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Evaluation Of Suicidality, Cognitions, And Pain Experience (ESCAPE): Implications For Cognitive Behavioral Therapy In Military Populations

Principal Investigator(s): Kathryn E. Kanzler, PsyD, Andrews Air Force Base
Don McGeary, PhD, ABPP, University of Texas Health Science Center
Craig J. Bryan, PsyD, ABPP, National Center for Veterans Studies
Funding Agency: Department of Defense
Collaborating Institutions: Wilford Hall Medical Center, Lackland Air Force Base
University of Texas Health Science Center at San Antonio
Status: Active
Tags Military Suicide


In this anonymous survey study, we are seeking to understand how chronic pain is related to mental health problems and suicide risk among active duty military personnel, veterans, and family members who are receiving outpatient psychological treatment for pain-related disorders. To date, we have found that pain intensity and suicide-specific beliefs such as perceived burdensomeness (i.e., the belief that others would be better off without you) are important predictors of suicidal thoughts among patients with chronic pain.

Suicidal Ideation And Perceived Burdensomeness In Patients With Chronic Pain


There is a clear relationship between suicide risk and chronic pain conditions. However, the exact nature of this link has been poorly understood, with risk attribution often limited to comorbid depression. Perceived burdensomeness has already been confirmed as a risk factor for suicidal ideation (SI) and suicide attempt in the general population. Self-perceived burden, studied among medically and terminally ill medical populations, has begun to receive a great deal of attention as a suicide risk factor. However, this risk has not been considered in an outpatient chronic pain population, a group likely to experience perceived burdensomeness as a particular problem. Guidelines recommend routine suicide risk screening in medical settings, but many questionnaires are time-consuming and do not allow for the assessment of the presence of newly identified risk constructs, such as perceived burdensomeness. This retrospective study examined the relationship between depression, perceived burdensomeness, and SI in a patient sample seeking behavioral treatment for chronic pain management. A logistic regression model was developed, with preliminary results indicating perceived burdensomeness was the sole predictor of SI, even in the presence of other well-established risk factors such as age, gender, depressive symptoms, and pain severity. Findings highlight the potential utility of a single-item screening question in routine clinical care as an incrementally superior predictor of SI in a chronic pain population.


Kanzler, K.E., Bryan, C.J., Morrow, C.E., & McGeary, D.D. (2012). Suicidal ideation and perceived burdensomeness in patients with chronic pain. Pain Practice, 12, 602-609. Full text available at

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For questions or comments on this project, please contact:

Craig Bryan, PsyD
Last Updated: 9/28/17