Chronic Pain and the Interpersonal Theory of Suicide

Brief Report: Chronic Pain and the Interpersonal Theory of Suicide – free full-text article /PMC3998981/ – Rehabil Psychol. – Feb 2013

Although chronic pain is a known risk factor for suicide, few studies to date have tested specific predictions about suicidal ideation that are derived from theory.

The interpersonal theory of suicide proposes that the psychological constructs of

  • thwarted belongingness and
  • perceived burdensomeness

are unique and independent precursors to suicidal ideation. We tested this hypothesis in a clinical sample of patients with chronic pain.  

Chronic pain has been recognized as an important risk factor for suicide, but the identification of relevant predictors within the chronic pain population is at a preliminary stage of research.

In a review of suicidality in chronic pain, Tang and Crane (2006) concluded that there is consistent evidence across studies that both depression and longer pain duration increase the likelihood of suicidal ideation, both self-perceived burden and distress in interpersonal relationships contributed significantly.

Of the other variables, only pain duration and depression were retained as significant predictors

It is noteworthy that pain catastrophizing, which has been strongly associated with suicidal ideation in previous research (Edwards et al., 2006), was a significant predictor only until the interpersonal variables were added in the final step.

Conceptually it points to the importance and, perhaps, centrality of interpersonal aspects of suicidal thinking. We conclude therefore, that the interpersonal theory may have merit in explaining the elevated rates of suicidal ideation that is evident among individuals with chronic pain.

In summary, the interpersonal theory of suicide was supported in this study of patients with chronic pain


People with chronic pain have elevated rates of suicidal ideation, but few studies have tested specific predictions about suicide risk factors that are derived from theory.

The interpersonal theory of suicide proposes that two factors – thwarted belongingness and perceived burdensomeness – combine to create the psychological context that leads to the desire to commit suicide

This exploratory study examined the applicability of the theory to chronic pain, and found that both of these interpersonal constructs contributed to the prediction of suicidal ideation in this population.

These findings highlight the importance of interpersonal relations in the motivation for suicide in people with chronic pain, and perhaps for other populations with chronic illness or disability.

They extend our understanding of suicidal ideation beyond the assessment of pain and depression and point to the importance of social interactions.

Suicidal ideation may be most likely to arise among people with longstanding pain who are depressed, but especially if they feel alienated from valued social groups and believe that they have become a burden to others.

These interpersonal dimensions merit greater attention in both research and clinical practice.

When working with individuals who are expressing suicidal thoughts, it may be critical to explore the extent to which they perceive their disabilities as socially isolating, or as having a negative impact on significant others.

Original article: Chronic Pain and the Interpersonal Theory of Suicide

3 thoughts on “Chronic Pain and the Interpersonal Theory of Suicide

  1. Kathy C

    The media has helped to stigmatize and alienate people with chronic pain. They continue to conflate chronic pain with drug addiction. They have forced people with chronic pain into silence and misinformed the public. The more social isolation people in pain experience, the less they are able to interact with other people. I have met some of these people, with their pain uncontrolled, they are basket cases, unable to even participate in a discussion. The alienation of people in pain, was deliberate. They had to cast this group in bad light, while at the same time getting compassionate types to turn against them.
    Catastrophization, is probably just a natural response to being stonewalled by a Provider. When pain is described to people who are trained to appear as if they are listening, or they appear to not register what the person in pain is conveying. Subtle clues like facial expression give away the fact that a Physician or Therapist is incapable of registering empathy or even clinical efficiency. The subject, a person with pain, is forced to repeat that fact that they are in pain, or add more descriptions. They created the term Catastrophizaion in order to discredit pain patients and dehumanize them. The stoic response of Physicians or therapists who are unable to even appear to be listening, are suspicious or just outright nasty, creates catastrophization. Our minds perceive even the tiniest inflection, the false smile, and the failure to register a natural human expression. For as person with pain who has waited sometimes months for an appointment, the frustration, pain, and perceived indifference of the provider, forces to patient to over explain. Since the catastrophization is more important than the pain and an easy way to discredit a pain patient, the provider is looking for it. It is almost impossible to covey the effect and duration of pain, to a person who clearly does not believe it.


  2. Pingback: Chronic Pain and Suicide: a Deadly Link | EDS and Chronic Pain News & Info

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