Chronic Pain, TBI, and PTSD in Military Veterans: A Link to Suicidal Ideation and Violent Impulses?
Chronic Pain, TBI, and PTSD in Military Veterans: A Link to Suicidal Ideation and Violent Impulses?
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DOI：
10.1016/j.jpain.2018.02.012
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发表时间：
2018-07-01
期刊：
影响因子：
4
通讯作者：
Elbogen, Eric B.
中科院分区：
文献类型：
--
作者：
Blakey, Shannon M.;Wagner, H. Ryan;Elbogen, Eric B.
多发性创伤临床三联征是指慢性疼痛、创伤性脑损伤（TBI）和创伤后应激障碍（PTSD）的共同发生。尽管研究暗示这些条件和不良后果之间的二元关系，很少有研究已经审查了多发性创伤临床三联症的自杀或暴力的关系。目前的横断面研究旨在检查这种复杂的临床表现是否会增加自杀意念和暴力冲动的风险后，占其他既定的风险因素。自2001年9月11日以来在军队服役的退伍军人（N = 667）谁报告慢性疼痛完成了采访和自我报告电池。双变量分析显示，自杀意念和暴力冲动均与PTSD、TBI+PTSD、疼痛强度和干扰、药物滥用和重性抑郁障碍（MDD）相关。多元回归分析显示：1）种族、慢性疼痛伴PTSD、酒精滥用和MDD显著预测自杀意念，2）疼痛干扰、慢性疼痛伴TBI、慢性疼痛伴PTSD、慢性疼痛伴TBI+PTSD、药物滥用和MDD显著预测暴力冲动，3）疼痛干扰比疼痛强度更能预测自杀和暴力意念。风险评估和治疗的影响进行了讨论。观点：本文介绍了一项研究的结果，研究预测自杀和暴力的风险之间的样本后9/11美国退伍军人慢性疼痛。卫生保健专业人员应评估疼痛干扰，结核病！，创伤后应激障碍，抑郁症和酒精/药物滥用时，进行风险评估与这一人群。(C)2018年美国疼痛协会American Pain Society
The polytrauma clinical triad refers to the co-occurrence of chronic pain, traumatic brain injury (TBI), and posttraumatic stress disorder (PTSD). Despite research implicating dyadic relationships between these conditions and adverse outcomes, scant research has examined the polytrauma clinical triad's relation to suicide or violence. The present cross-sectional study was designed to examine whether this complex clinical presentation increases risk of suicidal ideation and violent impulses after accounting for other established risk factors. Veterans who served in the military since September 11, 2001 (N = 667) who reported chronic pain completed an interview and self-report battery. Bivariate analyses showed that suicidal ideation and violent impulses both correlated with PTSD, TBI+PTSD, pain intensity and interference, drug abuse, and major depressive disorder (MDD). Multiple regression analyses showed that: 1) race, chronic pain with PTSD, alcohol abuse, and MDD significantly predicted suicidal ideation, 2) pain interference, chronic pain with TBI, chronic pain with PTSD, chronic pain with TBI+PTSD, drug abuse, and MDD significantly predicted violent impulses, and 3) pain interference was a more critical predictor of suicidal and violent ideation than pain intensity. Implications for risk assessment and treatment are discussed.Perspective: This article presents results from a study examining predictors of suicide and violence risk among a sample of post-9/11 U.S. Veterans with chronic pain. Health care professionals should assess for pain interference, TB!, PTSD, depression, and alcohol/drug abuse when conducting risk assessments with this population. (C) 2018 by the American Pain Society