Tang Nicole K Y, Beckwith Philippa, Ashworth Polly
*Department of Psychology, University of Warwick, Coventry †Neuropsychology, Solent NHS Trust, Southampton ‡Gloucestershire and Herefordshire Pain Self Management Service, Gloucestershire Hospitals NHS Trust, Gloucestershire, United Kingdom.
Clin J Pain. 2016 May;32(5):411-9. doi: 10.1097/AJP.0000000000000276.
Mental defeat has been implicated in precipitating suicide with effects not explained by depression. It has also been found to be elevated in people who are most distressed and disabled by chronic pain. This study examined the role of mental defeat in predicting suicide intent among chronic pain patients and compared the predictive value of mental defeat with other established pain and psychological constructs.
Sixty-two chronic pain patients attended a semistructured interview to assess pain characteristics and suicidality (present and worst-ever) and completed self-report measures of anxiety, depression, hopelessness, self-efficacy, pain catastrophizing, and mental defeat.
A total of 22.6% of people reported a history of suicide attempt (1 attempt=12.9%; ≥2 attempts=9.7%). The wish to die was reportedly moderate to strong for 63.3% of those who attempted suicide. No significant correlations were found for hopelessness and self-efficacy with suicide intent in this sample. Hierarchical regression analyses suggested that pain intensity was a significant predictor of worst-ever suicidal intent (R=0.11), and mental defeat significantly improved the prediction even when the effect of pain intensity was accounted for (ΔR=0.12). Anxiety, depression, and pain catastrophizing were significant correlates of suicide intent, but they did not add to the prediction of worst-ever suicide intent after the effect of pain intensity was controlled for.
Mental defeat may be a key indicator for heightened suicide risk. Therapeutic interventions targeting mental defeat offer a novel avenue for reducing suicide risk in chronic pain patients.
精神挫败被认为与自杀的诱发有关，其影响无法用抑郁症来解释。研究还发现，在受慢性疼痛困扰且功能受限最严重的人群中，精神挫败程度也会升高。本研究探讨了精神挫败在预测慢性疼痛患者自杀意图中的作用，并将精神挫败的预测价值与其他已确立的疼痛及心理指标进行比较。
62名慢性疼痛患者参加了半结构化访谈，以评估疼痛特征及自杀倾向（当前和有史以来最严重的情况），并完成焦虑、抑郁、绝望、自我效能感、疼痛灾难化及精神挫败的自我报告测量。
共有22.6%的人报告有自杀未遂史（1次未遂=12.9%；≥2次未遂=9.7%）。据报告，63.3%有自杀未遂经历的人想死的意愿为中度至强烈。在该样本中，绝望和自我效能感与自杀意图之间未发现显著相关性。分层回归分析表明，疼痛强度是有史以来最严重自杀意图的显著预测因素（R=0.11），即使考虑了疼痛强度的影响，精神挫败仍能显著改善预测效果（ΔR=0.12）。焦虑、抑郁和疼痛灾难化与自杀意图显著相关，但在控制疼痛强度的影响后，它们并未增加对有史以来最严重自杀意图的预测。
精神挫败可能是自杀风险升高的关键指标。针对精神挫败的治疗干预为降低慢性疼痛患者的自杀风险提供了一条新途径。
