Suicidal ideation in outpatients with chronic musculoskeletal pain - An exploratory study of the role of sleep onset insomnia and pain intensity

被引:97
作者
Smith, MT
Perlis, ML
Haythornthwaite, JA
机构
[1] Johns Hopkins Univ, Sch Med, Dept Psychiat & Behav Sci, Baltimore, MD 21287 USA
[2] Univ Rochester, Sch Med & Dent, Dept Psychiat, Rochester, NY 14642 USA
[3] Univ Rochester, Dept Clin & Social Psychol, Rochester, NY 14642 USA
关键词
chronic pain; suicide; sleep disturbance; insomnia; depression;
D O I
10.1097/00002508-200403000-00008
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Objectives: Sleep disturbance, depression, and heightened risk of suicide are among the most clinically significant sequelae of chronic pain. While sleep disturbance is associated with suicidality in patients with major depression and is a significant independent predictor of completed suicide in psychiatric patients, it is not known whether sleep disturbance is associated with suicidal behavior in chronic pain. This exploratory study evaluates the importance of insomnia in discriminating suicidal ideation in chronic pain relative to depression severity and other pain-related factors. Methods: Fifty-one outpatients with non-cancer chronic pain were recruited. Subjects completed a pain and sleep survey, the Pittsburgh Sleep Quality Index, the Beck Depression Inventory, and the Multidimensional Pain Inventory. Subjects were classified as "suicidal ideators" or "non-ideators" based on their responses to BDI-Item 9 (Suicide). Bivariate analyses and multivariate discriminant function analyses were conducted. Results: Twenty-four percent reported suicidal ideation (without intent). Suicidal ideators endorsed higher levels of. sleep onset insomnia, pain intensity, medication usage, pain-related interference, affective distress, and depressive symptoms (P < 0.03). These 6 variables were entered into stepwise discriminant function analyses. Two variables predicted group membership: Sleep Onset Insomnia Severity and Pain Intensity, respectively. The discriminant function correctly classified 84.3% of the cases (P < 0.0001). Discussion: Chronic pain patients who self-reported severe and frequent initial insomnia with concomitant daytime dysfunction and high pain intensity were more likely to report passive suicidal ideation, independent from the effects of depression severity. Future research aimed at determining whether sleep disturbance is a modifiable risk factor for suicidal ideation in chronic pain is warranted.
引用
收藏
页码:111 / 118
页数:8
相关论文
共 49 条
[1]  
Agargun MY, 1997, J CLIN PSYCHIAT, V58, P249
[2]   Subjective sleep quality and suicidality in patients with major depression [J].
Agargun, MY ;
Kara, H ;
Solmaz, M .
JOURNAL OF PSYCHIATRIC RESEARCH, 1997, 31 (03) :377-381
[3]  
*AM SLEEP DIS ASS, 1997, INT CLASS SLEEP DIS
[4]  
*AM SLEEP DIS ASS, 1990, INT CLASS SLEEP DIS
[5]   SUBJECTIVE SLEEP DISTURBANCE IN CHRONIC BACK PAIN [J].
ATKINSON, JH ;
ANCOLIISRAEL, S ;
SLATER, MA ;
GARFIN, SR ;
GILLIN, JC .
CLINICAL JOURNAL OF PAIN, 1988, 4 (04) :225-232
[6]   AN INVENTORY FOR MEASURING DEPRESSION [J].
BECK, AT ;
ERBAUGH, J ;
WARD, CH ;
MOCK, J ;
MENDELSOHN, M .
ARCHIVES OF GENERAL PSYCHIATRY, 1961, 4 (06) :561-&
[7]   MIGRAINE, SUICIDAL IDEATION, AND SUICIDE ATTEMPTS [J].
BRESLAU, N .
NEUROLOGY, 1992, 42 (02) :392-395
[8]   THE PITTSBURGH SLEEP QUALITY INDEX - A NEW INSTRUMENT FOR PSYCHIATRIC PRACTICE AND RESEARCH [J].
BUYSSE, DJ ;
REYNOLDS, CF ;
MONK, TH ;
BERMAN, SR ;
KUPFER, DJ .
PSYCHIATRY RESEARCH, 1989, 28 (02) :193-213
[9]  
CARSKADON MA, 1976, AM J PSYCHIAT, V133, P1382
[10]   PSYCHALGIC DEPRESSIVE DISORDER - A DESCRIPTIVE AND COMPARATIVE-STUDY [J].
CHATURVEDI, SK .
ACTA PSYCHIATRICA SCANDINAVICA, 1989, 79 (01) :98-102