Child Maltreatment, Depression and Suicide in Adolescents with Chronic Pain

Background and Purpose: Chronic pain decreases the quality of life across the lifespan and increases the risk for suicidal thoughts and behaviors. Maltreated children may also be more likely to experience some forms of chronic pain and thus, be more at risk for suicide. Both child maltreatment and pain have also been associated with depression which is a primary factor in suicide ideation/behavior. This study examines the relationship between chronic pain, child maltreatment and suicide ideation/behavior in adolescents. Our primary aim is to determine if the association with child maltreatment and chronic pain with suicide ideation/behavior may be at least partially mediated by depression.

Methods:  Path analysis is used to model the relationships between pain, child maltreatment, depression, and suicide ideation/behavior in a large national sample of adolescents (N=592). Separate models are tested for stomachaches and headaches.

Results:  Both stomach and head pain models are a good fit (χ² (1) =1.508 p=0.220 and χ² (1) = 0.881, p=0.348, respectively). Results indicate both stomach and head pain have a significant direct relationship with suicide ideation/behaviors (β=0.636, p<0.001 and β=0.823, p<0.05, respectively). The relationship between suicide ideation/behaviors and both stomach pain and child maltreatment are partially mediated by depression. Head pain and child maltreatment are significantly correlated, but the relationship between head pain and suicide is not mediated by depression, although depression does mediate the relationship between child maltreatment and suicide thoughts/behaviors (β=0.862, p<0.001).       

 Conclusion:  Headaches, stomachaches, and child maltreatment are associated with suicide ideation/behaviors. Our results support the hypothesis that the relationship between child maltreatment, stomach pain and suicide is partially mediated by depression, but did not support the hypothesis that the relationship between head pain and suicide is mediated by depression. Child maltreatment is also significantly correlated with head pain and suicide, although this cannot be explained by depression. Future research might consider other variables that may better explain the relationship between head pain and suicide. Social workers should consider screening for depression and suicide in adolescents reporting chronic stomach pain. Social workers working with the child welfare population might consider screening for chronic pain as a risk factor for both depression and suicide, and initiating necessary referrals. Early screening and treatment may prevent suicide and increase overall quality of life for maltreated children in adolescence and throughout adulthood.