The benefits of making peace with pain: chronic pain acceptance moderates the indirect effect of perceived burdensomeness between pain severity and suicidal cognitions.

OBJECTIVE: The purpose of this study was (1) to examine the degree to which perceived burdensomeness mediates the relationship between pain severity and suicidal cognitions and (2) to determine whether this mediated relationship was moderated by pain acceptance. We predicted that high levels of pain acceptance would buffer relationships on both paths of the indirect effect. METHODS: Two-hundred seven patients with chronic pain completed an anonymous self-report battery of measures, including the Chronic Pain Acceptance Questionnaire, the Interpersonal Needs Questionnaire, the Suicidal Cognitions Scale, and the pain severity subscale of the West Haven-Yale Multidimensional Pain Inventory. Conditional process models were examined with Mplus. RESULTS: Chronic pain acceptance significantly moderated both paths of the mediation model. Results from the conditional indirect effect model indicated that the indirect effect was significant for those with low (b = 2.50, P = .004) and medium (b = 0.99, P = .01) but not high (b = 0.08, P = .68) levels of pain acceptance and became progressively stronger as pain acceptance scores decreased. The nonlinear indirect effect became nonsignificant at acceptance scores 0.38 standard deviation above the mean-a clinically attainable treatment target. CONCLUSIONS: Higher acceptance mitigated the relationship between pain severity and perceived burdensomeness and the relationship between perceived burdensomeness and suicidal cognitions in this clinical sample of patients experiencing chronic pain. Findings indicate that any improvement in pain acceptance can be beneficial, and they provide clinicians with a clinical cut-point that might indicate lower vs higher suicide risk.

Traumatic events and adolescent psychopathology in a United States national probability sample.

Objective: Exposure to traumatic events has been associated with psychiatric symptoms and prevalence of psychiatric disorders in adolescents. This study was conducted to examine, in a U.S. probability sample of adolescents, the association between lifetime exposure to traumatic events and current (i.e., 30-day) severity of serious emotional disturbance (SED) using a brief screening measure commonly adopted for monitoring psychopathology in epidemiological surveys and community, educational, and clinical settings. Method: Data on lifetime prevalence of 17 traumatic events and a measure of SED (i.e., the Kessler Psychological Distress Scale) was examined in the National Comorbidity Survey Adolescent Supplement, a probability sample of 13-18-year-old adolescents (N = 10,106). Results: Sixty percent of adolescents reported experiencing at least one traumatic event, and the mean number of events reported was 1.3. Adjusting for demographics, 16 of 17 traumatic events were significantly and positively associated with SED, with traumas involving interpersonal violence having especially large effect sizes. The largest effect sizes were obtained for having been (a) badly beaten by date or romantic partner, (b) raped, and (c) badly beaten by parents or guardians. Fourteen of the traumatic events were significantly associated with SED when all 17 events were examined simultaneously, thereby providing evidence for the specificity of these associations. Conclusions: Results suggest that a broad range of traumatic events are uniquely associated with current severity of psychopathology in adolescents, using a measure commonly used in epidemiological surveys and community, educational, and clinical settings. Findings highlight the importance of traumas involving interpersonal violence for adolescent mental health. (PsycInfo Database Record (c) 2021 APA, all rights reserved).