title: Predictors of homicide-suicide affirmation in acute and chronic pain patients.
abstract: OBJECTIVE
  1) Determine and compare prevalence for homicide-suicide (H-S) affirmation in community non-patients (N=478), community patients (N=158), acute pain patients (APPs; N=326), and chronic pain patients (CPPs; N=341); and 2) Develop H-S predictor models in APPs and CPPs.
  
  
  METHODS
  A large set of items containing the H-S item was administered to the above groups, who were compared statistically for H-S endorsement. APPs and CPPs affirming the H-S item were compared with those not affirming on all available variables including the Battery for Health Improvement (BHI 2) with significant variables (P≤ 0.001) utilized in predictor models for H-S in APPs and CPPs.
  
  
  METHODS
  Community plus rehabilitation facilities.
  
  
  RESULTS
  The above population groups affirmed the H-S item according to the following percentages: healthy community 1.88%, community patients 3.16%, rehabilitation patients without pain 3.64%, rehabilitation AAPs 3.99%, and rehabilitation CPPs 4.40%. For both APPs and CPPs, the H-S item was significantly correlated with some suicidality items and some homicide items. The model for APPs identified "having a suicide plan" as being predictive of H-S affirmation. For CPPs, the items of having thoughts of revenge killing, being motivated to seek revenge without any verbal warning, and the Doctor Dissatisfaction Scale of the BHI 2 predicted H-S affirmation. The APPs model classified 96% of the APPs correctly, while the CPPs model classified 97% of the CPPs correctly. These predictor rates, however, were no better than the base rate.
  
  
  CONCLUSIONS
  The prevalence of H-S affirmation within APPs and CPPs is not insignificant. The APPs predictor model points to a close association between H-S affirmation and suicidality. The CPPs model indicates that there is a close association between H-S affirmation, and anger/hostility and anger directed at physicians. These results, however, should not lead to the belief that CPPs are at greater risk for actual H-S completion for the following reasons: 1) H-S is an extremely rare event; and 2) predictive validity of the H-S item for actual H-S completion has not been determined.
authors.affiliation: Department of Psychiatry, Miller School of Medicine, University of Miami, 1400 NW 10th Avenue, Miami, FL 33136, USA. d.fishbain@miami.edu
authors.forename: David A
authors.initials: DA
authors.lastname: Fishbain
authors.forename: Daniel
authors.initials: D
authors.lastname: Bruns
authors.forename: John E
authors.initials: JE
authors.lastname: Lewis
authors.forename: John Mark
authors.initials: JM
authors.lastname: Disorbio
authors.forename: Jinrun
authors.initials: J
authors.lastname: Gao
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Meyer
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D003627:Data Interpretation, Statistical; D057225:Data Mining; D005260:Female; D006708:Homicide / Q000523:psychology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000150:complications* / Q000523:psychology*; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012959:Socioeconomic Factors; D059020:Suicidal Ideation; D055815:Young Adult