title: Headache Disability, Suicidality and Pain Catastrophization - Are They Related.
abstract: BACKGROUND
  Studies have found that headache is associated with suicidality. Some demographic and clinical features have been reported to be associated with suicidality. Pain catastrophizing and disability may also have bearing on suicidality in patients with headache.
  
  
  OBJECTIVE
  To evaluate the relationship between pain disability and catastrophizing in headache and suicidal behaviour.
  
  
  METHODS
  Patients diagnosed with headache were recruited from neurology Out-Patient Department (OPD). With ethical approval and informed consent, patients were subjected to a structured interview. Headache disability and pain catastrophizing was assessed with the Henry Ford Hospital Headache Disability Inventory (HDI) and Pain Catastrophy Scale (PCS) respectively. For evaluation of suicidal ideation and behaviour, MINI International Neuropsychiatric Interview (MINI Plus) scale and The Columbia-Suicide Severity Rating Scale (C-SSRS) were applied. Data was analysed with Mann-Whitney U test and Kruskal-Wallis test using appropriate statistical programs.
  
  
  RESULTS
  In 200 patients of headache, male: female ratio was 0.48: 1. Headache disability was significantly higher in females (p=0.060) and unemployed (p=0.019) patients whereas, pain catastrophizing was significant in patients belonging to low socioeconomic class (p=0.045). Headache disability and pain catastrophizing had significant association with suicidal ideation. Disability score was significantly associated with the score of deterrents (p=0.067) and controllability (p=0.039) subscale of intensity of suicidal ideation. There were four patients who actually attempted suicide. Pain catastrophizing was significantly associated with non-suicidal self injurious behaviour (p=0.041).
  
  
  CONCLUSIONS
  Disability due to headache and pain catastrophizing is associated with increased suicidal tendencies, behaviour and suicidal attempts. Headache in females and patients in rural habitat, unemployed individuals belonging to low socioeconomic class need special attention to reduce high risk suicidal behaviour.
authors.affiliation: Resident, Department of Neurology, JSS Medical College , Mysore, Karnataka, India .
authors.forename: Harshal
authors.initials: H
authors.lastname: Rathod
authors.affiliation: Associate Professor, Department of Psychiatry, JSS Medical College , Mysore, Karnataka, India .
authors.forename: Dushad
authors.initials: D
authors.lastname: Ram
authors.affiliation: Professor, Department of Neurology, JSS Medical College , Mysore, Karnataka, India .
authors.forename: Harsha
authors.initials: H
authors.lastname: Sundarmurthy
authors.affiliation: Pathologist, Apollo Hospital , Mysore, Karnataka, India .
authors.forename: Snehal
authors.initials: S
authors.lastname: Rathod
authors.affiliation: Resident, Department of Neurology, JSS Medical College , Mysore, Karnataka, India .
authors.forename: Deepa
authors.initials: D
authors.lastname: John
keywords: Functional impairment; Pain sensitivity; Suicidal behaviour