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

Suicidal ideation is associated with chronic pain. The need for empathy is a common theme reported by survivors of suicide attempts.

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

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

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

The median age of patients was 55 years (interquartile range [IQR] 42-64 years) and 281 (75.9%) were female. Twenty-seven (14.6%) patients in the GCE group and 45 (24.3%) patients in the LCE group expressed suicidal ideation (relative risk [RR] 0.60, 95% confidence interval [CI] = 0.39 to 0.92; P = 0.02). Correspondingly, 140 (75.7%) patients in the GCE group and 164 (88.6%) patients in the LCE group expressed helplessness (RR 0.85, 95% CI = 0.78 to 0.94; P = 0.001).

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