Abstract
Adults who suffer from chronic pain are at increased risk for suicide ideation and
attempts, but it is not clear whether adolescents with chronic pain are similarly
at elevated risk. This study investigates whether chronic pain is associated with
an increase in suicidal ideation/attempts independent of depression in a population
sample of adolescents. We analyzed data from the National Longitudinal Study of Adolescent
Health, a longitudinal study of a nationally representative sample of adolescents
in the United States (N = 9,970). Most chronic pain was related to suicide ideation/attempt
both in the last year (odds ratio [OR] 1.3–2.1) and during the subsequent year (OR
1.2–1.8). After controlling for depressive symptoms, headaches (OR = 1.3 last year,
OR = 1.2 subsequent year) and muscle aches (OR = 1.3 last year) remained associated
with suicide ideation but not suicide attempt. These findings show that chronic pain
in adolescence is a risk factor for suicide ideation; this effect is partly but not
fully explained by depression. Youth with comorbid depression and chronic pain are
at increased risk of thinking about and attempting suicide. Clinicians should be alert
to suicide ideation/attempt and comorbid depression in this at-risk population.
Perspective
Adolescents who suffer from chronic pain are at increased risk for suicide ideation
and attempt. Depressive symptoms account for the link between chronic pain and suicide
attempt, but do not completely explain why adolescents with chronic pain show suicide
ideation.
Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Journal of PainAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Position Statement: Pediatric chronic pain.APS Bulletin. 2001; 11
- Suicide risk in patients with major depressive disorder.J Clin Psychiatry. 1999; 60: 57-62
- Recurrent abdominal pains: A field survey of 1,000 school children.Arch Dis Child. 1958; 33: 165-170
- Goodness-of-fit test for a logistic regression model fitted using survey sample data.The Stata Journal. 2006; 1: 97-105
- Suicidal thoughts and behavior among adults with self-reported pain conditions in the national comorbidity survey replication.J Pain. 2008; 9: 1106-1115
- Adult outcomes of pediatric Recurrent Abdominal Pain: Do they just grow out of it?.Pediatrics. 2001; 108: 1-7
- Youth risk behavior surveillance-United States, 2009.MMWR Surveill Summ. 2010; 59: 1-142
- Statistical and power analysis for the behavioral sciences.2nd ed. Lawrence Erlbaum Associates, Hillsdale, NJ1988
- Pain-related catastrophizing as a risk factor for suicidal ideation in chronic pain.Pain. 2006; 126: 272-279
- Suicide neurobiology.Prog Neurobiol. 2009; 89: 315-333
- Reducing suicide: A national imperative.National Academies Press, Washington, DC2002
- The epidemiology of pain in children and adolescents: A review.Pain. 1991; 46: 247-264
- Suicide in children and adolescents.Prim Care. 2007; 34: 259-273
- Psychiatric aspects of pain.Curr Opin Psychiatry. 2007; 20: 42-46
- Adolescent depression and suicide risk: Association with sex and drug behavior.Am J Prev Med. 2004; 27: 224-231
- Medically unexplained physical symptoms, anxiety, and depression: A meta-analytic review.Psychosom Med. 2003; 65: 528-533
- Applied logistic regression.2nd ed. Wiley, New York, NY1989
- The severity of chronic pediatric pain: An epidemiological study.J Pain. 2008; 9: 226-236
- Chronic pain and its impact on quality of life in adolescents and their families.J Pediatr Psychol. 2001; 26: 145-153
- Abdominal pain and irritable bowel syndrome in adolescents: A community-based study.J Pediatr. 1996; 129: 220-226
IASP Taks Force on Taxonomy, in Merskey H, Bogduk N (eds): Classification of Chronic Pain, 2nd ed. Seattle, WA, IASP Press, 1994
- Pain and suicidal thoughts, plans and attempts in the United States.Gen Hosp Psychiatry. 2008; 30: 521-527
- Risk factors for suicidal behavior in adolescents.Minerva Pediatr. 2006; 58: 443-450
- Children with unexplained chronic pain: Substantial impairment in everyday life.Arch Dis Child. 2005; 90: 680-686
- Suicidality in chronic abdominal pain: An analysis of the Hispanic Health and Nutrition Examination Survey (HHANES).Pain. 1998; 76: 137-144
