The association of self-injurious behaviour and suicide attempts with recurrent idiopathic pain in adolescents: evidence from a population-based study

Chinese Medicine

Michael Kaess¹  Franz Resch¹  Romuald Brunner¹  Johann Haffner¹  Peter Parzer¹  Rieke Oelkers-Ax¹  Julian Koenig² 

[1] Clinic for Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany;Department of Psychology, The Ohio State University, Columbus, OH, USA

关键词: Suicide attempts;    Self-injury;    Adolescents;    Pain;   

Others  :  1231879
DOI  :  10.1186/s13034-015-0069-0

 received in 2015-03-24, accepted in 2015-07-08,  发布年份 2015

【 摘 要 】

Background

While several population-based studies report that pain is independently associated with higher rates of self-destructive behaviour (suicidal ideation, suicide attempts, and self-injurious behaviour) in adults, studies in adolescents are rare and limited to specific chronic pain conditions. The aim of this study was to investigate the link between self-reported idiopathic pain and the prevalence and frequency of self-injury (SI) and suicide attempts in adolescents.

Methods

Data from a cross-sectional, school-based sample was derived to assess SI, suicide attempts, recurrent pain symptoms and various areas of emotional and behavioural problems via a self-report booklet including the Youth Self-Report (YSR). Adolescents were assigned to two groups (presence of pain vs. no pain) for analysis. Data from 5,504 students of 116 schools in a region of South Western Germany was available. A series of unadjusted and adjusted multinomial logistic regression models were performed to address the association of pain, SI, and suicide attempts.

Results

929 (16.88%) respondents reported recurrent pain in one of three areas of pain symptoms assessed (general pain, headache, and abdominal pain). Adolescents who reported pain also reported greater psychopathological distress on all sub-scales of the YSR. The presence of pain was significantly associated with an increased risk ratio (RR) for SI (1–3 incidences in the past year: RR: 2.96; >3 incidences: RR: 6.04) and suicide attempts (one attempt: RR: 3.63; multiple attempts: RR: 5.4) in unadjusted analysis. Similarly, increased RR was observed when adjusting for sociodemographic variables. While controlling for psychopathology attenuated this association, it remained significant (RRs: 1.4–1.8). Sub-sequent sensitivity analysis revealed different RR by location and frequency of pain symptoms.

Conclusions

Adolescents with recurrent idiopathic pain are more likely to report previous incidents of SI and suicide attempts. This association is likely mediated by the presence of psychopathological distress as consequence of recurrent idiopathic pain. However, the observed variance in dependent variables is only partially explained by emotional and behavioural problems. Clinicians should be aware of these associations and interview adolescents with recurrent symptoms of pain for the presence of self-harm, past suicide attempts and current suicidal thoughts. Future studies addressing the neurobiology underpinnings of an increased likelihood for self-injurious behaviour and suicide attempts in adolescents with recurrent idiopathic pain are necessary.

