Risk and Predisposing Factors for Suicide Attempts in Patients with Migraine and Status Migrainosus: A Nationwide Population-Based Study

Abstract

Objective: To investigate the risk and risk factors for suicide attempt by patients with regular migraines (RM) and status migrainosus (SM) in Taiwan. Methods: We analyzed a subset of the National Health Insurance Research Database of Taiwan and enrolled patients (≥20 years old) who had ever received a diagnosis of RM or SM between 2000 and 2012 in the RM and SM cohort. The SM cohort included 13,605 patients, the RM cohort had 21,485 patients, and the comparison cohort contained approximately four times that many patients. We calculated the adjusted hazard ratios and 95% confidence intervals (CI) for suicide attempts after adjusting for age, sex, monthly income, urbanization level, occupation, and comorbidities. Results: The SM cohort had a 1.81-fold risk of attempting suicide (95% CI = 1.14–2.89) compared to the comparison cohort. Other factors that predispose patients with SM to attempt suicide include the following: female sex, relatively young age (<50 years old), and low monthly income (<15,000 New Taiwan Dollars, approximately equivalent to 495 US Dollars). Additionally, the risk of attempting suicide only increased in patients who had been diagnosed with SM for longer than five years. Conclusion: SM is associated with a higher risk for suicide attempt in migraineurs in Taiwan. This finding is important to clinicians and government officials seeking to prevent patients from attempting suicide in Taiwan and other similar East Asian countries.

The Profile and Prognosis of Youth With Status Migrainosus: Results From an Observational Study

“…Status migrainosus (SM) is defined as a migraine attack that lasts 72 hours or more . These prolonged attacks are associated with significant disability from lost school, work, social and home functioning, and patients with a history of SM have an elevated risk of suicide attempts . Not only is SM debilitating to patients, but it is also associated with significant health care costs, especially pertaining to acute care services in the emergency department (ED) and inpatient hospitalizations.…”

Recent Evidence Regarding the Association Between Migraine and Suicidal Behaviors: A Systematic Review

“…The articles included were published between January 2015 and November 2019. Two of the studies were conducted in Canada (18,21), two studies in Taiwan (22,23), two in the Republic of Korea (20,24), and one study each in Ethiopia (25), France (19), Peru (26), and the USA (27). Seven of the studies used a crosssectional study design (21-27) and three were prospective cohort studies (18)(19)(20).…”

“…Seven of the studies used a crosssectional study design (21-27) and three were prospective cohort studies (18)(19)(20). Participants were recruited from outpatient clinics in six of the studies (18,20,(23)(24)(25)(26) and from nationwide samples in three studies (21,22,27). Clinic populations were recruited from the following outpatient clinics:…”

“…The nationwide samples were selected from hospital billing data (27), community-based mental health survey data (21), and a national health database (22). A single study used populationbased samples of participants from the electoral role of the Montpellier district (19).…”

Status Migrainosus in Children and Adults

“…A population-based study of adult Taiwanese patients diagnosed with either SM (n = 13,605) or migraine (n = 21,485) found that those with SM had a 1.81-fold risk of attempting suicide compared to a control group that did not have either diagnosis. 92 In addition, compared to men, individuals older than 50 years, and those who made ≥20,000 New Taiwan Dollars per month, patients with SM who were female, younger than 50 years old, and had a low monthly income had increased risk of suicide attempt (adjusted hazard ratios of 2.67, 3.27, and 2.44, respectively). There was no increased risk of suicide attempt in those with migraine without SM when compared to the comparison group.…”