Affect, coping, and self-harm among Veterans with comorbid serious mental illness and chronic pain: A pilot study

Abstract: OBJECTIVE: Among individuals with serious mental illness, chronic pain is an impairing and understudied comorbid condition. Although affective and behavioral treatment targets have been identified for individuals experiencing serious mental illness and chronic pain separately, studies examining these targets among veterans experiencing these conditions together have provided inconsistent results. To address this gap, the authors conducted a pilot study of veterans with comorbid chronic pain and serious mental illness to examine the affective and behavioral experiences of this population to better inform treatment efforts. METHODS: Cross-sectional analyses were used to characterize the experiences of negative affect (anger, depression, anxiety, stress, and emotional lability), self-harm, and coping among 41 treatment-seeking veterans experiencing comorbid serious mental illness and chronic pain. RESULTS: Of the sample, 40%-61% reported moderate to severe past-week negative affect. Moreover, rates of suicidal ideation and suicide attempts were higher in this sample than in general and chronic pain populations. Acute negative affect, but not past-week pain, was significantly and positively associated with acute self-harm ideation. Finally, the veterans endorsed a range of adaptive and maladaptive coping strategies; coping via emotional disengagement (e.g., substance use or avoidance) was associated with increased negative emotion, and emotion-focused coping (e.g., expressing emotions and receiving emotional support) buffered the impact of past-week pain on negative mood. CONCLUSIONS: These findings provide insight into the complex affective and behavioral profiles of veterans experiencing comorbid serious mental illness and chronic pain, suggesting that negative affect, emotional disengagement, and suicidality are important assessment and treatment targets in this population.