Costanza Alessandra, Chytas Vasileios, Piguet Valérie, Luthy Christophe, Mazzola Viridiana, Bondolfi Guido, Cedraschi Christine
Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
Division of Clinical Pharmacology & Toxicology, Multidisciplinary Pain Centre, Geneva University Hospitals, Geneva, Switzerland.
JMIR Form Res. 2021 Jun 4;5(6):e29365. doi: 10.2196/29365.
Patients with chronic pain have elevated risk of suicidal ideation and behavior, including suicide attempts and completed suicides. In most studies, associations between chronic pain and suicidal ideation/suicidal behavior are robust even after adjusting for the effect of sociodemographics and psychiatric comorbidity. However, to refine the risk profile of these patients, further exploration of other possible risk and protective factors is necessary.
There is a common clinical observation that experiencing chronic pain often requires a revision of life goals and expectations, and hence, it impacts the existential domain including one's perception of the meaning in life (MiL). This study aimed to characterize the main domains that constitute the personal MiL, including the "presence of" and "search for" constructs, in a group of patients with chronic pain and suicidal ideation.
Seventy participants were enlisted by ongoing recruitment through a larger project anchored in daily clinical practice at the Multidisciplinary Pain Center of the Geneva University Hospitals. It was an observational mixed method study. Data were recorded through both validated quantitative questionnaires and qualitative open-ended questions.
The total sample consisted of 70 patients. Responses to questionnaires showed a depressive episode in 68 (97%) patients and anxious disorders in 25 (36%) patients. With a score threshold for positive MiL of 24, the mean score for the "presence of" construct was 20.13 (SD 8.23), and 63% (44/70) of respondents had a score <24. The mean score for the "search for" construct was lower at 18.14 (SD 8.64), and 70% (49/70) of respondents had a score <24. The "presence of" and "search for" constructs were significantly positively correlated (R=0.402; P=.001). An open question addressed the "presence of" construct by inviting the respondents to cite domains they consider as providing meaning in their life at the present time. All patients responded to this question, citing one or more domains. The three main dimensions that emerged from content analysis of this qualitative section were as follows: the domain of relationships, the domain of personal activities, and pain and its consequences on MiL.
The study results provide insights into patients with chronic pain and suicidal ideation, including the domains that provide them with meaning in their lives and the impact of pain on these domains with regard to suicidal ideation. The main clinical implications concern both prevention and supportive/psychotherapeutic interventions. They are based on a narrative approach aiming to explore with the patients the content of their suffering and the MiL domains that they could identify to mitigate it, in order to restructure/reinforce these domains and thus possibly reduce suicidal ideation. Specifically, a focus on maintaining the domains of interpersonal relationships and personal activities can allow patients to ultimately escape the biopsychosocial vicious cycle of chronic pain-induced deep moral suffering.
慢性疼痛患者出现自杀意念和行为的风险升高，包括自杀未遂和自杀身亡。在大多数研究中，即使在调整了社会人口统计学和精神疾病共病的影响后，慢性疼痛与自杀意念/自杀行为之间的关联依然显著。然而，为了完善这些患者的风险特征，有必要进一步探索其他可能的风险和保护因素。
临床上常观察到，经历慢性疼痛往往需要重新审视生活目标和期望，因此，它会影响生存领域，包括一个人对生活意义的感知（生活意义）。本研究旨在描述构成个人生活意义的主要领域，包括“存在”和“追寻”结构，研究对象为一组患有慢性疼痛和自杀意念的患者。
通过日内瓦大学医院多学科疼痛中心基于日常临床实践的一个更大项目持续招募了70名参与者。这是一项观察性混合方法研究。数据通过经过验证的定量问卷和定性开放式问题进行记录。
总样本包括70名患者。问卷回复显示，68名（97%）患者有抑郁发作，25名（36%）患者有焦虑症。生活意义为阳性的分数阈值为24分，“存在”结构的平均分为20.13（标准差8.23），63%（44/70）的受访者得分<24分。“追寻”结构的平均分更低，为18.14（标准差8.64），70%（49/70）的受访者得分<24分。“存在”和“追寻”结构显著正相关（R = 0.402；P = 0.001）。一个开放式问题通过邀请受访者列举他们认为目前在生活中赋予意义的领域来探讨“存在”结构。所有患者都回答了这个问题，列举了一个或多个领域。对这一定性部分内容分析得出的三个主要维度如下：人际关系领域、个人活动领域以及疼痛及其对生活意义的影响。
研究结果为患有慢性疼痛和自杀意念的患者提供了见解，包括为他们的生活赋予意义的领域以及疼痛对这些领域在自杀意念方面的影响。主要临床意义涉及预防和支持性/心理治疗干预。它们基于一种叙事方法，旨在与患者探讨其痛苦的内容以及他们可以确定的用以减轻痛苦的生活意义领域，以便重组/强化这些领域，从而可能减少自杀意念。具体而言，关注维持人际关系和个人活动领域可以使患者最终摆脱慢性疼痛导致的深刻精神痛苦的生物心理社会恶性循环。
