This paper assessed the longitudinal association of suicide attempts by moderate to severe pain and insomnia before and after the initiation of pain services among veterans.
Overall, there were 2227 (1.0%) suicide attempts before initiating pain services and 1655 (0.8%) after initiating pain services. Cox proportional hazard models accounting for key covariates revealed that patients in the HighPain-INS group were significantly more likely to attempt suicide in the year after the initiation of pain services relative to all subgroups (versus LowPain-NoINS: hazard ratio [HR] = 1.44, 95% confidence interval [CI] = 1.21–1.72; versus LowPain-INS: HR = 1.71, 95% CI = 1.23–2.38; versus HighPain-NoINS: HR = 1.17, 95% CI = 1.01–1.34) even after accounting for prior attempts. Adjusted logistic regression analyses found that patients with moderate/severe pain and insomnia had higher odds of attempting suicide in the year before initiating pain services compared to all subgroups (versus LowPain-NoINS: HR = 1.75, 95% CI = 1.50–2.05; versus LowPain-INS: HR = 1.41, 95% CI = 1.09–1.82; versus HighPain-NoINS: HR = 1.21, 95% CI = 1.07–1.37). These results suggest that those with both moderate/severe pain and insomnia are more likely to have a history of suicide attempts and are at greater risk of a suicide attempt relative to those with insomnia with low/mild pain and those with moderate/severe pain with no insomnia. Suicide prevention efforts for chronic pain and insomnia could address pain and insomnia within the same intervention or in parallel.
Ashrafioun, Lisham PhD; Bishop, Todd M. PhD; Pigeon, Wilfred R. PhD The Relationship Between Pain Severity, Insomnia, and Suicide Attempts Among a National Veteran Sample Initiating Pain Care, Psychosomatic Medicine: September 2021 - Volume 83 - Issue 7 - p 733-738 doi: 10.1097/PSY.0000000000000975