Chronic Pain, Metacognition and Suicidality in Traumatic Brain Injured Patients Following a Road Traffic Accident

Chronic pain (CP) can contribute to excessive negative emotional states and pain behaviour that can exacerbate its clinical profiles, perception of disability and its treatment. Metacognitions can affect the experience of pain intensity. The concept embodies, amongst others, thoughts and beliefs regarding regulating internal cognitive processes. Traumatic brain injury (TBI) is a crucial cause of disability and socio-economic problems worldwide and is a frequent clinical presentation that can, inter alia, result in deficits in metacognition and in suicidality. Road traffic accidents (RTAs) often account for TBIs, although the incidence varies across countries. Despite a plethora of research regarding the above, to the best of my knowledge no studies have addressed issues specifically related to the association between CP, metacognitive abilities, suicidality and TBIs following a RTA. In view of this and its clinical significance, the present study aimed to investigate whether CP mediates the relationship between metacognition and suicidality in a sample of patients who suffered a TBI in a RTA. Methods for gathering data included post-interview analyses, a structured questionnaire, a comprehensive mental status examination, a set of standardised psychometric measures, information extracted from their medical files and interviews with relatives. The sample (N = 86) constituted a random number of adult volunteers who suffered a TBI after being involved in a RTA. Age was a significant risk factor as was gender. The results endorsed an implicit connection between CP combined with metacognitive deficits, and potential suicidality in younger male patients who sustained a TBI in a RTA. Imperatives of prevention of suicidality in these patients should include improved access to healthcare facilities and early recognition of the associated symptomatology where focused intervention strategies must be integrated into efficient service delivery programmes, guided by the necessary socio-cultural sensitivity.