Department of Pharmacy, AU Medical Center, Augusta University, Augusta, GA, United States of America.
Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States of America.
PLoS One. 2022 Apr 29;17(4):e0267844. doi: 10.1371/journal.pone.0267844. eCollection 2022.
Given the relatively high rates of suicidal ideation and attempt among people with chronic pain, there is a need to understand the underlying factors to target suicide prevention efforts. To date, no study has examined the association between pain phenotypes and suicide related behaviors among those with mild traumatic brain injuries.
To determine if pain phenotypes were independently associated with suicidal ideation / attempt or if comorbidities within the pain phenotypes account for the association between pain phenotypes and suicide related behaviors.
This is a longitudinal retrospective cohort study of suicide ideation/attempts among pain phenotypes previously derived using general mixture latent variable models of the joint distribution of repeated measures of pain scores and pain medications/treatment. We used national VA inpatient, outpatient, and pharmacy data files for Post-9/11 Veterans with mild traumatic injury who entered VA care between fiscal years (FY) 2007 and 2009. We considered a counterfactual causal modeling framework to assess the extent that the pain phenotypes during years 1-5 of VA care were predictive of suicide ideation/attempt during years 6-8 of VA care conditioned on covariates being balanced between pain phenotypes.
Without adjustment, pain phenotypes were significant predictors of suicide related behaviors. When we used propensity scores to balance the comorbidities present in the pain phenotypes, the pain phenotypes were no longer significantly associated with suicide related behaviors.
These findings suggest that suicide ideation/attempt is associated with pain trajectories primarily through latent multimorbidity. Therefore, it is critical to identify and manage comorbidities (e.g., depression, post-traumatic stress disorder) to prevent tragic outcomes associated with suicide related behaviors throughout the course of chronic pain and mild traumatic brain injury management.
鉴于慢性疼痛患者中自杀意念和尝试的比率相对较高，因此需要了解潜在因素，以针对自杀预防工作。迄今为止，尚无研究探讨轻度创伤性脑损伤患者中疼痛表型与自杀相关行为之间的关系。
确定疼痛表型是否与自杀意念/尝试独立相关，或者疼痛表型中的合并症是否解释了疼痛表型与自杀相关行为之间的关联。
这是一项使用重复测量疼痛评分和疼痛药物/治疗的联合分布的广义混合潜在变量模型先前得出的疼痛表型的自杀意念/尝试的纵向回顾性队列研究。我们使用国家退伍军人事务部（VA）门诊、门诊和药房数据文件，对在 2007 财年至 2009 财年期间进入 VA 护理的轻度创伤性损伤的后 9/11 退伍军人进行了研究。我们考虑了反事实因果建模框架，以评估在疼痛表型之间平衡协变量的情况下，VA 护理的前 5 年内的疼痛表型对 VA 护理的第 6-8 年内的自杀意念/尝试的预测程度。
未经调整，疼痛表型是自杀相关行为的重要预测指标。当我们使用倾向评分来平衡疼痛表型中存在的合并症时，疼痛表型与自杀相关行为不再有显著关联。
这些发现表明，自杀意念/尝试主要通过潜在的多合并症与疼痛轨迹相关。因此，识别和管理合并症（例如，抑郁，创伤后应激障碍）对于预防与慢性疼痛和轻度创伤性脑损伤管理相关的自杀相关行为的悲惨结局至关重要。
