Measuring Psychological Pain to Direct Care Where It Is Needed

By Steven Mee, MD · November 2, 2026

Much of medicine runs on screening. Blood pressure readings, cholesterol panels and routine imaging help clinicians spot people at higher risk before a crisis. Psychiatry has had fewer comparable tools. At the start of treatment, it is often hard to tell which patients are most likely to struggle.

A 2023 paper in Medical Research Archives by Steven Mee, MD, with Marissa Cascio, RN, BSN, and Christopher Reist argues that measuring psychological pain could help close that gap (DOI 10.18103/mra.v11i8.4281). This article walks through what the paper proposes, the evidence behind it, and its limits. It builds on our last post, Psychological Pain and Treatment Dropout: What Research Shows.

The gap the paper addresses

The authors note that ways to predict and prevent poor outcomes in common mental health conditions have lagged behind the rest of medicine. Genomics, brain imaging and biomarkers are promising. They are not yet ready for routine clinical use at a reasonable cost.

Validated questionnaires, by contrast, already exist. They are quick to complete and inexpensive. The paper's central point is that a well-chosen questionnaire, used consistently, can help now while newer technologies mature.

Psychological pain across diagnoses

Psychological pain is the intense inner suffering that many people with severe depression describe as worse than any physical pain they have known (Mee et al., 2006). It is sometimes called mental pain or "psychache."

The 2023 paper reviews research linking psychological pain to major depression, anxiety disorders, substance use disorders, obsessive-compulsive disorder and borderline personality disorder. Because it appears across diagnoses, it can be measured the same way in a mixed group of patients. That makes it a candidate for a single, practical screening signal.

One tool for measuring it is the Mee-Bunney Psychological Pain Assessment Scale (MBP, also written MBPPAS), a brief self-rating questionnaire. It was first validated in people experiencing a major depressive episode (Mee et al., 2011). You can read more about how we use it on our psychological pain page.

What "risk stratification" means here

The idea is simple. Patients complete the MBP when they start care. Anyone scoring above a set threshold (above 32) is placed in a higher-risk group. The paper summarizes three studies that used this same cutoff:

• Depression (2011). People in a major depressive episode who scored above the threshold reported average suicidality scores more than 2.5 times higher than those below it (DOI).
• Veterans in a suicide prevention program (2017). About 18% scored above the threshold. Their depression and suicidality scores were 75% and 80% higher than those of peers below it. During follow-up, 7 of 9 suicide attempts, and the one death by suicide, occurred in the high-pain group. The authors report this as a trend that did not reach their required level of statistical significance (DOI).
• Outpatient substance use treatment (2019). About 18% scored above the threshold. They had more than twice the odds of dropping out, and they left treatment up to 50% sooner than patients with lower pain (DOI).

The review also notes that, as of 2023, published predictions of outcomes other than suicide, such as treatment dropout, came from the MBP alone.

A proposed tiered approach

The paper sketches how a clinic could act on these scores. Patients are grouped into tiers by their psychological pain level:

1. Low pain: usual care, with periodic re-checks.
2. Medium pain: a physician evaluation and more frequent contact with staff or a therapist.
3. High pain: prompt psychiatric evaluation and more intensive support, re-checked more often.

Patients move between tiers as their scores change. The aim is to give extra, time-limited attention to the people who need it most, rather than the same intensity for everyone. This is a proposed framework. It has not yet been tested as a whole in a clinical trial.

Why this matters for patients and referring clinicians

For patients, the goal is that more support arrives earlier, before a crisis, guided by a measure of how they are actually feeling. Psychological pain can also become a treatment target in its own right.

For therapists and other referring clinicians, a brief, repeatable score offers a shared language. A rising score can act as an early warning that someone needs closer follow-up, while the therapist stays at the center of the person's care.

At Aspera & Applied Innovative Psychiatry in Los Alamitos, we are one of very few practices that build psychological pain measurement into care. We use the MBP before treatment begins and whenever needed during treatment, to help identify the sources of a person's pain and to shape a plan to relieve it. Depending on the person, that plan may include medication management, psychotherapy or, for depression that has not responded to standard treatment, our Ketamine Augmented Treatment Program. Each option is discussed openly, including its evidence, risks and alternatives. Learn more about our approach to care.

Limits and next steps

The authors describe the supporting data as preliminary but encouraging. The studies were modest in size, and the tiered model still needs to be tested prospectively. No questionnaire replaces a careful clinical evaluation, and no score predicts what any one person will do.

Disclosure: Dr. Mee holds the copyright to the MBP, as stated in the 2023 paper.

If you are having thoughts of suicide, call or text 988 to reach the 988 Suicide & Crisis Lifeline, or call 911 in an emergency.

Talk with us

If you, a family member or a patient you care for is living with psychological pain that has not eased, we can help you look at the next step. Virtual evaluations are available anywhere in California. Contact us, email smee@asperahealth.com, or call (562) 431-9999.