Nearly two-thirds of Canadian patients with chronic pain who had contemplated suicide at some point reported being free from suicidal ideation over the past year, according to a study published in The Journal of Pain.
Individuals living with vs without chronic pain are more prone to depression and often have other risk factors for suicide. Despite extensive research on the connection between chronic pain and suicidality, few studies have focused on the ability of individuals with long-term disabling pain to recover from suicidal thoughts.
In this secondary analysis of the 2012 Canadian Community Health Survey – Mental Health dataset, investigators examined members of this nationally representative cohort who reported current activity-limiting chronic pain and who had also seriously considered ending their lives at any point in time. Researchers were interested in documenting the characteristics and prevalence of patients no longer weighing suicide as an option compared with patients who continued to have suicidal thoughts.
The study’s primary outcome was freedom from suicidal ideation over the previous 12 months. Other outcomes included sociodemographic information and information on education, household income, childhood adversities, sleep disturbances, substance abuse, religious coping, availability of a “confidant,” and lifetime occurrence of anxiety or depression.
A total of 635 individuals were enrolled in the study;400 (63.0%; mean age, 49.9 years; 57.3% men; 66.4% white) reported no past-year suicidal ideation, and 235 (37.0%; mean age, 44.8 years; 42.7% men; 33.6% white) reported continued past-year suicidal thinking.
Compared with individuals with persistent ideation, participants with remission from suicidal thoughts were found to be older (odds ratio [OR], 1.30; 95% CI, 1.12-1.50; P <.001), better educated (OR, 1.34; 95% CI, 0.84-2.13; P = 01), more likely to be white (OR, 1.75; 95% CI, 1.11-2.76; P =.001), to be women (OR, 1.79; 95% CI, 1.19-2.71; P =.03), to have a confidant (OR, 1.87; 95% CI, 1.06-3.30; P =.001), and to use religion as a coping mechanism (OR, 1.14; 95% CI, 0.72-1.80; P =.027). In addition, participants without suicidal thoughts were more likely to have higher incomes (OR, 1.47; 95% CI, 0.86-2.52; P =.001), to be able to meet basic expenses (OR, 1.17; 95% CI, 0.74-1.86; P =.013), and less likely to have been diagnosed with anxiety (OR, 2.15; 95% CI, 1.44-3.22; P <.001) or depression (OR, 1.23; 95% CI, 0.82-1.86; P <.001).
Study limitations include a lack of information on pain duration, the timing of suicidal ideation in relation to chronic pain onset, and a cross-sectional design that precludes causal inference.
“These findings provide a hopeful message of resilience and recovery in the context of disabling pain and help to improve targeted outreach to those most at risk for unremitting suicidality,” noted the study authors. They recommended that future research involve longitudinal studies that focus on the impact of pain interventions.
Fuller-Thomson E, Kotchapaw LD. Remission from suicidal ideation among those in chronic pain: what factors are associated with resilience? [published online April 19, 2019]. J Pain. doi:10.1016/j.jpain.2019.02.096