Meaning in Life in Patients with Chronic Pain and Suicidal Ideation: A Mixed-Method Study.

BACKGROUND Patients suffering from chronic pain are at elevated risk of suicidal ideation (SI) and behavior (SB), including suicide attempts and completed suicides. In most studies associations between chronic pain and SI/SB are robust even after adjusting for the effect of socio-demographics and psychiatric comorbidity. However, to refine the risk profile of these patients, further exploration of other possible risk and protective factors is necessary. OBJECTIVE There is a common clinical observation that experiencing chronic pain often requires a revision of life goals and expectations and hence it impacts the existential domain including one's perception of the Meaning in Life (MiL). The aim of this study was to characterize the main domains that constitute the personal MiL, including the 'presence of' and 'search for' constructs, in a group of patients with chronic pain and SI. METHODS Participants (N=70) were enlisted by ongoing recruitment through a larger project anchored in daily clinical practice at the Multidisciplinary Pain Center of the Geneva University Hospitals (HUG). It was an observational mixed-method study: data was recorded through both validated quantitative questionnaires and qualitative open-ended questions. RESULTS Responses to questionnaires showed the presence of a depressive episode in 68 patients (97%) as well as the presence of anxious disorders in 25 patients (36%). With a threshold for positive MiL scoring of 24, the score (mean±SD) for the 'presence of' construct was 20.13±8.23 and about two-thirds (63%) of respondents presented with a score <24. The scores for the 'search for' MiL were lower (18.14±8.64 and 70% of respondents <24). The 'presence of' and 'search for' constructs were significantly and positively associated (Chi2=0.402; p=0.001). An open question addressed the 'presence of' construct by inviting the respondent to cite domains that they consider as providing meaning in their life at the present time. The 3 main dimensions that emerged from content analysis of this qualitative section were: the domain of relationships; the domain of personal activities; and pain and its consequences on MiL. CONCLUSIONS The results of this study provide insights into patients with chronic pain and SI including the domains that provide them with meaning in their lives and the impact of pain on these domains with regard to SI. Main clinical implications concern both prevention and supportive/psychotherapeutic interventions. They are based on a narrative approach aiming to explore with the patients the contents of their suffering and the MiL domains that they could identify to mitigate it, in order to restructure/reinforce these domains and thus possibly reduce SI. Specifically, as resulting from our study, a focus addressed on maintaining the domains of interpersonal relationships and personal activities can allow the patients to ultimately escape the bio-psycho-social vicious cycle of chronic pain-induced deep moral suffering. CLINICALTRIAL