{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T15:37:19Z","timestamp":1784302639913,"version":"3.55.0"},"reference-count":55,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2022,4,29]],"date-time":"2022-04-29T00:00:00Z","timestamp":1651190400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"DOI":"10.13039\/100000071","name":"National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["R21 HD089098-01."],"award-info":[{"award-number":["R21 HD089098-01."]}],"id":[{"id":"10.13039\/100000071","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007217","name":"Health Services Research and Development","doi-asserted-by":"publisher","award":["IK6HX002608"],"award-info":[{"award-number":["IK6HX002608"]}],"id":[{"id":"10.13039\/100007217","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["8UL1TR000105 (formerly UL1RR025764)"],"award-info":[{"award-number":["8UL1TR000105 (formerly UL1RR025764)"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Given the relatively high rates of suicidal ideation and attempt among people with chronic pain, there is a need to understand the underlying factors to target suicide prevention efforts. To date, no study has examined the association between pain phenotypes and suicide related behaviors among those with mild traumatic brain injuries.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Objective<\/jats:title>\n<jats:p>To determine if pain phenotypes were independently associated with suicidal ideation \/ attempt or if comorbidities within the pain phenotypes account for the association between pain phenotypes and suicide related behaviors.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Methods<\/jats:title>\n<jats:p>This is a longitudinal retrospective cohort study of suicide ideation\/attempts among pain phenotypes previously derived using general mixture latent variable models of the joint distribution of repeated measures of pain scores and pain medications\/treatment. We used national VA inpatient, outpatient, and pharmacy data files for Post-9\/11 Veterans with mild traumatic injury who entered VA care between fiscal years (FY) 2007 and 2009. We considered a counterfactual causal modeling framework to assess the extent that the pain phenotypes during years 1\u20135 of VA care were predictive of suicide ideation\/attempt during years 6\u20138 of VA care conditioned on covariates being balanced between pain phenotypes.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Results<\/jats:title>\n<jats:p>Without adjustment, pain phenotypes were significant predictors of suicide related behaviors. When we used propensity scores to balance the comorbidities present in the pain phenotypes, the pain phenotypes were no longer significantly associated with suicide related behaviors.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>These findings suggest that suicide ideation\/attempt is associated with pain trajectories primarily through latent multimorbidity. Therefore, it is critical to identify and manage comorbidities (e.g., depression, post-traumatic stress disorder) to prevent tragic outcomes associated with suicide related behaviors throughout the course of chronic pain and mild traumatic brain injury management.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0267844","type":"journal-article","created":{"date-parts":[[2022,4,29]],"date-time":"2022-04-29T17:30:38Z","timestamp":1651253438000},"page":"e0267844","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["Complex pain phenotypes: Suicidal ideation and attempt through latent multimorbidity"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6642-8753","authenticated-orcid":true,"given":"Kangwon","family":"Song","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4695-0290","authenticated-orcid":true,"given":"Ben J.","family":"Brintz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen-Pin","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9660-2652","authenticated-orcid":true,"given":"Donald D.","family":"McGeary","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cindy A.","family":"McGeary","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer S.","family":"Potter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos A.","family":"Jaramillo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Blessen C.","family":"Eapen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary Jo","family":"Pugh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,4,29]]},"reference":[{"key":"pone.0267844.ref001","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1056\/NEJMoa072972","article-title":"Mild Traumatic Brain Injury in U.S. Soldiers Returning from Iraq","volume":"358","author":"CW Hoge","year":"2008","journal-title":"N Engl J Med"},{"key":"pone.0267844.ref002","doi-asserted-by":"crossref","first-page":"1446","DOI":"10.1093\/aje\/kwn068","article-title":"Understanding sequelae of injury mechanisms and mild traumatic brain injury incurred during the conflicts in Iraq and Afghanistan: persistent postconcussive symptoms and posttraumatic stress disorder","volume":"167","author":"AI Schneiderman","year":"2008","journal-title":"Am J Epidemiol"},{"key":"pone.0267844.ref003","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1001\/jamaneurol.2018.3487","article-title":"Association of Concussion With the Risk of Suicide: A Systematic Review and Meta-analysis","volume":"76","author":"M Fralick","year":"2019","journal-title":"JAMA Neurol"},{"key":"pone.0267844.ref004","doi-asserted-by":"crossref","first-page":"E359","DOI":"10.36076\/ppj.2014\/17\/E359","article-title":"Prevalence of suicidal ideation in patients with chronic non-cancer pain referred to a behaviorally based pain program","volume":"17","author":"MD Cheatle","year":"2014","journal-title":"Pain Physician"},{"key":"pone.0267844.ref005","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1001\/jamapsychiatry.2013.908","article-title":"Noncancer Pain Conditions and Risk of Suicide","volume":"70","author":"MA Ilgen","year":"2013","journal-title":"JAMA Psychiatry"},{"key":"pone.0267844.ref006","unstructured":"Llorente E. 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