Pain and Suicidal Behavior in Primary Care Patients: Mediating Role of Interpersonal Needs
Individuals experiencing chronic pain are at greater risk for suicidal behavior. The mechanism of action for this association is unexplored, but may involve the influence of pain on interpersonal functioning. We examined the mediating role of unsatisfied interpersonal needs on the relation between pain severity and interference, and suicidal behavior. Low income, uninsured participants completed self-report measures of pain severity and interference, thwarted interpersonal needs and suicidal behavior. Our hypotheses were partially supported; in simple mediation models, an indirect only effect existed for both thwarted belongingness and perceived burdensomeness in the relation between pain severity and pain interference and suicidal behavior. These effects did not persist in multiple mediation analyses. Our findings suggest that, for patients experiencing pain, assessment and improvement of the quantity and quality of interpersonal relationships may reduce risk for suicide ideation and attempts.
KeywordsSuicidal behavior Pain severity Pain interference Thwarted interpersonal needs
- American Association of Suicidology. National suicide statistics. http://www.suicidology.org/stats-and-tools/suicide-statistics. Retrieved 2 August 2012.
- Baer, R.A. (Ed.) (2005). Mindfulness-based treatment approaches: Clinician’s guide to evidence base and applications. Academic Press.Google Scholar
- Bryan, C. J., & Rudd, M. (2011). Managing suicide risk in primary care. New York: Springer Publishing Co.Google Scholar
- Centers for Disease Control and Prevention. (2011). National suicide statistics at a glance. http://www.cdc.gov/ViolencePrevention/suicide/statistics/self_harm.html.
- Joiner, T. E., Jr. (2005). Why people die by suicide. Cambridge: Harvard University Press.Google Scholar
- Joiner, T. r., Van Orden, K. A., Witte, T. K., Selby, E. A., Ribeiro, J. D., Lewis, R., & Rudd, M. (2009). Main predictions of the interpersonal–psychological theory of suicidal behavior: empirical tests in two samples of young adults. Journal of Abnormal Psychology, 118(3), 634–646. doi:10.1037/a0016500.CrossRefPubMedPubMedCentralGoogle Scholar
- Mackenzie, T. B., & Popkin, M. K. (1990). Medical illness and suicide. In S. J. Blumenthal & D. J. Kupfer (Eds.), Suicide over the life cycle: Risk factors, assessment, and treatment of suicidal patients (pp. 205–232). Washington: American Psychiatric Association.Google Scholar
- Schulberg, H. C., Bruce, M. L., Lee, P. W., Williams, J. W., & Dietrich, A. J. (2004). Preventing suicide in primary care patients: the primary care physician's role. General Hospital Psychiatry, 26(5), 337-345. doi:10.1016/j.genhosppsych.2004.06.007.
- Smith, B. H., & Torrance, N. (2012). Epidemiology of chronic pain. ABC of Pain, 43.Google Scholar
- Tan, G., Lim, P., & Maymi, L. (1997). Managing chronic pain: a continuing dilemma for modern medicine. Federal Practitioner, 14, 11–22.Google Scholar
- Van Orden, K. A., Witte, T. K., Gordon, K. H., Bender, T. W., & Joiner, T. E., Jr. (2008a). Suicidal desire and the capability for suicide: tests of the interpersonal-psychological theory of suicidal behavior among adults. Journal of Consulting and Clinical Psychology, 76(1), 72. doi:10.1037/0022-006X.76.1.72.CrossRefPubMedGoogle Scholar
- Van Orden, K. A., Witte, T. K., James, L. M., Castro, Y., Gordon, K. H., Braithwaite, S. R., Hollar, D. L., & Joiner, T. E. (2008b). Suicidal ideation in college students varies across semesters: the mediating role of belongingness. Suicide & Life Threatening Behavior, 38(4), 427–435.CrossRefGoogle Scholar
- Van Orden, K. A., Cukrowicz, K. C., Witte, T. K., & Joiner, T. E. (2012). Thwarted belongingness and perceived burdensomeness: construct validity and psychometric properties of the Interpersonal Needs Questionnaire. Psychological Assessment, 24(1), 197–215. doi:10.1037/a0025358.CrossRefPubMedGoogle Scholar