John Mark Disorbio

Risk for Five Forms of Suicidality in Acute Pain Patients and Chronic Pain Patients vs Pain‐Free Community Controls

OBJECTIVES . The objective of this study was to determine the risk for five forms of suicidality in rehabilitation acute pain patients (APPs) and rehabilitation chronic pain patients (CPPs) vs pain-free community controls. DESIGN The Battery for Health Improvement 2 was developed utilizing a healthy (pain-free) community sample (N = 1,478), a community patient sample (N = 158), and a rehabilitation patient sample (N = 777). These groups were asked five suicidality questions relating to history of wanting to die, wanting to die because of pain, recent frequent suicide ideation, having a suicide plan, and history of suicide attempt. Of the rehabilitation patients, 326 were identified as being APPs, 341 as being CPPs, and 110 as having no pain. The risk for affirming each of the five suicidality questions was calculated for rehabilitation APPs, rehabilitation CPPs, and rehabilitation patients without pain utilizing the healthy pain-free community sample as the reference group. In addition, risk was calculated for various subgroups of rehabilitation patients: those with workers compensation status, with litigation status, and with personal injury status. SETTING There are a variety of settings. RESULTS In rehabilitation CPPs the risk for suicidality was greater than community pain-free controls for three suicidality questions: history of wanting to die, recent frequent suicide ideation, and having a suicide plan. Workers compensation status, litigation status, and personal injury status appeared to increase risk for affirmation of some types of suicidality in CPPs. Rehabilitation APPs were at greater risk for all five suicidality items than the community pain-free controls. CONCLUSION Rehabilitation CPPs are at greater risk for some forms of suicidality than community pain-free controls. This risk is increased by variables such as workers compensation status, litigation status, and personal injury status. However, it is yet unclear if these variables actually predict suicidality as this requires further analysis.

Assessment of Biopsychosocial Risk Factors for Medical Treatment: A Collaborative Approach

There is a growing body of evidence that psychosocial variables have a significant ability to predict the outcome of medical treatment procedures, especially when the procedure is performed to reduce pain. The study described in this paper serves as an illustration of the valuable role psychologists can play in dealing with the challenges of biopsychosocial assessment of patients who are candidates for medical treatments, especially elective, invasive procedures. Based on a convergent model of risk factors that can potentially influence outcomes from spinal surgery and spinal cord stimulation, exclusionary and cautionary risk factors were identified, and the BHI 2 and BBHI 2 tests were used to assess them. An estimate of the prevalence of these risk factors was calculated using data obtained from 1,254 patient and community subjects gathered from 106 sites in 36 US states. Standardized Cautionary Risk and Exclusionary Risk scores demonstrated a test-retest reliability of .85 to .91. Evidence of validity of these scores was also provided based on subjective and objective criteria, using multiple groups of patients and community subjects. Recommendations are made regarding how biopsychosocial assessments could be used in collaborative settings for presurgical candidates to identify risks that could compromise a patient’s ability to benefit from other medical treatments as well. Once identified, appropriate interventions could ameliorate these risks, or lead to the consideration of other treatments that are more likely to be effective. Methods of refining this approach for specific clinical applications are also discussed.

Correlates of self-reported violent ideation against physicians in acute--and chronic-pain patients

