Pain associated with elevated suicide risk in veterans

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1. Veterans with back pain, psychogenic pain, or migraine were more likely to commit suicide than veterans without those conditions. 

2. Compared to a single pain condition, having multiple pain conditions did not increase risk of suicide. 

Evidence Rating Level: 2 (Good) 

Study Rundown: This study found that veterans suffering from chronic back pain, psychogenic pain or migraine were more likely to commit suicide. Given that nearly 25% of veterans studied had one of these three conditions, these results highlight the need for providers to evaluate suicide risk in veterans affected by pain management issues. Strengths of the study include a large sample size (n=4,863,063) and control for psychiatric conditions. Though, study generalizability may be limited by a predominantly male (91.7%) population. Additionally, the authors’ inability to control for race/ethnicity, employment status, and social support networks may mask bias. Future research might employ a prospective design, enroll a more nationally representative population and collect information on the demographic factors missing in this study.

Click to read the study in JAMA Psychiatry

Relevant Reading: Severe pain predicts greater likelihood of subsequent suicide

In-Depth [retrospective cohort study]: This study examined the relationship between pain conditions and suicide risk in a national cohort of 4,863,086 Veterans Health Administration patients (ages ≥18). Eligible veterans were treated in fiscal year 2005 and alive when fiscal year 2006 began. Data obtained from patient records included suicide mortality (fiscal years 2006-2008) and diagnoses of back pain, arthritis, migraines, headache or tension headache, psychogenic pain, neuropathy, and fibromyalgia (fiscal years 2004-2005).

Overall, 0.01% of the cohort (4,823 patients) died from suicide in the 3-year study period. When controlling for concomitant psychiatric conditions, back pain (p<0.001), psychogenic pain (p<0.001) and migraine (p=0.005) were associated with elevated suicide risk. Veterans with ≥2 pain conditions were at no greater suicide risk than patients with 0-1 pain conditions. Those who committed suicide primarily used firearms (67.9%) or poison (16.6%).

By Caroline Huang and Leah Hawkins

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