# From Trauma to Suicidal Ideation in a Spanish Chronic Pain Population: Cognitive Mediation in the Genesis of Psychological Suffering

## TL;DR

This study explores how childhood trauma contributes to suicidal thoughts in people with chronic pain through cognitive processes like perceived burdensomeness and hopelessness.

## Contribution

The study is novel in simultaneously examining perceived burdensomeness, hopelessness, and pain catastrophizing as mediators between childhood trauma and suicidal ideation in chronic pain patients.

## Key findings

- Childhood trauma was significantly associated with perceived burdensomeness, hopelessness, and pain catastrophizing.
- These cognitive processes partially mediate the relationship between childhood trauma and suicidal ideation.
- Maladaptive cognitive patterns may explain how early adverse experiences lead to suicidal thoughts in chronic pain individuals.

## Abstract

Background: Chronic pain is consistently associated with increased vulnerability to suicidal ideation, particularly among individuals with a history of early adverse experiences. However, the cognitive mechanisms linking childhood trauma to suicidal thoughts in this population remain insufficiently understood. Methods: A cross-sectional study was conducted with 251 adults living with chronic pain. Participants completed validated measures assessing childhood trauma, perceived burdensomeness, hopelessness, pain catastrophizing, and suicidal ideation. Correlational analyses were conducted to examine associations among variables, followed by a multiple mediation model to test the mediating role of cognitive processes. Data were analyzed using Pearson correlations and robust-estimation mediation procedures implemented in JASP. Results: Childhood trauma showed positive and significant associations with perceived burdensomeness, hopelessness, pain catastrophizing, and suicidal ideation. Mediation analyses showed that perceived burdensomeness, hopelessness, and pain catastrophizing significantly mediated the relationship between childhood trauma and suicidal ideation, with small-to-moderate indirect effects. These findings suggest that maladaptive cognitive patterns may partially explain how early adverse experiences are associated with suicidal thoughts in individuals with chronic pain. Conclusions: The results highlight the relevance of considering early adverse experiences and pain-related cognitive processes in the clinical assessment of suicidal ideation among individuals with chronic pain. Further research using longitudinal and multimethod designs is needed to refine explanatory models and guide psychological interventions aimed at reducing vulnerability to suicidal ideation in this population. This study expands existing knowledge by simultaneously examining perceived burdensomeness, hopelessness, and pain catastrophizing as mediators between childhood trauma and suicidal ideation in individuals with chronic pain. These findings contribute to refining trauma-informed clinical approaches and identifying specific intervention targets.