Does depression moderate the relationship between pain and suicidality in adolescence? A moderated network analysis

Abstract

Background: Whilst growing research suggests that pain is associated with suicidality in adolescence, it remains unclear whether this relationship is moderated by co-morbid depressive symptoms. The present study aimed to investigate whether the pain-suicidality association is moderated by depressive symptoms.

Methods: We performed secondary analyses on cross-sectional, pre-intervention data from the 'My Resilience in Adolescence' [MYRIAD] trial (ISRCTN ref: 86619085; N=8072, 11-15 years). Using odds ratio tests and (moderated) network analyses, we investigated the relationship between pain and suicidality, after controlling for depression, anxiety, inhibitory control deficits and peer problems. We investigated whether depression moderates this relationship and explored gender differences.

Results: Overall, 20% of adolescents reported suicidality and 22% reported pain, whilst nine percent of adolescents reported both. The experience of pain was associated with a four-fold increased risk of suicidality and vice versa (OR=4.00, 95%-CI=[3.54;4.51]), with no gender differences. This cross-sectional association remained significant after accounting for depression, anxiety, inhibitory control deficits and peer problems (aOR=1.39). Depression did not moderate the pain-suicidality association.

Limitations: The item-based, cross-sectional assessment of pain and suicidality precludes any conclusions about the direction of the effects and which aspects of suicidality and pain may drive this association.

Conclusions: Our findings underscore the need to consider pain as an independent risk correlate of suicidality in adolescents. Longitudinal research should examine how this relationship develops during adolescence. Clinically, our findings emphasise the need to assess and address suicidality in adolescents with pain, even in the absence of depressive symptoms.

Keywords: Adolescence; Depression; Network analysis; Pain; Self-harm; Suicidality.

Fig. 1

Representation of the potential pain-suicidality association in adolescence.

Fig. 2

Pairwise network models for the whole sample and both genders. The light blue part of the rings represents the predictability by the intercept model. The dark blue part represents the additional predictability in a given node by all other nodes in the network. The sum of both blue parts reveals the predictability of the whole model. The green edge represents a positive weight between binary variables and the grey edges represent relationships between categorical variables of more than two levels, for which more than one parameter is estimated and therefore no sign can be defined. Legend: Inhibition=Inhibitory Control Deficits, Peers=Peer Problems, Pain=Combined pain measure.

Fig. 3

Moderated network models conditioned on the different levels of depression. Legend: 0 = ‘normal’, 1 = ‘at risk’ and 2 = ‘caseness’. Inhibition = Inhibitory control deficits, Peers = Peer problems, Pain = Combined pain measure.