Open AccessPredictors of Homicide–Suicide Affirmation in Acute and Chronic Pain Patients
Author(s) -
Fishbain David A,
Bruns Daniel,
Lewis John E,
Disorbio John Mark,
Gao Jinrun,
Meyer Laura J
Publication year - 2011
Publication title -
pain medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.893
H-Index - 97
eISSN - 1526-4637
pISSN - 1526-2375
DOI - 10.1111/j.1526-4637.2010.01013.x
Subject(s) - medicine , rehabilitation , homicide , population , psychiatry , chronic pain , clinical psychology , suicide prevention , poison control , physical therapy , medical emergency , environmental health
Objectives. 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. Design. 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. Setting. 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. Conclusion. 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.