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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Article info
Publication history
Published online: March 08, 2018
Accepted:
February 27,
2018
Received in revised form:
February 7,
2018
Received:
December 16,
2017
Footnotes
Preparation of this report was supported by the VA Mid-Atlantic Mental Illness Research, Education and Clinical Center and a grant from National Center for Complementary and Integrative Health (R34 AT008399-01). Dr. Naylor was funded by a Department of Veterans Affairs Rehabilitation Research and Development Career Development Award (1lK2RX000908).
The authors have no conflicts of interest to declare.
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© 2018 by the American Pain Society