OBJECTIVES Physicians are at risk for patient-perpetrated violence. This study attempts to identify predictors for violent ideation against medical doctors (VI-MD), in acute-pain patients (APPs) and chronic-pain patients (CPPs). This is the first such study in the literature. DESIGN Patients were asked if they had thoughts of killing one of their physicians (VI-MD) during the development of the Battery for Health Improvement (BHI 2). This instrument was developed utilizing a healthy community sample (n = 1,478), a community patient sample (n = 158) and a rehabilitation patient sample (patients undergoing rehabilitation for pain or physical injury in a variety of settings) (n = 777). Of the rehabilitation patient sample, 326 were identified as APPs, 341 as CPPs, and 110 as having no pain. The APPs and CPPs were compared for the risk of affirming VI-MD, and those two groups were then compared by t-test and chi(2)-square on categorical demographic variables, categorical nondemographic variables, and BHI 2 scale scores. Significant variables (P < 0.001) were then utilized as independent variables in logistic regression models for APPs and CPPs to predict VI-MD affirmation. SETTING Patients treated in a variety of settings. RESULTS Risk for affirmation of VI-MD was increased in the following groups relative (number of times) to the healthy community sample as follows: rehabilitation patients, 3.5; rehabilitation patients without pain, 2.8; rehabilitation patients with acute pain, 3.1; rehabilitation patients with chronic pain, 4.1; rehabilitation patients with Workers Compensation or personal injury 4.6; rehabilitation patients with litigation 7.3; and rehabilitation patients with Workers Compensation and litigation and chronic pain, 10.4. In the APPs logistic regression models, demographic variables did not predict VI-MD affirmation, but some BHI 2 scales and items did (P < 0.001). These pertained to depression, hostility and doctor dissatisfaction (angry at the physician). A high perseverance score on the BHI 2 predicted against VI-MD affirmation among APPs. For CPPs, three major variables predicted VI-MD affirmation: being in litigation; borderline traits and doctor dissatisfaction (trusting/not trusting the physician, forced to see physician, patient does not trust). The logistic regressions classified 95.7% of APPs and CPPs correctly. However, because of the total low numbers of rehabilitation patients affirming VI-MD (5.5%), the logistic regression prediction was only slightly better than the base rate prediction of 94.5%. CONCLUSIONS Being a rehabilitation patient increases the relative risk of affirming VI-MD. This risk is further increased by such variables as chronic pain, Workers Compensation status, personal injury status, and, most important, litigation. We cannot as yet predict VI-MD affirmation significantly better than base rate prediction. Some variables implicated in this study for VI-MD affirmation relate to the physician-patient interaction and are clinically useful.

Borderline personality disorder features and pain: the mediating role of negative affect in a pain patient sample.

ObjectivesThere is considerable evidence that personality disorders, including borderline personality disorder (BPD), tend to co-occur with chronic pain. There is also evidence that mood disorders co-occur with chronic pain conditions. Given the central role of affective instability and negative mood states in BPD, we proposed that affective features of depression, anxiety, and hostility may account for the association between BPD features and the severity of pain reported in a patient sample. MethodsSeven hundred seventy-seven patient participants completed the Battery for Health Improvement. This included measures of DSM-IV BPD features, affect scales (depression, anxiety, hostility), and pain items assessing the severity of pain and somatic symptoms. ResultsAs predicted, individuals with higher levels of BPD features reported greater severity of pain and somatic complaints, including higher levels of maximum and minimum pain levels in the past month. In addition as predicted, this association was no longer significant after controlling for affect scales. In particular, depression was strongest in accounting for this association. DiscussionThese results indicate that the association between BPD features and pain is accounted for by negative affect, primarily in the form of depression. This is consistent with current theoretical perspectives on BPD. This also suggests that clinicians observing or detecting BPD features among pain patients should consider negative affect, especially depression, in addressing these issues.

Variables Associated with Self‐Prediction of Psychopharmacological Treatment Adherence in Acute and Chronic Pain Patients

Objectives:  The objectives of this article were the following: (1) determine risk for self‐predicted future psychopharmacological nonadherence in rehabilitation acute pain patients (APPs) and rehabilitation chronic pain patients (CPPs) vs. pain‐free community controls and community patients, and (2) determine which variables predict nonadherence.

