Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania.
Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China; Department of Psychology, REACH Institute, Arizona State University, Tempe, Arizona.
J Pain. 2021 Jul;22(7):852-863. doi: 10.1016/j.jpain.2021.02.007. Epub 2021 Feb 23.
Chronic pain and suicidal behavior are prevalent in adolescents. This longitudinal study examined the associations between pain symptoms and suicidal behavior in adolescents. A total of 7,072 adolescents participated in a follow-up study of behavior and health in Shandong, China. A self-administered structured questionnaire was used to assess pain symptoms (headache, stomachache, and other nonspecific pain), insomnia, anxiety/depression, substance use, stressful life events, prior suicidal behavior, and family environment in November-December in 2015. One year later, a follow-up survey was conducted. Mean age of the sample was 14.6 years, and half were female. Of the sample, 44.8% and 8.4% reported having one or more pain symptoms "sometimes" and "often", respectively. A total of 22.4% and 10.6% reported having lifetime suicidal behavior at baseline and subsequent suicidal behavior over the 1-year follow-up, respectively. Frequent pain was significantly associated with increased risk of suicidal behavior at baseline (OR=1.64, 95%CI=1.32-2.03) and during the subsequent year (OR=1.50, 95%CI=1.17-1.93) while adjusting for adolescent individual and family covariates. Among adolescents without a history of prior suicidal behavior, frequent pain was significantly associated with an approximately 70% increased risk of incident suicidal behavior (OR= 1.69, 95%CI=1.14-2.51). In conclusion, frequent pain appears to be predictive of adolescent suicidal behavior one year later. PERSPECTIVE: This article presents the prospective associations of frequent pain symptoms with suicidal behavior in adolescents. Frequent pain was associated with a 50-70% increased risk of suicidal behavior 1 year later. The finding underscores the importance of pain assessment and treatment in comprehensive suicide prevention efforts in adolescents.
慢性疼痛和自杀行为在青少年中很普遍。本纵向研究探讨了青少年疼痛症状与自杀行为之间的关系。共有 7072 名青少年参加了中国山东青少年行为和健康的随访研究。在 2015 年 11 月至 12 月期间，使用自我管理的结构化问卷评估了疼痛症状（头痛、腹痛和其他非特异性疼痛）、失眠、焦虑/抑郁、物质使用、生活压力事件、既往自杀行为和家庭环境。一年后，进行了随访调查。样本的平均年龄为 14.6 岁，其中一半为女性。在样本中，分别有 44.8%和 8.4%的人报告“有时”和“经常”有一个或多个疼痛症状。共有 22.4%和 10.6%的人在基线时有过终生自杀行为，在随后的 1 年随访中有过自杀行为。频繁的疼痛与基线时自杀行为的风险增加显著相关（OR=1.64，95%CI=1.32-2.03）和随后的一年（OR=1.50，95%CI=1.17-1.93），同时调整了青少年个体和家庭的混杂因素。在没有既往自杀行为史的青少年中，频繁的疼痛与发生自杀行为的风险增加约 70%显著相关（OR=1.69，95%CI=1.14-2.51）。总之，频繁的疼痛似乎可以预测青少年一年后的自杀行为。展望：本文提出了青少年频繁疼痛症状与自杀行为的前瞻性关联。频繁的疼痛与一年后自杀行为的风险增加 50-70%相关。这一发现强调了在青少年全面预防自杀工作中进行疼痛评估和治疗的重要性。
