Acute Pain at Discharge From Hospitalization is a Prospective Predictor of Long-Term Suicidal Ideation After Burn Injury

Edwards RR, Magyar-Russell G, Thombs B, Smith MT, Holavanahalli RK, Patterson DR, Blakeney P, Lezotte DC, Haythornthwaite JA, Fauerbach JA. Acute pain at discharge from hospitalization is a prospective predictor of long-term suicidal ideation after burn injury. Objective: To determine the extent to which pain contributes to risk for suicidal ideation after burn injury. Design: This longitudinal cohort study evaluated participants at discharge, 6 months, and 1 year after burn injury. Setting: Inpatient rehabilitation units of multiple regional burn centers. Participants: Survivors of major burns (N=128). Interventions: Not applicable. Main Outcome Measures: Pain severity, assessed using the Medical Outcomes Study 36-Item Short-Form Health Survey bodily pain subscale, and passive and active suicidal ideation, assessed by self-report. Results: At each time point, approximately one quarter to one third of the sample reported some form of suicidal ideation. In logistic regression analyses, pain severity at discharge was the sole consistent predictor of suicidal ideation at follow-up, with greater pain severity being associated with enhanced risk for both passive and active suicidal ideation. These associations were observed even after controlling for discharge mental health. Conclusions: These are the first findings to suggest an association between acute pain severity and the development and maintenance of suicidal ideation in burn patients. Further research in this area, including the study of improved pain management programs as a prophylaxis against suicidal ideation, may benefit those who are at elevated suicide risk as a consequence of burn injuries.