Mental Defeat Predicts Increased Suicide Risk in Chronic Pain: A 12-Month Prospective Study.

Themelis K, Gillett JL, Karadag P, Cheatle MD, Ilgen MA, Balasubramanian S, Singh SP, Tang NKY. Mental Defeat Predicts Increased Suicide Risk in Chronic Pain: A 12-Month Prospective Study. European journal of pain (London, England). 2025 Feb 1; 29(2):e4779.

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Abstract:

BACKGROUND: Mental defeat is considered a potential risk factor for suicidal thoughts and behaviours in chronic pain. This study evaluated the role of mental defeat in predicting future suicide risk and examined whether depression influences this relationship. METHODS: A total of 340 participants with chronic pain completed questionnaires at two time points, 12?months apart. Data collected included sociodemographic and pain characteristics, mental defeat, psychosocial risk factors including depression and health-related variables. Weighted univariate and multivariable analyses assessed the link between mental defeat and suicide risk, with a moderation analysis testing the role of depression. RESULTS: Higher levels of mental defeat and depression were linked to increased suicide risk at 12?months. Depression significantly amplified the effect of mental defeat on suicide risk, particularly in individuals with higher depression levels (B? = 0.06, SE? = 0.01, t? = 6.21, p? < 0.001) compared with moderate (B? = 0.05, SE? = 0.01, t? = 5.20, p? < 0.001) or low levels of depression (B? = 0.04, SE? = 0.01, t? = 2.83, p? = 0.004), indicating a dose-response relationship. CONCLUSIONS: Mental defeat is a significant risk factor for suicide in chronic pain, with depression intensifying this risk. Addressing both mental defeat and depression simultaneously in treatment may help reduce suicide risk in these patients. SIGNIFICANCE: This study strengthens the evidence linking mental defeat with heightened suicide risk in chronic pain. By providing prospective data, it clarifies the temporality of this relationship. Given that suicide risk doubles in chronic pain patients, whereby comorbid depression is common, these findings have crucial clinical implications. Both mental defeat and depression are modifiable. Addressing them together in treatment may help reduce suicide risk in this population.