The role of pain, functioning, and mental health in suicidality among Veterans Affairs primary care patients

Magruder KM, Yeager D, Brawman-Mintzer O.
Am J Public Health. 2012 Mar;102 Suppl 1:S118-24. doi: 10.2105/AJPH.2011.300451. Epub 2012 Jan 25.

Mental Health Service Line, Ralph H. Johnson VA Medical Center, Charleston, SC 29401, USA.

OBJECTIVES:  We examined suicidality, pain, functioning, and psychiatric disorders among veterans in primary care by using both self-report and clinical measures of pain and mental health to determine correlates that might be clinically useful in primary care settings.

METHODS:  Data were from 884 Veterans Affairs patients enrolled in a regional 4-site cross-sectional study. Patients were administered measures that assessed functioning (including pain) and psychiatric disorders. Data were merged with medical records for clinical pain indicators.

RESULTS:  Overall, 9.1% (74 of 816) of patients indicated suicidal ideation, with those who were middle-aged, unemployed because of disability, had less than college education, and served in a warzone most likely to consider suicidality. Suicidal patients had worse functioning (measured by the Short Form-36) than did nonsuicidal patients in every domain, including bodily pain, and were more likely to meet criteria for a psychiatric diagnosis. However, when pain and mental health were jointly considered, only mental health (both psychiatric diagnosis and mental health functioning) was related to suicidality.

CONCLUSIONS:  Although providers should be alert to the possibility of suicidality in patients with pain, they should be vigilant when patients have a psychiatric disorder or poor mental health.