慢性疼痛与自杀风险:一项全面综述。

Chronic pain and suicide risk: A comprehensive review.

作者信息

Racine Mélanie

机构信息

Department of Clinical Neurological Sciences, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.

出版信息

Prog Neuropsychopharmacol Biol Psychiatry. 2018 Dec 20;87(Pt B):269-280. doi: 10.1016/j.pnpbp.2017.08.020. Epub 2017 Aug 26.

Abstract

Death by suicide is one of the leading causes of mortality worldwide. Because individuals with chronic pain are at least twice as likely to report suicidal behaviors or to complete suicide, it is of utmost importance to target which risk factors contribute the most to increasing suicidality. This comprehensive review aims to provide an update on research advancements relating to the identification of potential risk factors for suicidality in individuals with chronic pain. Supporting the results of prior reviews, we found robust evidence that chronic pain itself, regardless of type, was an important independent risk factor for suicidality. The only sociodemographic factor found to be associated with suicidality in individuals with chronic pain was being unemployed/disabled. Depressive symptoms, anger problems, harmful habits (e.g. smoking, alcohol misuse, illicit drugs), childhood or adulthood adversities, and family history of depression/suicide were all also identified as general risk factors. Regarding pain-related factors, sleep problems, poorer perceived mental health, concurrent chronic pain conditions, and more frequent episodes of intermittent pain, were all found to be predictors of suicidality. Unexpectedly, pain characteristics (e.g. type, duration, and intensity/severity) and physical status (e.g. pain interference or disability) were not related to suicide risk. We also identified promising new psychosocial factors (e.g. mental defeat, pain catastrophizing, hopelessness, perceived burdensomeness and thwarted belongingness) associated with suicidality outcomes. A large number of these factors are amenable to change through targeted intervention, highlighting the importance of comprehensively assessing chronic pain patients at risk for suicide, while also incorporating a suicide prevention component into chronic pain management programs.

摘要

自杀是全球主要死因之一。由于慢性疼痛患者报告自杀行为或完成自杀的可能性至少是其他人的两倍,因此确定哪些风险因素对自杀倾向增加的影响最大至关重要。这篇综述旨在提供有关慢性疼痛患者自杀潜在风险因素识别方面研究进展的最新情况。支持先前综述的结果,我们发现有力证据表明,无论慢性疼痛的类型如何,其本身就是自杀的一个重要独立风险因素。在慢性疼痛患者中,唯一被发现与自杀倾向相关的社会人口统计学因素是失业/残疾。抑郁症状、愤怒问题、有害习惯(如吸烟、酗酒、滥用非法药物)、童年或成年期的逆境以及抑郁症/自杀家族史也都被确定为一般风险因素。关于疼痛相关因素,睡眠问题、较差的心理健康感知、并发慢性疼痛状况以及更频繁的间歇性疼痛发作,均被发现是自杀倾向的预测因素。出乎意料的是,疼痛特征(如类型、持续时间和强度/严重程度)以及身体状况(如疼痛干扰或残疾)与自杀风险无关。我们还确定了与自杀结果相关的有前景的新社会心理因素(如心理挫败、疼痛灾难化、绝望、感知到的负担感和归属感受挫)。这些因素中的许多都可以通过有针对性的干预来改变,这凸显了全面评估有自杀风险的慢性疼痛患者的重要性,同时也将自杀预防纳入慢性疼痛管理计划中。

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