History of abuse is associated with thoughts of harm among patients with pain after accounting for depressive symptoms.

Abstract

Screening for depressive symptoms is often the first step to understanding risk for thoughts of harm among patients with pain. Pain characteristics and history of abuse are also associated with thoughts of harm; however, little is known about these associations after accounting for depressive symptoms. This study examined the association between pain characteristics and history of abuse with thoughts of harm among pain patients with moderate to severe and low to mild depressive symptoms. We conducted a cross-sectional analysis of patients (n=7510) who presented to a tertiary-care, outpatient pain clinic. Abuse history was significantly associated with increased odds of reporting thoughts of harm for both patients with moderate to severe depressive symptoms as well as low to mild depressive symptoms. Abuse did not modify the association between any of the pain characteristics and thoughts of harm. Our results highlight the importance of abuse history in assessing thoughts of harm. Although we are unable to infer causality due to the cross-sectional design, this study highlights the importance of screening for abuse history when assessing for suicidal and homicidal ideation.