title: The impact of physical pain on suicidal thoughts and behaviors: Meta-analyses.
abstract: Although the relationship between physical pain and suicidal thoughts and behaviors has been explored in multiple epidemiologic and clinical studies, it is still far from being well understood. Consequently, we conducted a meta-analysis of studies comparing rates of suicidal thoughts and behaviors in individuals with and without physical pain. We searched MEDLINE and PsycINFO (May 2015) for studies comparing rates of current and lifetime suicidal thoughts and behaviors (death wish, suicide ideation, plan, attempt and death: DW, SI, SP, SA, SD) in individuals with any type of physical pain (headache, back, neck, chest, musculoskeletal, abdominal and pelvic pains, arthritis, fibromyalgia, medically unexplained pain, and other not specified pain) versus those without it. Data were analyzed with Cochrane Collaboration Review Manager Software (RevMan, version 5.3). We assessed the methodological quality of the studies with the STROBE statement. Of the 31 included studies, three focused on lifetime DW, twelve focused on current SI (six lifetime), six focused on current SP (two lifetime), nine focused on current SA (11 lifetime) and eight on SD. Individuals with physical pain were more likely to report lifetime DW (p = 0.0005), both current and lifetime SI (both p < 0.00001), SP (current: p = 0.0008; lifetime: p < 0.00001), and SA (current: p < 0.0001; lifetime: p < 0.00001). Moreover, they were more likely to report SD (p = 0.02). In all analyses, the between study heterogeneity was high. Moreover, the presence of publication bias has been detected in the main outcomes. Physical pain is a consistent risk factor for suicidal thoughts and behaviors. Further research is required to investigate the specific impact of: 1) chronic versus acute pain, 2) different types of pain (e.g., medically unexplained pain), and 3) risk factors for suicide in chronic pain patients.
authors.affiliation: INSERM U1061, La Colombière Hospital, University of Montpellier UM1, Montpellier, France; Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France; FondaMental Foundation, France. Electronic address: raffaella.calati@gmail.com.
authors.forename: Raffaella
authors.initials: R
authors.lastname: Calati
authors.affiliation: INSERM U1061, La Colombière Hospital, University of Montpellier UM1, Montpellier, France; Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France; Psychiatric Unit, CHU Casablanca, Hassan II University, Casablanca, Morocco.
authors.forename: Camelia
authors.initials: C
authors.lastname: Laglaoui Bakhiyi
authors.affiliation: INSERM U1061, La Colombière Hospital, University of Montpellier UM1, Montpellier, France.
authors.forename: Sylvaine
authors.initials: S
authors.lastname: Artero
authors.affiliation: VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; University of Michigan Department of Psychiatry, Ann Arbor, MI, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Ilgen
authors.affiliation: INSERM U1061, La Colombière Hospital, University of Montpellier UM1, Montpellier, France; Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France; FondaMental Foundation, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Courtet
mesh_terms: D006801:Humans; D010146:Pain / Q000453:epidemiology* / Q000523:psychology*; D013405:Suicide / Q000706:statistics & numerical data*
keywords: Meta-analysis; Pain; Suicidal behaviors; Suicidal thoughts