Suicidal ideation, plans, and attempts in chronic pain patients: factors associated with increased risk

Abstract

This study describes suicidal behavior in a cross-sectional sample of chronic pain patients and evaluates factors associated with increased risk for suicidal ideation. One hundred-fifty-three adults with nonmalignant pain (42% back pain) who were consecutively referred to a tertiary care pain center completed a Structured Clinical Interview for Suicide History, the McGill Pain Questionnaire, and the Beck Depression Inventory. Nineteen-percent reported current passive suicidal ideation (PSI), 13% had active thoughts of committing suicide (ASI), 5% had a current suicide plan, and 5% reported a previous suicide attempt. Drug overdose was the most commonly reported plan and method of attempt (75%). Thirteen-percent reported a family history of suicide attempt/completion. Pain-specific and traditional suicide risk factors were evaluated as predictors of current PSI and ASI. Logistic regression analyses revealed that a family history of suicide attempts/completions was associated with a 7.5 fold increase in risk of PSI (P=0.001) and a 6.6 fold increase in ASI (P=0.003), after adjusting for significant covariates. Having abdominal pain was associated with an adjusted 5.5 fold increase in PSI (P=0.05) and a 4.2 fold increase in ASI (P=0.10). Neuropathic pain significantly reduced risk for both PSI (P=0.002) and ASI (P=0.01). Demographics, pain severity, and depression severity were not associated with suicidal ideation in multivariate analyses. These findings highlight the need for routine evaluation and monitoring of suicidal behavior in chronic pain, especially for patients with family histories of suicide, those taking potentially lethal medications, and patients with abdominal pain.

The role of physical and mental health multimorbidity in suicidal ideation

“…More recently, attention has focused on somatic illness and associated morbidities such as chronic pain as potential suicide risk factors (Braden et al, 2008;Pompili et al, 2014;Ratcliffe et al, 2008;Robson, 2010;Stenager et al, 1994;Tang et al, 2006;Qin et al, 2013). More specifically, pain-related physical conditions like migraine and back pain have been associated with an increased risk of suicidal behaviours (Ilgen et al, 2013;Smith et al, 2004) The influence of multiple mental illnesses on risk of suicide is of considerable interest from a global public health perspective. Several studies have reported that major depression, anxiety disorder and substance abuse are often found to co-occur with other psychiatric conditions within suicidal populations (Hawton et al, 2003a;Nock et al, 2010;Suominen et al, 1996).…”

Mental Defeat Is Associated With Suicide Intent in Patients With Chronic Pain

“…It has been reported that as many as 25% of these individuals, who attend multidisciplinary pain centres for treatment, report at least one suicide attempt or self-harming incident in the past [8][9][10][11][12]. Drug overdose is the commonest means for suicide attempt and self-harm among chronic pain patients [11].…”

“…The female gender [13], a family history of suicide [12], a personal history of suicide attempt [14], and the presence of depression and/or other psychiatric conditions [8,10,[13][14][15] have been identified as generic risk factors of suicidality in chronic pain. Some evidence also suggests that patients of certain pain conditions [e.g., migraine, abdominal pain and fibromyalgia; 5,6,8,10,12,16] have higher rates of suicidality. Moreover, the risk of suicidality also appears to augment as the pain increases in chronicity [9,15], spread [17] and intensity [12,14,18].…”

“…Some evidence also suggests that patients of certain pain conditions [e.g., migraine, abdominal pain and fibromyalgia; 5,6,8,10,12,16] have higher rates of suicidality. Moreover, the risk of suicidality also appears to augment as the pain increases in chronicity [9,15], spread [17] and intensity [12,14,18]. Though informative, most of these risk factors are not amenable to change (e.g., gender, history of suicide and psychiatric conditions).…”

Chronic Pain in Pediatric Patients and the Association of Suicidal Ideations and Suicidal Attempts

“…Therefore, cross-sector collaborations are important to reduce suicide [16]. Through an interdisciplinary approach incorporating behavioral health professionals into the regular assessment and management of pediatric pain patients, efforts to eliminate suicide will be maximized [17][18][19][20][21].…”