Ilgen MA (COE Ann Arbor), Zivin K
(COE Ann Arbor), Austin K
(COE Ann Arbor), Valenstein M
(COE Ann Arbor), Kilbourne A
(COE Ann Arbor)
Chronic pain is common among veterans, with approximately 50% of general medical patients in the VA healthcare system diagnosed with at least one chronic pain condition. Individuals with chronic pain have a higher prevalence of depression, anxiety, problematic alcohol or drug use, suicidal thoughts, and suicide attempts than those without pain. Studies in non-veterans have linked pain to increased risk for suicide mortality; however, it is unclear whether this association exists after controlling for the other psychiatric disorders associated with pain. The present study was designed to test if self-reported pain severity predicts subsequent completed suicide after accounting for demographic characteristics and psychiatric conditions in a large sample of VA patients.
This study combined self-report data from the 1999 Large Health Survey of Veterans (LHSV) with VA electronic medical records from 1999 and data from the National Death Index (NDI) on cause of death from 2000 to 2004. A total of 268,788 veterans completed the LHSV, which included questions about demographic characteristics and average level of pain over the last four weeks. Pain level was dichotomized into: less than severe (combining “none,” “very mild,” “mild,” and “moderate”) vs. severe (combining “severe” and “very severe”); the NDI data were used to identify all veterans who died by suicide following completion of the LHSV. A multivariable logistic regression analysis examined the unique impact of pain on risk of suicide, after accounting for demographic characteristics and psychiatric conditions.
Thirty-four percent of LHSV respondents rated their pain as severe in the prior four weeks. After accounting for demographic characteristics and psychopathology, severe pain was associated with an increased likelihood of suicide [1.44 (95% CI: 1.23-1.69)].
Pain is common in veterans served by the VA healthcare system, and those who report severe pain are significantly more likely to die by suicide.
Treatment providers within the VA system frequently encounter veterans with significant pain. These patients should be assessed for current suicidal thoughts, plans, recent attempts, and for access to lethal means.