Skip to main content

Advertisement

Log in

Examining the Relationship Between Pain Catastrophizing and Suicide Risk in Patients with Rheumatic Disease: the Mediating Role of Depression, Perceived Social Support, and Perceived Burdensomeness

  • Published:
International Journal of Behavioral Medicine Aims and scope Submit manuscript

Abstract

Purpose

Little research has examined the role of pain catastrophizing (PC) in predicting suicide among patients with rheumatic disease or the mechanisms through which it works. This study examines whether depression, perceived social support (PSS), and perceived burdensomeness (PB) mediate the relationship between PC and suicide risk. It also examines the relative importance of sociodemographic, clinical, and psychological factors in predicting suicide risk.

Methods

Three hundred sixty patients from a rheumatology clinic in Korea completed measures of pain catastrophizing, social support, depression, and perceived burdensomeness.

Results

In hierarchical multiple regression analysis, the PC magnification, PB, physical disability, and PSS were significantly related to suicide risk. Results of the serial multiple mediation analysis indicated that the total indirect effect of PC magnification on suicide risk was significant while the direct effect was not. Four specific indirect effects of PC magnification were found to be statistically significant. First of all, PC magnification was associated with suicide risk through PB and through depression and PB. PC magnification was also associated with suicide risk through depression and PSS. Lastly, PC magnification was associated with suicide risk through depression, PSS, and PB.

Conclusions

The identified pathways through which PC affects suicide risk suggest the importance of depression, PSS, and PB. Evaluation and intervention targeted at physical disability and the psychological factors of PC magnification, depression, PSS, and PB may be integrated into the management of suicide risk in patients with rheumatic disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Diseases NIoAaMaS. Arthritis and rheumatic diseases. 2014. http://www.niams.nih.gov/health_info/arthritis/arthritis_rheumatic.asp. Accessed 15 April 2016.

  2. Cross M, Smith E, Hoy D, et al. The global burden of rheumatoid arthritis: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014;73(7):1316–22.

    Article  PubMed  Google Scholar 

  3. Gettings L. Psychological well-being in rheumatoid arthritis: a review of the literature. Musculoskeletal Care. 2010;8(2):99–106.

    PubMed  Google Scholar 

  4. Fuller-Thomson E, Shaked Y. Factors associated with depression and suicidal ideation among individuals with arthritis or rheumatism: findings from a representative community survey. Arthritis care & research. 2009;61(7):944–50. doi:10.1002/art.24615.

    Article  Google Scholar 

  5. Treharne GJ, Lyons AC, Kitas GD, Collinge T, Shah A. Suicidal ideation in patients with rheumatoid arthritis. Br Med J. 2000;321(7271):1290.

    Article  CAS  Google Scholar 

  6. Mok CC, Chan KL, Cheung EF, Yip PS. Suicidal ideation in patients with systemic lupus erythematosus: incidence and risk factors. Rheumatology (Oxford, England). 2014;53(4):714–21. doi:10.1093/rheumatology/ket404.

    Article  Google Scholar 

  7. Magni G, Rigatti-Luchini S, Fracca F, Merskey H. Suicidality in chronic abdominal pain: an analysis of the Hispanic Health and Nutrition Examination Survey (HHANES). Pain. 1998;76(1):137–44.

    Article  CAS  PubMed  Google Scholar 

  8. Tang NKY, Crane C. Suicidality in chronic pain: a review of the prevalence, risk factors and psychological links. Psychol Med. 2006;36(05):575–86. doi:10.1017/S0033291705006859.

    Article  PubMed  Google Scholar 

  9. Edwards RR, Smith MT, Kudel I, Haythornthwaite J. Pain-related catastrophizing as a risk factor for suicidal ideation in chronic pain. Pain. 2006;126(1–3):272–9. doi:10.1016/j.pain.2006.07.004.

    Article  PubMed  Google Scholar 

  10. Cheatle MD, Wasser T, Foster C, Olugbodi A, Bryan J. Prevalence of suicidal ideation in patients with chronic non-cancer pain referred to a behaviorally based pain program. Pain physician. 2014;17(3):E359–67.

    PubMed  Google Scholar 

  11. Braden JB, Sullivan MD. Suicidal thoughts and behavior among adults with self-reported pain conditions in the national comorbidity survey replication. J Pain. 2008;9(12):1106–15.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Campbell G, Darke S, Bruno R, Degenhardt L. The prevalence and correlates of chronic pain and suicidality in a nationally representative sample. Australian and New Zealand journal of psychiatry. 2015:0004867415569795.

