背景:慢性疼痛是自杀意念(SI)和自杀行为(SB)的重要危险因素,包括20%-40%的SI患病率,自杀企图的发生率在5%到14%之间,与对照组相比,慢性疼痛患者自杀死亡的风险增加了一倍。在大多数研究中,慢性疼痛和自杀之间的关联是强烈的,即使在调整了社会人口统计学和精神病合并症的影响之后,特别是对于抑郁症。已经研究了许多可以调节慢性疼痛患者自杀风险的特定条件。但是需要对它们进行更具体的表征。许多最近的研究表明,士气低落和生命意义(MiL)结构影响自杀作为风险和保护因素,分别。这些结构主要在患有躯体疾病的患者和社区居住的个体中进行了研究,这些个体可能独立于抑郁症的精神病学诊断而出现SI或SB。然而,很少有研究在受慢性疼痛影响的自杀患者中进行调查。
目的:本项目的主要目的是调查慢性疼痛患者的士气低落与MiL对SI风险的关系。次要目标是(1)测试慢性疼痛和SI患者是否可以独立于抑郁症发生士气低落,(2)检查士气低落和SI之间的预期关联是否可以用士气低落的唯一维度来解释:绝望,(3)检查是否存在MiL,但不是搜索MiL,与较少的SI相关联,和(4)探索先前描述的MiL配置文件(即,高存在-高搜索,高存在-低搜索,适度存在-适度搜索,低存在-低搜索,和低存在-高搜索)出现在我们的队列中。
方法:这个项目是一个单中心,观察,病例对照研究-由临床药理学和毒理学部进行的道德和生命意义(DEMiL)研究,多学科疼痛中心,和日内瓦大学医院联络精神病学和危机干预处。在患者和对照组中进行自我和异型问卷调查,年龄和性别相匹配。日内瓦州道德委员会批准了科学利用收集的数据(项目编号:2017-02138;2018年1月25日的决定)。数据已经用SPSS进行了分析,版本23.0,软件(IBM公司)。
结果:从2018年3月1日至2019年11月30日,招募了70名患者和70名对照。统计分析仍在进行中,预计将于2020年11月完成。迄今为止,我们没有观察到任何可以排除与健康相关个人数据收集的因果关系的不利事件.这项研究的结果有望成为可能的预防和心理治疗干预措施的基础,这些干预措施旨在针对慢性疼痛的自杀患者的士气低落和MiL结构。
结论:探索慢性疼痛患者的士气低落和MiL的兴趣源于常见的临床观察,即经历慢性疼痛通常需要修订一个人的生活目标和期望。因此,慢性疼痛的影响不仅限于患者的生物心理社会功能,但它也会影响存在领域。慢性疼痛的自杀患者的主要临床意义在于试图(1)描绘更精确和个性化的自杀风险状况,(2)通过调查SI也在不存在临床诊断抑郁症的个体中改善检测和预防策略,和(3)通过扩大支持或心理治疗行动来加强干预措施小组,考虑到一个遭受痛苦并努力处理他或她的痛苦的人的生存状况。
■DERR1-10.2196/24882。
BACKGROUND: Chronic pain is a significant risk factor for suicidal ideation (SI) and suicidal behavior (SB), including a 20%-40% prevalence rate of SI, a prevalence between 5% and 14% of suicide attempts, and a doubled risk of death by suicide in patients with chronic pain compared to controls. In most studies, associations between chronic pain and suicidality are robust, even after adjusting for the effect of sociodemographics and psychiatric comorbidity, and particularly for depressive conditions. A number of specific conditions that can modulate suicidality risk in patients with chronic pain have been investigated, but there is a need for their more specific characterization. Numerous recent studies have shown that demoralization and meaning in life (MiL) constructs affect suicidality as risk and protective factors, respectively. These constructs have been mainly investigated in patients with somatic illness and in community-dwelling individuals who may present with SI or SB independently of a psychiatric diagnosis of depression. However, a paucity of studies investigated them in suicidal patients affected by chronic pain.
OBJECTIVE: The primary objective of this project is to investigate the relationship between demoralization and MiL on SI risk in patients with chronic pain. The secondary objectives are (1) to test whether demoralization can occur independently of depression in patients with chronic pain and SI, (2) to examine whether the expected association between demoralization and SI may be explained by a sole dimension of demoralization: hopelessness, (3) to examine whether the presence of MiL, but not the search for MiL, is associated with less SI, and (4) to explore whether previously described MiL profiles (ie, high presence-high search, high presence-low search, moderate presence-moderate search, low presence-low search, and low presence-high search) emerge in our cohort.
METHODS: This project is a single-center, observational,
case-control study-the Demoralization and Meaning in Life (DEMiL) study-conducted by the Division of Clinical Pharmacology and Toxicology, the Multidisciplinary Pain Centre, and the Service of Liaison Psychiatry and Crisis Intervention at the Geneva University Hospitals. Self- and hetero-administered questionnaires were conducted among patients and controls, matched by age and gender. The Ethics Committee of the Canton of Geneva approved the scientific utilization of collected data (project No. 2017-02138; decision dated January 25, 2018). Data have been analyzed with SPSS, version 23.0, software (IBM Corp).
RESULTS: From March 1, 2018, to November 30, 2019, 70 patients and 70 controls were enrolled. Statistical analyses are still in progress and are expected to be finalized in November 2020. To date, we did not observe any unfavorable event for which a causal relationship with the collection of health-related personal data could be ruled out. Results of this study are expected to form the basis for possible prevention and psychotherapeutic interventions oriented toward demoralization and MiL constructs for suicidal patients with chronic pain.
CONCLUSIONS: The interest in exploring demoralization and MiL in chronic pain patients with SI arises from the common clinical observation that experiencing chronic pain often requires a revision of one\'s life goals and expectations. Hence, the impact of chronic pain is not limited to patients\' biopsychosocial functioning, but it affects the existential domain as well. The major clinical implications in suicidal patients with chronic pain consist in trying to (1) delineate a more precise and individualized suicide risk profile, (2) improve detection and prevention strategies by investigating SI also in individuals who do not present with a clinically diagnosed depression, and (3) enhance the panel of interventions by broadening supportive or psychotherapeutic actions, taking into consideration the existential condition of a person who suffers and strives to deal with his or her suffering.
UNASSIGNED: DERR1-10.2196/24882.