Acute Pain at Discharge From Hospitalization is a Prospective Predictor of Long-Term Suicidal Ideation After Burn Injury
Abstract
Edwards RR, Magyar-Russell G, Thombs B, Smith MT, Holavanahalli RK, Patterson DR, Blakeney P, Lezotte DC, Haythornthwaite JA, Fauerbach JA. Acute pain at discharge from hospitalization is a prospective predictor of long-term suicidal ideation after burn injury.
Objective
To determine the extent to which pain contributes to risk for suicidal ideation after burn injury.
Design
This longitudinal cohort study evaluated participants at discharge, 6 months, and 1 year after burn injury.
Setting
Inpatient rehabilitation units of multiple regional burn centers.
Participants
Survivors of major burns (N=128).
Interventions
Not applicable.
Main Outcome Measures
Pain severity, assessed using the Medical Outcomes Study 36-Item Short-Form Health Survey bodily pain subscale, and passive and active suicidal ideation, assessed by self-report.
Results
At each time point, approximately one quarter to one third of the sample reported some form of suicidal ideation. In logistic regression analyses, pain severity at discharge was the sole consistent predictor of suicidal ideation at follow-up, with greater pain severity being associated with enhanced risk for both passive and active suicidal ideation. These associations were observed even after controlling for discharge mental health.
Conclusions
These are the first findings to suggest an association between acute pain severity and the development and maintenance of suicidal ideation in burn patients. Further research in this area, including the study of improved pain management programs as a prophylaxis against suicidal ideation, may benefit those who are at elevated suicide risk as a consequence of burn injuries.
aDepartment of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
bJohns Hopkins Burn Center, Johns Hopkins Bayview Medical Center, Baltimore, MD
cUniversity of Texas–Southwestern Medical Center, Dallas, TX
dUniversity of Washington, Harborview Burn Center, Seattle, WA
eGalveston Burn Center, Shriners Hospitals for Children, University of Texas Medical Branch, Galveston, TX
fUniversity of Colorado, Health Sciences Center, Denver, CO.
Reprint requests to Robert R. Edwards, PhD, Dept of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, Meyer 1-108, Baltimore, MD 21287
Supported by Burn Model Systems grants from the National Institute on Disability and Rehabilitation Research, Office of Special Education and Rehabilitative Services, U.S. Department of Education (grant no. H133A020101), and by the National Institutes of Health (grants nos. AR 051315, NS02225).
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.
ABSTRACT