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Chronic Pain, TBI, and PTSD in Military Veterans: A Link to Suicidal Ideation and Violent Impulses?

  • Shannon M. Blakey
    Correspondence
    Address reprint requests to Shannon M. Blakey, MS, University of North Carolina at Chapel Hill, Department of Psychology and Neuroscience, Davie Hall (CB # 3270), Chapel Hill, NC 27599-3270.
    Affiliations
    Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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  • H. Ryan Wagner
    Affiliations
    Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, North Carolina

    Durham VA Medical Center, Durham, North Carolina

    Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
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  • Jennifer Naylor
    Affiliations
    Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, North Carolina

    Durham VA Medical Center, Durham, North Carolina

    Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
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  • Mira Brancu
    Affiliations
    Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, North Carolina

    Durham VA Medical Center, Durham, North Carolina

    Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
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  • Ilana Lane
    Affiliations
    Durham VA Medical Center, Durham, North Carolina
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  • Meghann Sallee
    Affiliations
    Durham VA Medical Center, Durham, North Carolina
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  • Nathan A. Kimbrel
    Affiliations
    Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, North Carolina

    Durham VA Medical Center, Durham, North Carolina

    Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
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  • VA Mid-Atlantic MIRECC Workgroup
  • Eric B. Elbogen
    Affiliations
    Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, North Carolina

    Durham VA Medical Center, Durham, North Carolina

    Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
    Search for articles by this author

      Highlights

      • The polytrauma clinical triad includes chronic pain, traumatic brain injury, and posttraumatic stress disorder.
      • The polytrauma clinical triad was associated with suicidal ideation.
      • The polytrauma clinical triad was associated with violent impulses.
      • Pain interference was a stronger predictor of outcomes than was pain intensity.
      • Chronic pain is relevant to suicide and violence risk assessment in veterans.

      Abstract

      The polytrauma clinical triad refers to the co-occurrence of chronic pain, traumatic brain injury (TBI), and posttraumatic stress disorder (PTSD). Despite research implicating dyadic relationships between these conditions and adverse outcomes, scant research has examined the polytrauma clinical triad's relation to suicide or violence. The present cross-sectional study was designed to examine whether this complex clinical presentation increases risk of suicidal ideation and violent impulses after accounting for other established risk factors. Veterans who served in the military since September 11, 2001 (N = 667) who reported chronic pain completed an interview and self-report battery. Bivariate analyses showed that suicidal ideation and violent impulses both correlated with PTSD, TBI+PTSD, pain intensity and interference, drug abuse, and major depressive disorder (MDD). Multiple regression analyses showed that: 1) race, chronic pain with PTSD, alcohol abuse, and MDD significantly predicted suicidal ideation, 2) pain interference, chronic pain with TBI, chronic pain with PTSD, chronic pain with TBI+PTSD, drug abuse, and MDD significantly predicted violent impulses, and 3) pain interference was a more critical predictor of suicidal and violent ideation than pain intensity. Implications for risk assessment and treatment are discussed.

      Perspective

      This article presents results from a study examining predictors of suicide and violence risk among a sample of post-9/11 U.S. Veterans with chronic pain. Health care professionals should assess for pain interference, TBI, PTSD, depression, and alcohol/drug abuse when conducting risk assessments with this population.

      Key words

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