Prevalence and Correlates of Suicidal Distress in Adolescents in a Chronic Pain Service

ABSTRACT Chronic pain is increasingly recognized as an independent correlate of suicidality in adolescence, yet most evidence comes from community‐based studies. This observational, cross‐sectional study (NCT04261114) explored the prevalence and correlates of suicidal distress in a pediatric pain service. Adolescents with chronic pain ( n  = 77; 12–18 years; 79% female; 96% musculoskeletal pain) completed questionnaires on their pain experience and suicidal distress, including perceived burdensomeness, hopelessness, and self‐harm thoughts and behaviors. Self‐harm thoughts and behaviors were common (past two‐week thoughts = 27%, behaviors = 7%; lifetime thoughts = 58%, behaviors = 47%), with prevalence increasing from mid‐adolescence. Perceived burdensomeness and hopelessness were strongly associated with past two‐weeks and lifetime self‐harm thoughts and behaviors (perceived burdensomeness: r  = 0.31–0.55; hopelessness: r  = 0.30–0.44). After adjustment for sadness and correction for multiple comparisons, higher perceived burdensomeness was associated with greater social impairment (adjusted risk ratio [aRR] = 1.24 [1.09–1.41]) and pain‐related cognitive intrusions (aRR = 1.25 [1.08–1.44]). Similarly, higher levels of hopelessness were associated with higher daily impairment (aRR = 1.21 [1.08–1.37]), especially social impairment (aRR = 1.32 [1.17–1.48]), and pain‐related cognitive intrusions (aRR = 1.26 [1.12–1.42]). Pain intensity and physical impairment were not associated with suicidal distress outcomes. Exploratory analyses identified additional correlates associated with hopelessness and self‐harm thoughts and behaviors (e.g., constant pain with pain flares, multiple pain locations and widespread pain, greater endorsement of affective and sensory pain descriptors). Suicidal distress is common in pediatric pain services, highlighting the need for routine assessments and integrated psychological support. Trial Registration: The study was prospectively registered on ClinicalTrials.gov ( NCT04261114 dated 07/02/2020)