Prevalence comparisons of somatic and psychiatric symptoms between community nonpatients without pain, acute pain patients, and chronic pain patients

OBJECTIVES Somatic/psychiatric symptoms are frequently found in chronic pain patients (CPPs). The objectives of this study were to determine 1) which somatic/psychiatric symptoms are more commonly found in acute pain patients (APPs) and CPPs vs community nonpatients without pain (CNPWPs) and 2) if somatic/psychiatric symptom prevalence differs between APPs and CPPs. DESIGN The above groups were compared statistically for endorsement of 15 symptoms: fatigue, numbness/tingling, dizziness, difficulty opening/closing mouth, muscle weakness, difficulty staying asleep, depression, muscle tightness, nervousness, irritability, memory, falling, nausea, concentration, and headaches. RESULTS After controlling for age, gender, and level of pain, APPs and CPPs had a statistically significantly greater prevalence (at a P < 0.01 level) for 11 and 13 symptoms, respectively, vs CNPWPs. After controlling for age, gender, and level of pain, CPPs had a statistically significantly greater prevalence (at a P < 0.01 level) for eight symptoms vs APPs. Symptoms were highly correlated in both APPs and CPPs. CONCLUSIONS CPPs are characterized to a significantly greater extent than comparison groups by somatic/psychiatric symptoms that are highly intercorrelated. This has implications for clinical practice and future research.

Exploration of the Relationship Between Disability Perception, Preference for Death over Disability, and Suicidality in Patients with Acute and Chronic Pain

HYPOTHESIS Passive, active, and historical suicidality are associated with preference for death over disability. DESIGN Community nonpatients without pain, community patients with pain, and patients with acute and chronic pain were compared for endorsement of disability perception and preference for death over disability. Phi correlations and chi-square analyses were calculated between preference for death over disability and six suicidality items representing passive, active, and historical suicidality. Logistic regression was used to predict preference for death over disability in patients with acute and chronic pain. RESULTS For patients with acute and chronic pain, endorsement of preference for death over disability correlated significantly with all six suicidality items. The logistic regression models identified the following variables as predictors for preference for death over disability in patients with acute pain: the Behavior Health Inventory (BHI 2) family dysfunction scale, history of wanting to die, and disability perception. For patients with chronic pain, predictors were the BHI 2 Borderline scale, history of wanting to die, treated fairly by family item, frequent suicide ideation, people I trust turn on me item, and disability perception. Preference for death over disability was a statistically significant predictor in patients with chronic pain for disability perception, recent suicide ideation, having a suicidal plan, and a history of wanting to die but was not a significant predictor for any suicide items in patients with acute pain. CONCLUSION Preference for death over disability is associated with passive and active suicide ideation and historical suicidality in patients with chronic pain.

Exploration of Anger Constructs in Acute and Chronic Pain Patients vs. Community Patients

Objectives:  (1) Determine and compare prevalence of forms of anger (FOA; anger, hostility, aggression, anger‐in, anger‐out, chronic anger) in community nonpatients (n = 478), community patients (n = 158), acute pain patients (APPs; n = 326), chronic pain patients (CPPs; n = 341); and (2) develop FOA predictor models in APPs and CPPs.

The Psychological Evaluation of Patients with Chronic Pain: a Review of BHI 2 Clinical and Forensic Interpretive Considerations

Pain is the most common reason why patients see a physician. Within the USA, it has been estimated that at least 116 million US adults suffer from chronic pain, with an estimated annual national economic cost of

The Psychological Assessment of Patients with Chronic Pain

560–635 billion. While pain is in part a sensory process, like sight, touch, or smell, pain is also in part an emotional experience, like depression, anxiety, or anger. Thus, chronic pain is arguably the quintessential biopsychosocial condition. Due to the overwhelming evidence of the biopsychosocial nature of pain and the value of psychological assessments, the majority of chronic pain guidelines recommend a psychological evaluation as an integral part of the diagnostic workup. One biopsychosocial inventory designed for the assessment of patients with chronic pain is the Battery for Health Improvement 2 (BHI 2). The BHI 2 is a standardized psychometric measure, with three validity measures, 16 clinical scales, and a multidimensional assessment of pain. This article will review how the BHI 2 was developed, BHI 2 concepts, validation research, and an overview of the description and interpretation of its scales. Like all measures, the BHI 2 has strengths and weaknesses of which the forensic psychologist should be aware, and particular purposes for which it is best suited. Guided by that knowledge, the BHI 2 can play a useful role in the forensic psychologist’s toolbox.