The relationship between pain and suicidal vulnerability in adolescence: a systematic review.

Leading suicide theories and research in adults suggest that pain can exacerbate the suicidal risk of an individual. Although pain and suicidality (including suicidal ideation, behaviour, and death by suicide) both increase in prevalence during adolescence, the relationship between these factors remains unclear. We aimed to systematically review the empirical evidence for such an association in adolescence. We included 25 observational studies published between January 1961 and December 2018, exploring the potential association between pain and suicidality in adolescents aged 10-19 years. Across various samples and manifestations of pain and suicidality, we found that pain approximately doubles the suicidal risk in adolescents, with a few studies suggesting that pain can predict suicidality longitudinally. Although depression was an important factor, it did not fully explain the association between pain and suicidality. Evidence for associations between pain characteristics and suicidality is sparse and inconclusive, and potentially hides developmental differences between adolescents and adults. Identification of psychological mediators and moderators is required to develop interventions tailored to the needs of adolescents experiencing pain. This study is registered with the PROSPERO database, number CRD42018097226.VH is funded by the Oskar-Helene Heim Foundation and the FAZIT foundation. CC is funded by the Wellcome Trust, (107496/Z/14/Z). RB is funded by the Defehr-Neumann foundation. BG is funded by the Faculty of Social Sciences University of Oslo

Does depression moderate the relationship between pain and suicidality in adolescence? A moderated network analysis

BACKGROUND: Whilst growing research suggests that pain is associated with suicidality in adolescence, it remains unclear whether this relationship is moderated by co-morbid depressive symptoms. The present study aimed to investigate whether the pain-suicidality association is moderated by depressive symptoms. METHODS: We performed secondary analyses on cross-sectional, pre-intervention data from the ‘My Resilience in Adolescence’ [MYRIAD] trial (ISRCTN ref: 86619085; N=8072, 11-15 years). Using odds ratio tests and (moderated) network analyses, we investigated the relationship between pain and suicidality, after controlling for depression, anxiety, inhibitory control deficits and peer problems. We investigated whether depression moderates this relationship and explored gender differences. RESULTS: Overall, 20% of adolescents reported suicidality and 22% reported pain, whilst nine percent of adolescents reported both. The experience of pain was associated with a four-fold increased risk of suicidality and vice versa (OR=4.00, 95%-CI=[3.54;4.51]), with no gender differences. This cross-sectional association remained significant after accounting for depression, anxiety, inhibitory control deficits and peer problems (aOR=1.39). Depression did not moderate the pain-suicidality association. LIMITATIONS: The item-based, cross-sectional assessment of pain and suicidality precludes any conclusions about the direction of the effects and which aspects of suicidality and pain may drive this association. CONCLUSIONS: Our findings underscore the need to consider pain as an independent risk correlate of suicidality in adolescents. Longitudinal research should examine how this relationship develops during adolescence. Clinically, our findings emphasise the need to assess and address suicidality in adolescents with pain, even in the absence of depressive symptoms

Biclustering models for two-mode ordinal data

The work in this paper introduces finite mixture models that can be used to simul- taneously cluster the rows and columns of two-mode ordinal categorical response data, such as those resulting from Likert scale responses. We use the popular proportional odds parameterisation and propose models which provide insights into major patterns in the data. Model-fitting is performed using the EM algorithm and a fuzzy allocation of rows and columns to corresponding clusters is obtained. The clustering ability of the models is evaluated in a simulation study and demonstrated using two real data sets

Fra laboratoriet til terapirommet

Forskningsprogram som oversetter teorier til testbare hypoteser- translational research - har en sentral rolle i kliniskbehandlingsforskning generelt, men er lite brukt som basisfor utvikling av effektive og evidensbaserte behandlingerinnen selvmordsfeltet. Cry of Pain-teorien og det teoretiskbeslektede rammeverket Differential Activation for suicidalitethar vært toneangivende i prosessen med å nyansere myterom selvmordsatferd som et ‘rop om hjelp’, men like viktig erat den demonstrerer potensialet for translational researchi selvmordsforskning. Artikkelen viser hvordan teorien hargenerert testbare hypoteser som i sin tur har lagt grunnlagetfor nyskapende behandlinger. Den har derfor markert etveiskille i forskningstilnærmingen til behandlingsutvikling innenselvmordsfeltet.AbstractClark’s (2004) translational research agenda in clinical psychologicalscience has been extremely influential in treatments foranxiety and depression, but have been underutilised in suicideresearch. Williams’s Cry of Pain theory of suicide highlights thepotential for using this model in the context of treatment developmentin the suicide field. This paper outlines the theory, its evidencebase and clinical implications. It is argued that researchdelineating mechanisms underpinning suicidal behaviour is keyin the process towards more robust clinical treatments of peopleat risk of suicide and suicidal behaviour

DDD per quarter year before and year after the episode by medication group, cumulating quarterly within each year.

<p>Comparison of year prior to and following the episode is potentially inaccurate as patients may be prescribed medication at different times in the two years, i.e., we may not be comparing the same time periods. We therefore investigated whether they were accumulating at the same rate in the two years. Figure 4 depicts the accumulated (total) DDD collected over the year prior to and the year following the episode, broken down into quarters and reported for non-psychotropic, psychotropic, and antidepressants within each quarter. The pace with which patients accumulated prescribed medication was steady over the two years, although the increase was faster over the first three months following the episode compared to the year preceding it.</p

One year psychotropic load by age and gender.

<p>Figure 2A displays one year psychotropic medication load before and after the episode for females with the means (solid lines) and standard error envelopes (dashed lines). Psychotropic medication load increased significantly in the year after compared to the year prior to the episode (p = 0.04). Psychotropic medication load increased with age irrespective of time period and gender (p<0.01), and peaked in the 50–70 age bracket. There was no significant difference between males' and females' psychotropic medication load (p = 0.27).</p

One year medication load by age and gender.

<p>Total medication load increased significantly in the year following the episode compared to beforehand (p<0.01). Figure 1A displays one year total medication load (DDD) for females by age before and after the episode, with the means (solid lines) and standard error envelopes (dashed lines). Females collected significantly more medication in the year after compared to the year prior to the episode (p<0.01), with the increase in DDD collected amounting to 21.2%. The pre-post difference for females gradually increased with age. There was no significant pre-post difference for males.</p

One year non-psychotropic load by age and gender.

<p>Figure 3A displays one year non-psychotropic medication load before and after the episode for females, and Figure 3B displays the corresponding information for males. Solid lines represent the means with dashed lines showing standard error envelopes. There was a significant increase in non-psychotropic medication load in the year after the episode (p<0.01) compared to the year prior to the DSP episode (a 24.3% increase in DDD collected), but this increase was not dependent on gender (p = 0.53). Non-psychotropic medication load increased with age (p<0.01), and females collected more non-psychotropic overall irrespective of age and time period (p = 0.01).</p