  13. Van Orden KA, Witte TK, Cukrowicz KC, Braithwaite SR, Selby EA, Joiner Jr TE. The interpersonal theory of suicide. Psychol Rev. 2010;117(2):575.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Timonen M, Viilo K, Hakko H, et al. Suicides in persons suffering from rheumatoid arthritis. Rheumatology (Oxford, England). 2003;42(2):287–91.

    Article  CAS  Google Scholar 

  15. Tektonidou MG, Dasgupta A, Ward MM. Suicidal ideation among adults with arthritis: prevalence and subgroups at highest risk. Data from the 2007–2008 National Health and Nutrition Examination Survey. Arthritis care & research. 2011;63(9):1322–33.

    Article  Google Scholar 

  16. Sullivan MJL. The communal coping model of pain catastrophising: clinical and research implications. Canadian Psychology/Psychologie canadienne. 2012;53(1):32–41. doi:10.1037/a0026726.

    Article  Google Scholar 

  17. Racine M, Choinière M, Nielson WR. Predictors of suicidal ideation in chronic pain patients: an exploratory study. Clin J Pain. 2014;30(5):371–8.

    PubMed  Google Scholar 

  18. Racine M, Sánchez-Rodríguez E, Gálan S, et al. Factors associated with suicidal ideation in patients with chronic non-cancer pain. Pain Medicine. 2016:pnw115.

  19. Dougados M, Soubrier M, Antunez A, et al. Prevalence of comorbidities in rheumatoid arthritis and evaluation of their monitoring: results of an international, cross-sectional study (COMORA). Ann Rheum Dis. 2014;73(1):62–8.

    Article  PubMed  Google Scholar 

  20. Matcham F, Rayner L, Steer S, Hotopf M. The prevalence of depression in rheumatoid arthritis: a systematic review and meta-analysis. Rheumatology (Oxford, England). 2013;52(12):2136–48. doi:10.1093/rheumatology/ket169.

    Article  PubMed Central  Google Scholar 

  21. Sullivan MJ, Rodgers WM, Kirsch I. Catastrophizing, depression and expectancies for pain and emotional distress. Pain. 2001;91(1–2):147–54.

    Article  CAS  PubMed  Google Scholar 

  22. Sturgeon JA, Zautra AJ. State and trait pain catastrophizing and emotional health in rheumatoid arthritis. Ann Behav Med. 2013;45(1):69–77. doi:10.1007/s12160-012-9408-z.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Edwards RR, Cahalan C, Mensing G, Smith M, Haythornthwaite JA. Pain, catastrophizing, and depression in the rheumatic diseases. Nat Rev Rheumatol. 2011;7(4):216–24.

    Article  CAS  PubMed  Google Scholar 

  24. Xie LF, Chen PL, Pan HF, et al. Prevalence and correlates of suicidal ideation in SLE inpatients: Chinese experience. Rheumatol Int. 2012;32(9):2707–14. doi:10.1007/s00296-011-2043-3.

    Article  PubMed  Google Scholar 

  25. Sullivan MJ, Thorn B, Haythornthwaite JA, et al. Theoretical perspectives on the relation between catastrophizing and pain. Clin J Pain. 2001;17(1):52–64.

    Article  CAS  PubMed  Google Scholar 

  26. Sullivan MJ, Stanish W, Sullivan ME, Tripp D. Differential predictors of pain and disability in patients with whiplash injuries. Pain research & management. 2002.

  27. Keefe FJ, Lipkus I, Lefebvre JC, et al. The social context of gastrointestinal cancer pain: a preliminary study examining the relation of patient pain catastrophizing to patient perceptions of social support and caregiver stress and negative responses. Pain. 2003;103(1–2):151–6.

    Article  PubMed  Google Scholar 

  28. Cano A. Pain catastrophizing and social support in married individuals with chronic pain: the moderating role of pain duration. Pain. 2004;110(3):656–64.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Boothby JL, Thorn BE, Overduin LY, Ward LC. Catastrophizing and perceived partner responses to pain. Pain. 2004;109(3):500–6. doi:10.1016/j.pain.2004.02.030.

    Article  PubMed  Google Scholar 

  30. Buenaver LF, Edwards RR, Haythornthwaite JA. Pain-related catastrophizing and perceived social responses: inter-relationships in the context of chronic pain. Pain. 2007;127(3):234–42. doi:10.1016/j.pain.2006.08.018.

    Article  PubMed  Google Scholar 

  31. Christensen H, Batterham PJ, Mackinnon AJ, Donker T, Soubelet A. Predictors of the risk factors for suicide identified by the interpersonal-psychological theory of suicidal behaviour. Psychiatry Res. 2014;219(2):290–7. doi:10.1016/j.psychres.2014.05.029.

