Adverse Childhood Experiences Moderate the Relationship between Pain and Later Suicidality Severity Among Youth: A Longitudinal High-Risk Cohort Study

Perri R Tutelman; Melanie Noel; Emily Bernier; Fiona S M Schulte; Daniel C Kopala-Sibley

doi:10.1016/j.jpain.2024.104554

Adverse Childhood Experiences Moderate the Relationship between Pain and Later Suicidality Severity Among Youth: A Longitudinal High-Risk Cohort Study

J Pain. 2024 May 6:104554. doi: 10.1016/j.jpain.2024.104554. Online ahead of print.

Authors

Perri R Tutelman¹, Melanie Noel², Emily Bernier³, Fiona S M Schulte⁴, Daniel C Kopala-Sibley⁵

Affiliations

¹ Department of Oncology, University of Calgary, Calgary, AB, Canada; Department of Psychology, University of Calgary, Calgary, AB, Canada.
² Department of Psychology, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, Calgary, AB, Canada; Hotchkiss Brain Institute, Calgary, AB, Canada; Mathison Centre for Mental Health Research and Education, Calgary, AB, Canada; Owerko Centre, Calgary, AB, Canada.
³ Department of Psychology, University of Calgary, Calgary, AB, Canada.
⁴ Department of Oncology, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, Calgary, AB, Canada.
⁵ Alberta Children's Hospital Research Institute, Calgary, AB, Canada; Hotchkiss Brain Institute, Calgary, AB, Canada; Mathison Centre for Mental Health Research and Education, Calgary, AB, Canada; Department of Psychiatry, University of Calgary, Calgary, AB, Canada. Electronic address: daniel.kopalasibley@ucalgary.ca.

PMID: 38719156
DOI: 10.1016/j.jpain.2024.104554

Abstract

Pain in adolescence can lead to the development of serious mental health issues, including suicidality. This risk may be strengthened among youth exposed to more adverse childhood experiences (ACEs; abuse, neglect, household challenges). This longitudinal study examined the role of ACEs in the relationship between pain and later suicidality onset and severity among a cohort of adolescents at risk for developing mental health problems. Participants were 139 healthy youth (M_age=13.74 years, SD=1.56, 64% female) between the ages of 11-17 years, recruited based on parental history of depression or anxiety. Youth completed validated measures of internalizing symptoms, ACEs, and pain characteristics at baseline and follow-up diagnostic interviews 9- and/or 18-months later to assess for onset and severity of suicidality. After controlling for demographics, baseline internalizing symptoms, and ACEs, worse pain interference and increased ACEs at baseline predicted increased suicidality severity at follow-up. Moderation analyses revealed that there was a significant interaction between ACEs and pain interference and pain intensity. Increased pain interference (b = 7.65, p <.0001) or intensity (b = 6.96, p =.0003) was only associated with increased suicidality severity at follow-up in youth with high levels of ACEs. This study demonstrates that ACEs strengthen the relationship between pain and later suicidality severity among youth at risk of developing mental health problems. Findings underscore the critical need to adopt a trauma informed lens to pediatric pain prevention and treatment (e.g., screening for ACEs), and for pain to be on the child mental health agenda. PERSPECTIVE: This article provides evidence that while pain is a risk factor for future increased suicidality severity, it is a particularly strong risk factor in youth who experienced increased childhood adversity. These results may help identify youth at greatest risk for suicidality.

Keywords: Adverse childhood experiences; adolescence; mental health; pain; suicidality.