- Neurobiology of depression, fibromyalgia and neuropathic pain.Front Biosci. 2009; 14: 5291-5338
- Characteristics of patients requesting and receiving physician-assisted death.Arch Intern Med. 2003; 163: 1537-1542
- Suicidal ideation in patients with irritable bowel syndrome.Clin Gastroenterol Hepatol. 2004; 2: 1064-1068
- Trajectories of symptoms and impairment for pediatric patients with functional abdominal pain: A 5-year longitudinal study.J Am Acad Child Adolesc Psychiatry. 2006; 45: 737-744
- Beyond the Tower of Babel: A nomenclature for suicidology.Suicide Life Threat Behav. 1996; 26: 237-252
- Pain signalling pathways: From cytokines to ion channels.Int J Biochem Cell Biol. 2007; 39: 490-496
- Pain in children and adolescents: A common experience.Pain. 2000; 87: 51-58
- Chronic pain among children and adolescents: Physician consultation and medication use.Clin J Pain. 2000; 16: 229-235
- Insights in the use of health care services in chronic benign pain in childhood and adolescence.Pain. 2001; 94: 205-213
- The use of the Center for Epidemiological Studies Depression Scale in adolescent and young adults.J Youth Adolesc. 1991; 20: 149-166
- The CES-D Scale: A Self-Report Depression Scale for Research in the General Population.Appl Psychol Meas. 1977; 1: 385-401
- Chronic pain conditions and suicidal ideation and suicide attempts: An epidemiologic perspective.Clin J Pain. 2008; 24: 204-210
- Pain in adolescent psychiatric patients.Child Adolesc Mental Health. 2006; 11: 185-191
- Prevalence and predictors of headaches in US adolescents.Headache. 2000; 40: 528-538
Rhee H, Miles MS, Halpern CT, Holditch-Davis D: Prevalence of recurrent physical symptoms in U.S. adolescents. Pediatr Nurs 31:314-319, 350, 2005
- Pain among children and adolescents: Restrictions in daily living and triggering factors.Pediatrics. 2005; 115: e152-e162
- Epidemiology of depressive symptoms in the National Longitudinal Study of Adolescent Health.J Am Acad Child Adolesc Psychiatry. 2002; 41: 199-205
- A prospective school-based study of abdominal pain and other common somatic complaints in children.J Pediatr. 2009 Nov 28; ([Epub ahead of print])
- A prospective community-based study of gastroenterological symptoms in school-age children.J Pediatr Gastroenterol Nutr. 2006; 43: 477-482
- Chronic pain in primary care.Fam Pract. 1999; 16: 475-482
- Suicidal ideation, plans, and attempts in chronic pain patients: Factors associated with increased risk.Pain. 2004; 111: 201-208
- Suicidal ideation in outpatients with chronic musculoskeletal pain: An exploratory study of the role of sleep onset insomnia and pain intensity.Clin J Pain. 2004; 20: 111-118
- Systematic review: The prevalence of suicidal behaviour in patients with chronic abdominal pain and irritable bowel syndrome.Aliment Pharmacol Ther. 2007; 26: 183-193
- Suicidal behaviour in children and adolescents. Part 1: Etiology and risk factors.Can J Psychiatry. 2007; 52: 21S-33S
- Recurrent abdominal pain.Am J Dis Child. 1979; 133: 486-489
- Suicidality in chronic pain: A review of the prevalence, risk factors and psychological links.Psychol Med. 2006; 36: 575-586
- Antidepressants for the treatment of chronic pain.Drugs. 2008; 68: 2611-2632
- Recurrent abdominal pain: A potential precursor of irritable bowel syndrome in adolescents and young adults.J Pediatr. 1998; 132: 1010-1015
- Systematic review of the comorbidity of irritable bowel syndrome with other disorders: What are the causes and implications?.Gastroenterol. 2002; 122: 1140-1156
- Headache complaints and the risk of suicidal thoughts or behaviors.J Nerv Ment Dis. 2008; 196: 822-828
- Chronic abdominal pain and depressive symptoms: Analysis of the national longitudinal study of adolescent health.Clin Gastroenterol Hepatol. 2008; 6: 329-332
Article info
Publication history
Published online: June 20, 2011
Accepted:
March 14,
2011
Received in revised form:
February 15,
2011
Received:
July 26,
2010
Footnotes
The authors have no conflicts of interest related to this manuscript.
Identification
Copyright
© 2011 American Pain Society. Published by Elsevier Inc. All rights reserved.