5 Laboratoire CLIPSYD, EA4430, Université Paris-Nanterre, FR-92000, Nanterre, France
  6. 6 Person with Lived Experience, Paris, France
  7. 7 Department of Psychiatry, Service Hospitalo-Universitaire, GHU Paris Psychiatry &Neurosciences, FR-75014, Paris, France
  8. 8 Department of Clinical Psychology, Leiden University, Leiden, The Netherlands
  1. Correspondence to Dr Astrid Chevance, Public health, University of Paris, Paris, France; astrid.chevance{at}


Question Although mental pain is present in many mental disorders and is a predictor of suicide, it is rarely investigated in research or treated in care. A valid tool to measure it is a necessary first step towards better understanding, predicting and ultimately relieving this pain.

Study selection and analysis Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we performed a systematic review to identify all published standardised measures of mental pain. We used qualitative content analysis to evaluate the similarity of each measure, quantified via Jaccard Index scores ranging from no similarity (0) to full similarity (1). Finally, using the Consensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology, we evaluated each measure’s development (assessing 35 features), its content validity (31 features) and if the latter was rated at least adequate, its other psychometric properties.

Findings We identified 10 self-reported scales of mental pain in 2658 screened studies relying on diverse definitions of this construct. The highest average similarity coefficient for any given measure was 0.24, indicative of weak similarity (individual pairwise coefficients from 0 to 0.5). Little to no information was provided regarding the development and the content validity of all 10 scales. Therefore, their development and content validity were rated ‘inadequate’ or ‘doubtful’.

Conclusions and clinical implications There is not enough evidence of validity to recommend using one measure over others in research or clinical practice. Heterogeneous use of disparate measures across studies limits comparison and combination of their results in meta-analyses. Development by all stakeholders (especially patients) of a consensual patient-reported measure for mental pain is needed.

PROSPERO registration number CRD42021242679.

  • suicide & self-harm
  • adult psychiatry
  • depression & mood disorders
  • anxiety disorders
  • substance misuse

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

View Full Text


  • Twitter @ChevanceAstrid

  • Contributors AC conceptualised the project, designed the methods, performed the analysis, critically reviewed and edited the draft and supervised the project. CC extracted the data, performed the analysis and the data visualisation and wrote the first draft. CLB extracted the data, performed the analysis and reviewed and edited the draft. YM performed the analysis and reviewed and edited the draft. ST performed the analysis and reviewed and edited the draft. RG reviewed and edited the draft. IB designed the project and reviewed and edited the draft. EF designed the methods and data visualisation and reviewed and edited the draft.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests CC, IB, CLB, YM, EF, ST and AC report no conflict of interest. RG has received compensation as a member of the scientific advisory board of Janssen, Lundbeck, Roche, SOBI, Takeda. He has served as consultant and/or speaker for AstraZeneca, Boehringer-Ingelheim, Pierre Fabre, Lilly, Lundbeck, LVMH, MAPREG, Novartis, Otsuka, Pileje, SANOFI, Servier and received compensation, and he has received research support from Servier. Co-founder and stock shareholder: Regstem.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.