• Shannon M Blakey, WagnerH RyanHRVeterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, North Carolina; Durham VA Medical Center, Durham, North Carolina; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center,, Jennifer Naylor, Mira Brancu, Ilana Lane, Meghann Sallee, Nathan A Kimbrel, VA Mid-Atlantic MIRECC Workgroup, and Eric B Elbogen.
• Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. Electronic address: sblakey@unc.edu.
• J Pain. 2018 Jul 1; 19 (7): 797806797-806.

UnlabelledThe polytrauma clinical triad refers to the co-occurrence of chronic pain, traumatic brain injury (TBI), and posttraumatic stress disorder (PTSD). Despite research implicating dyadic relationships between these conditions and adverse outcomes, scant research has examined the polytrauma clinical triad's relation to suicide or violence. The present cross-sectional study was designed to examine whether this complex clinical presentation increases risk of suicidal ideation and violent impulses after accounting for other established risk factors. Veterans who served in the military since September 11, 2001 (N = 667) who reported chronic pain completed an interview and self-report battery. Bivariate analyses showed that suicidal ideation and violent impulses both correlated with PTSD, TBI+PTSD, pain intensity and interference, drug abuse, and major depressive disorder (MDD). Multiple regression analyses showed that: 1) race, chronic pain with PTSD, alcohol abuse, and MDD significantly predicted suicidal ideation, 2) pain interference, chronic pain with TBI, chronic pain with PTSD, chronic pain with TBI+PTSD, drug abuse, and MDD significantly predicted violent impulses, and 3) pain interference was a more critical predictor of suicidal and violent ideation than pain intensity. Implications for risk assessment and treatment are discussed.PerspectiveThis article presents results from a study examining predictors of suicide and violence risk among a sample of post-9/11 U.S. Veterans with chronic pain. Health care professionals should assess for pain interference, TBI, PTSD, depression, and alcohol/drug abuse when conducting risk assessments with this population.Copyright © 2018 The American Pain Society. All rights reserved.

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