【 授权许可】

   
2015 Koenig et al.

【 参考文献 】

• [1]Kessler RC, Borges G, Walters EE. Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey. Arch Gen Psychiatry. 1999; 56:617-626.
• [2]Hankin BL, Abramson LY. Development of gender differences in depression: an elaborated cognitive vulnerability-transactional stress theory. Psychol Bull. 2001; 127:773-796.
• [3]Resch F, Parzer P, Brunner R. Self-mutilation and suicidal behaviour in children and adolescents: prevalence and psychosocial correlates: results of the BELLA study. Eur Child Adolesc Psychiatry. 2008; 17(1):92-98.
• [4]Hallfors DD, Waller MW, Ford CA, Halpern CT, Brodish PH, Iritani B. Adolescent depression and suicide risk: association with sex and drug behavior. Am J Prev Med. 2004; 27:224-231.
• [5]King S, Chambers CT, Huguet A, MacNevin RC, McGrath PJ, Parker L et al.. The epidemiology of chronic pain in children and adolescents revisited: a systematic review. Pain. 2011; 152(12):2729-2738.
• [6]Smith MT, Edwards RR, Robinson RC, Dworkin RH. Suicidal ideation, plans, and attempts in chronic pain patients: factors associated with increased risk. Pain. 2004; 111(1–2):201-208.
• [7]Ratcliffe GE, Enns MW, Belik SL, Sareen J. Chronic pain conditions and suicidal ideation and suicide attempts: an epidemiologic perspective. Clin J Pain. 2008; 24(3):204-210.
• [8]Magni G, Rigatti-Luchini S, Fracca F, Merskey H. Suicidality in chronic abdominal pain: an analysis of the Hispanic Health and Nutrition Examination Survey (HHANES). Pain. 1998; 76(1–2):137-144.
• [9]Breslau N. Migraine, suicidal ideation, and suicide attempts. Neurology. 1992; 42(2):392-395.
• [10]Ilgen MA, Zivin K, McCammon RJ, Valenstein M. Pain and suicidal thoughts, plans and attempts in the United States. Gen Hosp Psychiatry. 2008; 30(6):521-527.
• [11]Reigstad B, Jørgensen K, Wichstrøm L. Pain in adolescent psychiatric patients. Child Adolesc Mental Health. 2006; 11:185-191.
• [12]Wang SJ, Juang KD, Fuh JL, Lu SR. Psychiatric comorbidity and suicide risk in adolescents with chronic daily headache. Neurology. 2007; 68(18):1468-1473.
• [13]Wang SJ, Fuh JL, Juang KD, Lu SR. Migraine and suicidal ideation in adolescents aged 13–15 years. Neurology. 2009; 72(13):1146-1152.
• [14]van Tilburg MA, Spence NJ, Whitehead WE, Bangdiwala S, Goldston DB. Chronic pain in adolescents is associated with suicidal thoughts and behaviors. J Pain. 2011; 12(10):1032-1039.
• [15]Swannell SV, Martin GE, Page A, Hasking P, St John NJ. Prevalence of nonsuicidal self-injury in nonclinical samples: systematic review, meta-analysis and meta-regression. Suicide Life Threat Behav. 2014; 44:273-303.
• [16]Muehlenkamp JJ, Claes L, Havertape L, Plener PL. International prevalence of adolescent non-suicidal self-injury and deliberate self-harm. Child Adolesc Psychiatry Ment Health. 2012; 6:10. BioMed Central Full Text
• [17]Brunner R, Parzer P, Haffner J, Steen R, Roos J, Klett M et al.. Prevalence and psychological correlates of occasional and repetitive deliberate self-harm in adolescents. Arch Pediatr Adolesc Med. 2007; 161:641-649.
• [18]Kaess M, Parzer P, Haffner J, Steen R, Roos J, Klett M et al.. Explaining gender differences in non-fatal suicidal behaviour among adolescents: a population-based study. BMC Public Health. 2011; 28(11):597. BioMed Central Full Text
• [19]Statistisches Bundesamt (2006) Bildung und Kultur: Allgemeinbildende Schulen, Schuljahr 2004/2005. Wiesbaden/Germany
• [20]Delmo C, Weiffenbach O, Gabriel M, Poustka F (2000) Kiddie-sads-present and lifetime version (K-SADS-PL). 5. Auflage der deutschen Forschungsversion. Frankfurt am Main: Klinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters der Universität Frankfurt
• [21]Kaufman J, Birmaher B, Brent D, Rao U, Flynn C, Moreci P et al.. Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry. 1997; 36:980-988.
• [22]Doepfner M, Plück JSB, Lenz K, Melchers P, Heim K (1998) Youth self-report: German adaption of the youth self-report (YSR). University of Cologne, Germany
• [23]Achenbach TM. Manual for the youth self-report and 1991 profile. University of Vermont, Department of Psychology, Burlington; 1991.
• [24]Achenbach TM. Manual for the child behavior checklist/4–18 and 1991 profile. University of Vermont, Department of Psychology, Burlington; 1991.
• [25]Rogers WH. Regression standard errors in clustered samples. Stata Tech Bull. 1993; 13:19-23.
• [26]Tang NK, Crane C. Suicidality in chronic pain: a review of the prevalence, risk factors and psychological links. Psychol Med. 2006; 36(5):575-586.
• [27]Härmä AM, Kaltiala-Heino R, Rimpelä M, Rantanen P. Are adolescents with frequent pain symptoms more depressed? Scand J Prim Health Care. 2002; 20(2):92-96.
• [28]Just U, Oelkers R, Bender S, Parzer P, Ebinger F, Weisbrod M et al.. Emotional and behavioural problems in children and adolescents with primary headache. Cephalalgia. 2003; 23(3):206-213.
• [29]Fichtel A, Larsson B. Psychosocial impact of headache and comorbidity with other pains among Swedish school adolescents. Headache. 2002; 42(8):766-775.
• [30]White KS, Farrell AD. Anxiety and psychosocial stress as predictors of headache and abdominal pain in urban early adolescents. J Pediatr Psychol. 2006; 31(6):582-596.
• [31]Fishbain DA, Cutler R, Rosomoff HL, Rosomoff RS. Chronic pain-associated depression: antecedent or consequence of chronic pain? A review. Clin J Pain. 1997; 13(2):116-137.
• [32]Blackburn-Munro G, Blackburn-Munro RE. Chronic pain, chronic stress and depression: coincidence or consequence? J Neuroendocrinol. 2001; 13(12):1009-1023.
• [33]Hooley JM, Franklin JC, Nock MK. Chronic pain and suicide: understanding the association. Curr Pain Headache Rep. 2014; 18(8):435.
• [34]Van Orden KA, Witte TK, Cukrowicz KC, Braithwaite SR, Selby EA, Joiner TE. The interpersonal theory of suicide. Psychol Rev. 2010; 117(2):575-600.
• [35]Nock MK. Self-injury. Annu Rev Clin Psychol. 2010; 6:339-363.
• [36]Koenig J, Thayer JF, Kaess M. A meta-analysis of self-injurious behavior and sensitivity to experimentally induced pain (under review)
• [37]Bresin K, Gordon KH. Changes in negative affect following pain (vs. nonpainful) stimulation in individuals with and without a history of nonsuicidal self-injury. Pers Disord. 2013; 4:62-66.
• [38]Groschwitz R, Plener PL. The neurobiology of non-suicidal self-injury (NSSI): a review. Suicidol Online. 2012; 3:24-32.
• [39]Sher L, Stanley BH. The role of endogenous opioids in the pathophysiology of self-injurious and suicidal behavior. Arch Suicide Res. 2008; 12(4):299-308.
• [40]Bruehl S, Chung OY, Chont M. Chronic pain-related changes in endogenous opioid analgesia: a case report. Pain. 2010; 148(1):167-171.
• [41]Bruehl S, Chung OY, Ward P, Johnson B. Endogenous opioids and chronic pain intensity: interactions with level of disability. Clin J Pain. 2004; 20(5):283-292.
• [42]Martikainen IK, Peciña M, Love TM, Nuechterlein EB, Cummiford CM, Green CR et al.. Alterations in endogenous opioid functional measures in chronic back pain. J Neurosci. 2013; 33(37):14729-14737.