(172) The Associations Between Pain, Hopelessness, and Suicide Risk Among Adult Medical Inpatients

Abstract: Background/Significance: Medically ill adults are at elevated risk for suicide, with pain exacerbating risk (Ahmedani, 2017). This study aims to describe the association of suicide risk with self-reported pain and hopelessness among a sample of adult medical inpatients.



Methods: This study is a secondary analysis using cross-sectional data from an instrument validation study. A convenience sample of adult medical inpatients was recruited from four US hospitals. Patients completed the Ask Suicide-Screening Questions (ASQ; Horowitz, 2012), a brief four-item tool to identify suicide risk. A “yes” response to any ASQ item indicates elevated suicide risk. Participants answered questions about physical pain (“Do you have chronic pain that affects your daily life?”; pain rating on a scale of 1-10) and hopelessness (“In the past few weeks, have you felt hopeless about your medical condition, like things would never get better?”; “In the past few weeks, has your medical condition led you to seriously consider killing yourself?”). Binary logistic regression models described the associations between hopelessness and suicide risk, the presence of chronic pain and suicide risk, and pain ratings and suicide risk.



Results: The sample consisted of 724 adult medical inpatients (53.3% male, 61.5% White, 19.5% Black, age M [SD] = 50.2 years [16.3]). 15.5% (112/724) of patients screened positive for suicide risk on the ASQ. Of these patients, 73.2% (82/112) reported chronic pain and 62.5% (70/112) felt hopeless about their medical condition. 2.8% (20/724) seriously considered suicide due to their medical condition; 95% (19/20) of these patients were positive on the ASQ. Patients with chronic pain had greater odds of screening positive for suicide risk compared to patients without chronic pain (p< 0.001, adjusted OR=3.25 [2.10, 5.17]). Participants with higher pain rating scores were more likely to screen positive for suicide risk (p< 0.001, adjusted OR = 1.17 [95% CI, 1.09-1.26]). Participants who reported hopelessness about their medical condition had greater odds of screening positive for suicide risk compared to participants who did not feel hopeless (p< 0.001, adjusted OR = 6.25 [95% CI, 4.07-9.68]).



Discussion: Pain and hopelessness are distressing symptoms that may be closely associated with suicide risk. Given the high prevalence of suicide risk in this adult medical sample and its association with physical symptoms, this analysis further supports universal suicide risk screening of adult medical patients.

Conclusions/Implications: Understanding the relationship between pain, hopelessness, and suicide risk can inform collaborative efforts between C-L psychiatrists and other medical professionals.



References:

Ahmedani BK, Peterson EL, Hu Y, et al. Major Physical Health Conditions and Risk of Suicide. Am J Prev Med. 2017;53(3):308-315. doi:10.1016/j.amepre.2017.04.001

Horowitz LM, Bridge JA, Teach SJ, et al. Ask Suicide-Screening Questions (ASQ): a brief instrument for the pediatric emergency department. Arch Pediatr Adolesc Med. 2012;166(12):1170-1176. doi:10.1001/archpediatrics.2012.1276