Risk of suicidal behaviour in subjects with pain : A population based longitudinal cohort study

Aims: To assess the influence of pain severity and interference due to pain on incident suicidal behaviour in a population cohort. Methods: Data from the first two waves (baseline and follow-up of 3 years) of the NEMESIS-2 cohort were used for this population based, longitudinal study. Persons who reported suicidal behaviour at baseline were excluded, leaving 5242 participants. Pain severity and interference due to pain in the past month were measured at baseline using the SF36. Suicidal behaviour and DSM-IV mental disorders were assessed at both waves using the CIDI interview. Logistical regression analyses were performed. Results: Subjects with moderate to very severe pain had a higher risk than subjects reporting no pain for developing suicidal behaviour at follow-up (OR=3.39, 95% CI=1.74–6.61). Subjects with moderate to very severe interference due to pain also had a higher risk than subjects reporting no interference due to pain for developing suicidal behaviour at follow-up (OR=2.35, 95% CI=1.22–4.53). These results were adjusted for baseline sociodemographics and mental disorders. No interaction effects were found between pain severity or interference due to pain and mental disorders. Conclusions: Our study contributes substantial evidence indicating that pain is associated with risk for suicidal behaviour. In addition, it shows that having a concomitant mental disorder does not change this association; thus pain is an independent factor in suicidal behaviour. Future research should further explore this association and suicide prevention plans should explicitly include assessment and management of suicidal behaviour in persons with pain.