    Article  PubMed  Google Scholar 

  32. Kowal J, Wilson KG, McWilliams LA, Péloquin K, Duong D. Self-perceived burden in chronic pain: relevance, prevalence, and predictors. Pain. 2012;153(8):1735–41.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Wilson KG, Kowal J, Henderson PR, McWilliams LA, Peloquin K. Chronic pain and the interpersonal theory of suicide. Rehabil Psychol. 2013;58(1):111–5. doi:10.1037/a0031390.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Donker T, Batterham PJ, Van Orden KA, Christensen H. Gender-differences in risk factors for suicidal behaviour identified by perceived burdensomeness, thwarted belongingness and acquired capability: cross-sectional analysis from a longitudinal cohort study. BMC psychology. 2014;2(1):1.

    Article  Google Scholar 

  35. Ilgen MA, Zivin K, McCammon RJ, Valenstein M. Pain and suicidal thoughts, plans and attempts in the United States. Gen Hosp Psychiatry. 2008;30(6):521–7. doi:10.1016/j.genhosppsych.2008.09.003.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Yoo S, Kim Y, Noh J, Oh K, Kim C, Nam G. Korean Mini International Neuropsychiatric Interview validation study. Anxiety and Mood. 2006;2(1):50–5.

    Google Scholar 

  37. Cho S, Kim HY, Lee JH. Validation of the Korean version of the Pain Catastrophizing Scale in patients with chronic non-cancer pain. Qual Life Res. 2013;22(7):1767–72. doi:10.1007/s11136-012-0308-2.

    Article  PubMed  Google Scholar 

  38. Oh SM, Min KJ, Park DB. A study on the standardization of the hospital anxiety and depression scale for Koreans: a comparison of normal, depressed and anxious groups. J Korean Neuropsychiatr Assoc DE - 2001-01-01. 1999;38(2):289–96.

    Google Scholar 

  39. Broadhead W, Gehlbach SH, De Gruy FV, Kaplan BH. The Duke-UNC Functional Social Support Questionnaire: measurement of social support in family medicine patients. Medical care. 1988:709–23.

  40. Suh SY, Im YS, Lee SH, Park MS, Yoo T. A study for the development of Korean version of the Duke-UNC functional social support questionnaire. J Korean Acad Fam Med DE - 2001-01-01. 1997;18(3):250–60.

    Google Scholar 

  41. Lee H, Lee J, Oh K. Validation of the Korean Version of Interpersonal Needs Questionnaire (K-INQ) for older adults. Korean Journal of Clinical Psychology. 2015;34(1):291–312.

    Article  Google Scholar 

  42. Van Orden KA, Cukrowicz KC, Witte TK, Joiner TE. Thwarted belongingness and perceived burdensomeness: construct validity and psychometric properties of the Interpersonal Needs Questionnaire. Psychol Assess. 2012;24(1):197–215. doi:10.1037/a0025358.

    Article  PubMed  Google Scholar 

  43. Bae S, Cook E, Kim S-Y. Psychometric evaluation of a Korean Health Assessment Questionnaire for clinical research. J Rheumatol. 1998;25(10):1975–9.

    CAS  PubMed  Google Scholar 

  44. Fries JF, Spitz PW, Young DY. The dimensions of health outcomes: the health assessment questionnaire, disability and pain scales. J Rheumatol. 1982;9(5):789–93.

    CAS  PubMed  Google Scholar 

  45. Bruce B, Fries J. The health assessment questionnaire (HAQ). Clin Exp Rheumatol. 2005;23(5):S14.

    CAS  PubMed  Google Scholar 

  46. Choi SA, Son C, Lee J-H, Cho S. Confirmatory factor analysis of the Korean version of the short-form McGill pain questionnaire with chronic pain patients: a comparison of alternative models. Health Qual Life Outcomes. 2015;13(1):1–5. doi:10.1186/s12955-014-0195-z.

    Article  Google Scholar 

  47. Hayes AF. PROCESS: a versatile computational tool for observed variable mediation, moderation, and conditional process modeling. 2012.

  48. Hayes A. A versatile computational tool for observed variable mediation, moderation, and conditional process modeling [White paper]. 2012.

  49. Preacher KJ, Hayes AF. Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Methods. 2008;40(3):879–91.

    Article  PubMed  Google Scholar 

  50. Preacher KJ, Hayes AF. SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behav Res Methods Instrum Comput. 2004;36(4):717–31.

    Article  PubMed  Google Scholar 

  51. MacKinnon DP, Krull JL, Lockwood CM. Equivalence of the mediation, confounding and suppression effect. Prev Sci. 2000;1(4):173–81.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Kanzler KE, Bryan CJ, McGeary DD, Morrow CE. Suicidal ideation and perceived burdensomeness in patients with chronic pain. Pain Pract. 2012;12(8):602–9. doi:10.1111/j.1533-2500.2012.00542.x.

