Association of clinical empathy with suicidal ideation among patients with chronic pain: target trial emulation

Background Suicidal ideation is associated with chronic pain.

Aim To measure the association of clinical empathy with suicidal ideation among patients with chronic low back pain.

Design & setting A target trial emulation was performed using adult patients selected from a national pain research registry in the United States from May 2018 to December 2023.

Method Patients having a physician who provided primary health care for their pain were followed for 12 months. Clinical empathy was assessed using the Consultation and Relational Empathy measure. Propensity-score matching of 936 registry patients without suicidal ideation at baseline yielded 185 patients each in greater and lesser clinical empathy groups. Suicidal ideation and helplessness were measured with the Pain Catastrophizing Scale.

Results The median (IQR) age of patients was 55 (42-64) years and 281 (75.9%) were female. Twenty-seven (14.6%) patients in the greater clinical empathy group and 45 (24.3%) patients in the lesser clinical empathy group expressed suicidal ideation (RR, 0.60; 95% CI, 0.39-0.92; P=0.02). Correspondingly, 140 (75.7%) patients in the greater clinical empathy group and 164 (88.6%) patients in the lesser clinical empathy group expressed helplessness (RR, 0.85; 95% CI, 0.78-0.94; P=0.001).

Conclusion The decreased risk of suicidal ideation in the greater clinical empathy group has potentially important implications for the delivery of primary health care for chronic pain. Research is needed to replicate these findings and determine the effects of clinical empathy on suicide attempts and completed suicides.