Demoralization and Suicidal Ideation in Chronic Pain Patients

Abstract

The literature has clearly stressed that patients suffering from chronic pain are at high risk of suicidal behavior (SB). Hence the need to improve the characterization of this behavior risk profile in these patients. Some findings indicate a possible relationship between demoralization and pain, with functional disability found to be correlated with demoralization. The primary objective of this study was to investigate the relationship between demoralization and suicidal ideation (SI) in patients with chronic pain. The secondary objective was to verify whether demoralization can occur independently of depression in these patients. Inclusion criteria were patients with chronic pain, with SI or not, matched for age and gender, aged > 18 years. Seventy patients with SI and 70 patients without SI were included. Between-group difference was statistically significant (F=1.064; t= 7.21, p<0.001, d=1.22), confirming the presence of numerous and intense depressive symptoms in the patients of the SI group. Regarding the Demoralization Scale (DS), the difference between the two groups was statistically highly significant (F=1.49; t=9.44; p<0.001, d=1.6). There was also a strong positive correlation between DS and Beck Depression Inventory (BDI-II) (R=0.749; p<0.001 for the study group and R=0.704; p<0.001 for the control group). Furthermore, there was a strong positive correlation between the DS and the Scale for Suicide Ideation (SSI) in the SI patients group, meaning that high demoralization is associated with higher suicidal ideation as well. Our findings did not allow us to distinguish between the notions of depression and demoralization, since the two constructs show almost the same strong positive correlation with suicidal thoughts, the two also being strongly correlated with each other.

Prevalence of suicidal behavior in patients with chronic pain: a systematic review and meta-analysis of observational studies

“…Importantly, demoralization is relevant to chronic pain as it developed in a somatic context associated to psychic suffering ( Clarke and Kissane, 2002 ). A recent case–control study found that demoralization in patients with chronic pain had a positive correlation with SI, almost as strong as depression ( Chytas et al, 2023 ). Demoralization is often underestimated, but because it is likely an independent risk factor for SB ( Costanza et al, 2022 ), it can be considered an important target to be considered along with chronic pain in the detection of suicide risk.…”

Dynamic Interrelations between Sensory and Affective Aspects of Pain in Patients with Chronic Pain

“…Although depression is often perceived as a normal reaction to prolonged and debilitating pain, its underestimation carries risks of future disability and auto-aggression [19,20]. Therefore, when evaluating patients with chronic pain, it is important to examine not only the physical characteristics of pain, but also the emotional ones -depression and anxiety -as they are interdependent variables of a common phenomenon.…”