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      Meaning in Life Among Patients With Chronic Pain and Suicidal Ideation: Mixed Methods Study

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          Abstract

          Background

          Patients with chronic pain have elevated risk of suicidal ideation and behavior, including suicide attempts and completed suicides. In most studies, associations between chronic pain and suicidal ideation/suicidal behavior are robust even after adjusting for the effect of sociodemographics 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). This study aimed 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 suicidal ideation.

          Methods

          Seventy participants were enlisted by ongoing recruitment through a larger project anchored in daily clinical practice at the Multidisciplinary Pain Center of the Geneva University Hospitals. It was an observational mixed method study. Data were recorded through both validated quantitative questionnaires and qualitative open-ended questions.

          Results

          The total sample consisted of 70 patients. Responses to questionnaires showed a depressive episode in 68 (97%) patients and anxious disorders in 25 (36%) patients. With a score threshold for positive MiL of 24, the mean score for the “presence of” construct was 20.13 (SD 8.23), and 63% (44/70) of respondents had a score <24. The mean score for the “search for” construct was lower at 18.14 (SD 8.64), and 70% (49/70) of respondents had a score <24. The “presence of” and “search for” constructs were significantly positively correlated ( R=0.402; P=.001). An open question addressed the “presence of” construct by inviting the respondents to cite domains they consider as providing meaning in their life at the present time. All patients responded to this question, citing one or more domains. The three main dimensions that emerged from content analysis of this qualitative section were as follows: the domain of relationships, the domain of personal activities, and pain and its consequences on MiL.

          Conclusions

          The study results provide insights into patients with chronic pain and suicidal ideation, including the domains that provide them with meaning in their lives and the impact of pain on these domains with regard to suicidal ideation. The main clinical implications concern both prevention and supportive/psychotherapeutic interventions. They are based on a narrative approach aiming to explore with the patients the content 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 suicidal ideation. Specifically, a focus on maintaining the domains of interpersonal relationships and personal activities can allow patients to ultimately escape the biopsychosocial vicious cycle of chronic pain–induced deep moral suffering.

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          Most cited references57

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          How Many Interviews Are Enough?: An Experiment with Data Saturation and Variability

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                Author and article information

                Contributors
                Journal
                JMIR Form Res
                JMIR Form Res
                JFR
                JMIR Formative Research
                JMIR Publications (Toronto, Canada )
                2561-326X
                June 2021
                4 June 2021
                : 5
                : 6
                : e29365
                Affiliations
                [1 ] Department of Psychiatry Faculty of Medicine University of Geneva Geneva Switzerland
                [2 ] Division of Clinical Pharmacology & Toxicology Multidisciplinary Pain Centre Geneva University Hospitals Geneva Switzerland
                [3 ] Department of Psychiatry Service of Liaison Psychiatry and Crisis Intervention Geneva University Hospitals Geneva Switzerland
                [4 ] Division of General Medical Rehabilitation Geneva University Hospitals Geneva Switzerland
                [5 ] Department of Geriatrics and Rehabilitation Faculty of Medicine University of Geneva Geneva Switzerland
                Author notes
                Corresponding Author: Alessandra Costanza alessandra.costanza@ 123456unige.ch
                Author information
                https://orcid.org/0000-0001-6387-6462
                https://orcid.org/0000-0002-1897-3578
                https://orcid.org/0000-0001-5830-9252
                https://orcid.org/0000-0003-1804-1903
                https://orcid.org/0000-0001-7151-3450
                https://orcid.org/0000-0002-4352-5531
                https://orcid.org/0000-0002-3743-5644
                Article
                v5i6e29365
                10.2196/29365
                8214181
                34003136
                a8d44cda-bee0-499b-98fa-215a3caf5053
                ©Alessandra Costanza, Vasileios Chytas, Valérie Piguet, Christophe Luthy, Viridiana Mazzola, Guido Bondolfi, Christine Cedraschi. Originally published in JMIR Formative Research (https://formative.jmir.org), 04.06.2021.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Formative Research, is properly cited. The complete bibliographic information, a link to the original publication on https://formative.jmir.org, as well as this copyright and license information must be included.

                History
                : 3 April 2021
                : 24 April 2021
                : 6 May 2021
                : 16 May 2021
                Categories
                Original Paper
                Original Paper

                suicide,suicidal behavior,suicidal ideation,suicide attempt,chronic pain,meaning in life,protective factors,risk factors,mental health

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