    Article  PubMed  Google Scholar 

  53. Fishbain DA, Bruns D, Bruns A, et al. The perception of being a burden in acute and chronic pain patients is associated with affirmation of different types of suicidality. Pain medicine (Malden, Mass). 2015; doi:10.1111/pme.12889.

    Google Scholar 

  54. Christensen H, Batterham PJ, Soubelet A, Mackinnon AJ. A test of the interpersonal theory of suicide in a large community-based cohort. J Affect Disord. 2013;144(3):225–34.

    Article  PubMed  Google Scholar 

  55. Kleiman EM, Liu RT, Riskind JH. Integrating the interpersonal psychological theory of suicide into the depression/suicidal ideation relationship: a short-term prospective study. Behav Ther. 2014;45(2):212–21. doi:10.1016/j.beth.2013.10.007.

    Article  PubMed  Google Scholar 

  56. Tucker RP, Wingate LR. Basic need satisfaction and suicidal ideation: a self-determination perspective on interpersonal suicide risk and suicidal thinking. Arch Suicide Res. 2014;18(3):282–94. doi:10.1080/13811118.2013.824839.

    Article  PubMed  Google Scholar 

  57. Van Orden KA, Witte TK, Gordon KH, Bender TW, Joiner Jr TE. Suicidal desire and the capability for suicide: tests of the interpersonal-psychological theory of suicidal behavior among adults. J Consult Clin Psychol. 2008;76(1):72–83. doi:10.1037/0022-006x.76.1.72.

    Article  PubMed  Google Scholar 

  58. Xie L-F, Chen P-L, Pan H-F, et al. Prevalence and correlates of suicidal ideation in SLE inpatients: Chinese experience. Rheumatol Int. 2012;32(9):2707–14.

    Article  PubMed  Google Scholar 

  59. Breivik H, Reme SE, Linton SJ. High risk of depression and suicide attempt among chronic pain patients: always explore catastrophizing and suicide thoughts when evaluating chronic pain patients. Scand J Pain. 2014;5:1–3.

    Article  Google Scholar 

  60. Thorn BE, Boothby JL, Sullivan MJ. Targeted treatment of catastrophizing for the management of chronic pain. Cogn Behav Pract. 2002;9(2):127–38.

    Article  Google Scholar 

  61. Wideman TH, Sullivan MJ. Reducing catastrophic thinking associated with pain. Pain management. 2011;1(3):249–56.

    Article  PubMed  Google Scholar 

  62. Hill RM, Pettit JW. Perceived burdensomeness and suicide-related behaviors in clinical samples: current evidence and future directions. J Clin Psychol. 2014;70(7):631–43. doi:10.1002/jclp.22071.

    Article  PubMed  Google Scholar 

  63. Stellrecht NE, Gordon KH, Van Orden K, et al. Clinical applications of the interpersonal-psychological theory of attempted and completed suicide. J Clin Psychol. 2006;62(2):211–22. doi:10.1002/jclp.20224.

    Article  PubMed  Google Scholar 

  64. Sharpe L, Sensky T, Timberlake N, Ryan B, Allard S. Long-term efficacy of a cognitive behavioural treatment from a randomized controlled trial for patients recently diagnosed with rheumatoid arthritis. Rheumatology. 2003;42(3):435–41.

    Article  CAS  PubMed  Google Scholar 

  65. Sung Y-K, Cho S-K, Choi C-B, Bae S-C. Prevalence and incidence of rheumatoid arthritis in South Korea. Rheumatol Int. 2013;33(6):1525–32.

    Article  PubMed  Google Scholar 

  66. Mailis-Gagnon A, Yegneswaran B, Lakha SF, et al. Pain characteristics and demographics of patients attending a university-affiliated pain clinic in Toronto. Ontario Pain Res Manag. 2007;12(2):93–9.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Bong-Jin Hahm.

Ethics declarations

Funding

This study was supported by a 2-Year Research Grant of Pusan National University and by the Brain Korea 21 Plus program (F16HR31D1802), National Research Foundation of Korea.

Conflicts of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Seoul National University Hospital Institutional Review Board.

Informed Consent

We obtained the informed consent from the participants. Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shim, E.J., Song, Y.W., Park, SH. et al. Examining the Relationship Between Pain Catastrophizing and Suicide Risk in Patients with Rheumatic Disease: the Mediating Role of Depression, Perceived Social Support, and Perceived Burdensomeness. Int.J. Behav. Med. 24, 501–512 (2017). https://doi.org/10.1007/s12529-017-9648-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12529-017-9648-1

Keywords

Navigation