Suicide Prevention for Patients with Chronic Pain

项目总结/摘要 每天有120人死于自杀，也就是说，每15分钟就有一人自杀。自杀预防治疗 专注于那些风险最高的人，主要作为心理健康治疗提供，但70%的患者 有自杀风险的人不接受心理健康治疗。为没有得到服务的患者开发治疗方法 现有的自杀预防计划将改善获得护理的机会，并对阻止自杀是必要的。患者 在美国，慢性疼痛患者（1亿人）的自杀风险是长期服用阿片类药物的患者的2.6倍。 治疗的风险更大。不幸的是，他们往往得不到心理健康治疗， 没有采取自杀预防措施。他们经常接受医疗保健，为他们的疼痛提供 将自杀预防纳入疼痛治疗的机会。本研究旨在测试 问题解决治疗（PST）作为一种可以 在非心理健康环境中提供。我们的假设是，PST的自杀意念和慢性疼痛， 通过减少解决问题的缺陷和负担感来减少自杀意念， 归属感本研究的目的是测试远程传递PST对自杀和慢性疼痛的疗效 并阐明治疗的有效成分。我们的具体目标是：（目标1）远程交付PST 减少（H1）自杀意念（H2）解决问题的缺陷（H3）疼痛相关的残疾，（H4） 与加强患者健康教育相比， 治疗后即刻和治疗后6个月出现慢性疼痛和自杀意念。(Aim（二） 通过检查是否减少解决问题的缺陷， 负担感和不归属感介导了PST和减少 自杀意念和慢性疼痛患者的自杀意念。（探索性目标3）探索（如果远程） PST对慢性疼痛和中度自杀风险的患者有效， 长期阿片类药物和非处方长期阿片类药物。这项研究的结果将有助于阐明机制 慢性疼痛导致自杀意念，重要的是，确定积极的中介目标， 自杀预防治疗。

Project Summary/Abstract Every day, 120 people die from suicide, that is one person every 15 minutes. Suicide prevention treatments focus on those at highest risk and are primarily delivered as mental health treatments, and yet 70% of patients with suicide risk do not attend mental health treatment. Developing treatment for patients not served by existing suicide prevention programs will improve access to care and is necessary to stop suicide. Patients with chronic pain in the US (100 million) have 2.6-times greater risk of suicide and those on long-term opioid treatment are at even greater risk. Unfortunately, they often do not receive mental health treatment and thus do not receive suicide prevention interventions. They do receive frequent healthcare for their pain providing an unmet opportunity to integrate suicide prevention into their treatment for pain. This study aims to test the efficacy of Problem-Solving Treatment (PST) for suicidal ideation and chronic pain as a therapy that can be delivered in non-mental health settings. Our hypothesis is that PST for suicidal ideation and chronic pain will reduce suicidal ideation by reducing problem-solving deficits and feelings of burdensomeness and not belonging. The goal of this study is to test the efficacy of remote-delivered PST for suicide and chronic pain and elucidate the active components of treatment. Our specific aims are: (Aim 1) remote-delivered PST reduces (H1) suicidal ideation (H2) problem-solving deficits (H3) pain-related disability, (H4) feelings of burdensomeness and (H5) feelings of not belonging as compared to enhanced health education for patients with chronic pain and suicidal ideation immediately after treatment and 6 months after treatment. (Aim 2) Determine mechanisms of change by examining whether reductions in problem-solving deficits, feelings of burdensomeness, and feelings of not belonging mediate the relationship between PST and reductions in suicidal ideation among patients with suicidal ideation and chronic pain. (Exploratory Aim 3) Explore if remote delivered PST is efficacious for patients with chronic pain and moderate suicide risk who are prescribed long- term opioids and not prescribed long-term opioids. Findings from this study will help elucidate the mechanisms by which chronic pain contributes to suicidal ideation and importantly, identify the active mediating targets for suicide prevention treatments.