title: Change in suicidal ideation after interdisciplinary treatment of chronic pain.
abstract: OBJECTIVE
  To examine suicidal ideation (SI) in individuals with chronic pain, especially change in suicidal thinking after interdisciplinary treatment.
  
  
  METHODS
  Consecutive patients (n=250) admitted to a 4-week, group-based chronic pain management program completed measures of pain intensity, functional limitations, depressive symptoms, overall distress, pain catastrophizing, self-perceived burden, and SI at pretreatment and posttreatment.
  
  
  RESULTS
  Before treatment, 30 (12.0%) participants were classified as having a high level of SI, 56 (22.4%) had a low level of SI, and 164 (65.6%) reported none. After treatment, there was a significant reduction in SI and improvements in all other outcomes, but there were still some individuals with high (n=22, 8.8%) or low (n=28, 11.2%) levels at discharge. Patients with high SI at baseline differed from those with no suicidal thinking on pretreatment and posttreatment measures of depression, distress, catastrophizing, and self-perceived burden, but not on pain intensity or functional limitations. Patients high in SI endorsed greater pain catastrophizing and self-perceived burden than those low in suicidal thinking. Sustained SI after treatment was associated with higher baseline levels of suicidal thinking and self-perceived burden to others, as well as a more limited overall response to treatment.
  
  
  CONCLUSIONS
  SI was common in individuals with chronic pain, although mostly at a low level. Interdisciplinary treatment may result in reduced suicidal thinking; however, some patients continue to express thoughts of self-harm. Future studies could examine processes of change and interventions for treatment-resistant suicidal concerns.
authors.affiliation: *Department of Psychology, The Ottawa Hospital Rehabilitation Centre †School of Psychology ‡Department of Anaesthesiology ∥Department of Medicine, University of Ottawa §Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada ¶Department of Psychology, University of Saskatchewan, Saskatoon, SK, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Kowal
authors.forename: Keith G
authors.initials: KG
authors.lastname: Wilson
authors.forename: Peter R
authors.initials: PR
authors.lastname: Henderson
authors.forename: Lachlan A
authors.initials: LA
authors.lastname: McWilliams
mesh_terms: D000328:Adult; D001007:Anxiety / Q000628:therapy; D058443:Catastrophization / Q000628:therapy; D059350:Chronic Pain / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy*; D017281:Cost of Illness; D003863:Depression / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D010348:Patient Care Team; D015995:Prevalence; D012649:Self Concept; D059020:Suicidal Ideation; D011795:Surveys and Questionnaires; D016896:Treatment Outcome