Suicidal thoughts and behavior among adults with self-reported pain conditions in the national comorbidity survey replication.
We sought to examine whether the presence of a noncancer pain condition is independently associated with an increased risk for suicidal ideation, plan, or attempt after adjusting for sociodemographic and psychiatric risk factors for suicide and whether risk differs by specific type of pain. We analyzed data from the National Comorbidity Survey Replication, a household survey of U.S. civilian adults age 18 years and older (n = 5692 respondents). Pain conditions, nonpain medical conditions, and suicidal history were obtained by self-report. DSM-IV mood, anxiety, and substance use disorders were assessed using the World Health Organization's Composite International Diagnostic Interview. Antisocial and borderline personality traits were assessed with the International Personality Disorder Examination screening questionnaire. In unadjusted logistic regression analyses, the presence of any pain condition was associated with lifetime and 12-month suicidal ideation, plan, and attempt. After controlling for demographic, medical, and mental health covariates, the presence of any pain condition remained significantly associated with lifetime suicidal ideation (odds ratio, 1.4; 95% confidence interval, 1.1-1.8) and plan. Among pain subtypes, severe or frequent headaches and "other" chronic pain remained significantly associated with lifetime suicidal ideation and plan; "other" chronic pain was also associated with attempt.


CONCLUSIONS
The risk for suicidal thoughts and behaviors that may accompany back, neck, and joint pain can be accounted for by comorbid mental health disorders. There may be additional risk accompanying frequent headaches and "other" chronic pain that is secondary to psychosocial processes not captured by the mental disorders assessed.
Braden
Jennifer Brennan
JB
Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98195-6560, USA. jkbrenn@u.washington.edu
Sullivan
Mark D
MD
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000987:Antisocial Personality Disorder / Q000175:diagnosis / Q000453:epidemiology; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology; D001519:Behavior / Q000502:physiology*; D001883:Borderline Personality Disorder / Q000175:diagnosis / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000175:diagnosis / Q000453:epidemiology; D010146:Pain / Q000145:classification / Q000453:epidemiology* / Q000523:psychology; D011569:Psychiatric Status Rating Scales; D012044:Regression Analysis; D012307:Risk Factors; D012647:Self-Assessment; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D055815:Young Adult