Understanding suicidal ideation and behaviour in individuals with chronic pain: a review of the role of novel transdiagnostic psychological factors

Abstract

Individuals with chronic pain are at elevated risk of suicide, yet psychosocial factors that may be involved in increasing or decreasing vulnerability for suicidal ideation and behaviour have received little attention. Extant literature on the topic of suicide in individuals with chronic pain only incorporates a limited number of the wide array of known vulnerability and protective factors from the field of suicide research. The current review focuses on transdiagnostic psychological processes, i.e. processes of relevance for both chronic pain and suicide. We synthesize a selection of the previous literature on chronic pain and suicide, concentrating on previously unexplored and underexplored lines of research, including future orientation, mental imagery and psychological flexibility. A far greater degree of cross-pollination between the fields of chronic pain and suicide research is required if we are to progress in our understanding of why some people with chronic pain become suicidal and others do not.

Suicidal Ideation Profiles in Patients with Fibromyalgia Using Transdiagnostic Psychological and Fibromyalgia-Associated Variables

“…A positive, moderate, and statistically significant association has also been found between mental defeat and the worst suicide attempt [73]. The conceptual and methodological overlap between perception of defeat and mental defeat [27], together with the high perception of defeat presented by FM patients in the profile of high vulnerability to suicidal ideation, suggests a similar functioning of both constructs in people with chronic pain. Given that IMV [31] is one of the most prominent models in the field of suicide, the study of key variables and their association with the characteristics of the chronic pain population may help to explain suicidal ideation in these patients.…”

“…According to the cry of pain theory hypothesis [37], suicidal ideation/intention arises when people feel defeated (i.e., perceived failed struggle and helplessness as a result of a loss or significant alteration of social status, identity, or goals) and there is no perceived escape or rescue from such a situation (i.e., entrapment). While the main assumptions of IMV have been supported empirically in previous studies [38][39][40][41], they have not been tested in people with chronic pain [27].…”

“…Previous studies [25,26] have highlighted the need to go beyond psychiatric disorders to predict and explain suicidal ideation and other behaviors in patients with chronic pain [27]. A novel perspective on the conceptualization of the suicidal phenomenon is the ideation-to-action framework [28,29].…”

The relationship between pain and suicidal vulnerability in adolescence: a systematic review

“…66 In an attempt to better understand the complex pain-suicidality association in adults, a recent review has revealed psychological processes that are common to both conditions (e.g., psychological flexibility, future orientation and mental imagery). 67 However, it remains unknown whether these psychological processes may also drive the behavioural change that may explain the pain-suicidality relationship in adolescence. It is, therefore, essential to better understand the pain-suicidality trajectories and the potentially complex interplay with unique correlates in adolescence to identify these vulnerable youth.…”

Comorbid chronic pain and depression: Shared risk factors and differential antidepressant effectiveness

“…Given suicide is a leading cause of death — particularly for young people 98 — and that depression and chronic pain are both treatable conditions, assessing their comorbidity in both at-risk youth and older adult populations may help to reduce suicide rates. 99–102…”