Abstract
Suicidality is a common public health concern in young people. Previous research has highlighted pain as a key correlate of suicidality in young people. However, the long-term experience of pain may vary between individuals, and the relationship between distinct pain trajectories and suicidality is poorly understood. This study aims to describe the number and nature of distinct pain trajectories, their demographic and clinical correlates, including baseline suicidality, and whether identified pain trajectories may predict future suicidality. Secondary data analyses were performed, using longitudinal data from the British Child and Adolescent Mental Health Survey (N = 7977), collected at five timepoints between 2004 and 2007 on a population-based sample of UK youth (5–16 years). Data were collected from up to three respondents (parents, teachers, and 11 + year-olds). Latent Class Growth Analysis was used to identify distinct pain trajectories, explore predictors of these trajectories, and establish whether trajectories predicted future suicidality. We identified the following four pain trajectories: increasing (33.6%), decreasing (4.5%), persistent/recurrent probability of pain (15.7%), and no pain (46.2%). Pain trajectories were associated with unique demographic and clinical correlates. Only the persistent/recurrent (vs. no-pain) trajectory was predicted by baseline suicidality (aOR = 2.24; 95% bootstrap-CI = 1.59–3.26). Furthermore, the persistent/recurrent trajectory predicted future suicidality (aOR = 1.03, 95% bootstrap-CI = 1.01–1.06), after controlling for baseline suicidality, psychiatric disorder, age, and gender. Findings provide a better understanding of correlates associated with distinct pain trajectories and long-term risk of suicidality in young people, suggesting a bidirectional pain–suicidality association and emphasising the need of targeted support for young people with persistent/recurrent pain.
Highlights
Death by suicide was the leading cause of death in 5- to 19-year-olds in England and Wales in 2020 [1]
As the pain–suicidality association remained significant after controlling for psychiatric disorders, including depression, we propose that the observed bidirectional relationship here may be driven by risk mechanisms, different from those associated with depression, including, e.g., an acquired capacity to enact self-harm through access to lethal means
This study rigorously and innovatively suggests that distinct pain trajectories longitudinally relate to suicidality and other clinically modifiable correlates in young people aged 5 to 16 years
Summary
Death by suicide was the leading cause of death in 5- to 19-year-olds in England and Wales in 2020 [1]. Far more young people think about suicide and self-harm (29.9%) or engage in self-harm (9.7%), together referred to as ‘suicidality’ [2, 3]. Self-harm is defined as intentional self-injury or self-poisoning, regardless of Cambridge, UK 4 Department of Psychology, University of Oslo, Oslo, Norway suicidal intent [4]. This definition is consistent with the UK national guidelines on self-harm [5] and the view that suicidal intent is a dimensional phenomenon [3, 6]. Self-harm often re-occurs in young people and is associated with substantial suffering [7, 8] and risk of future death by suicide [9]. The identification of youth at-risk of suicidality is vital
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