Citation

Owen-Smith AA, Ahmedani BK, Peterson E, Simon GE, Rossom RC, Lynch F, Lu CY, Waitzfelder BE, Beck A, DeBar L, Sanon V, Maaz Y, Khan S, Miller-Matero LR, Prabhakar D, Frank C, Drake CL, Braciszewski JM. Pain Pract. 2019; 19(4): 382-389.

Affiliation

Henry Ford Health System, Center for Health Policy and Health Services Research.

Copyright

(Copyright © 2019, John Wiley and Sons)

DOI

10.1111/papr.12750

PMID

30462885

Abstract

IMPORTANCE: Few studies have examined the relationship between non-malignant chronic pain (NMCP) and suicide death and even fewer have specifically explored what role sleep disturbance might play in the association between NMCP and suicide death.

OBJECTIVE: To assess whether sleep disturbance mediates the relationship between NMCP and suicide death.

DESIGN: This case-control study included 2,674 individuals who died by suicide between 2000-2013 (cases) and 267,400 matched individuals (controls). SETTING: Eight Mental Health Research Network (MHRN)-affiliated healthcare systems. PARTICIPANTS: All cases and matched controls were health plan members for at least 10 months during the year prior to the index date.

MAIN OUTCOMES AND MEASURES: Sociodemographic data and diagnosis codes for NMCP and sleep disorders were extracted from the MHRN's Virtual Data Warehouse. Suicide mortality was identified using ICD-10 codes from official government mortality records matched to health system records.

RESULTS: After accounting for covariates, there was a significant relationship between NMCP and sleep disturbance; those who were diagnosed with NMCP were more likely to develop subsequent sleep disturbance. Similarly, sleep disturbance was significantly associated with suicide death. Finally, a significant indirect effect of NMCP on suicide death, through sleep disturbance, and a non-significant direct effect of NMCP on suicide death provide support for a fully mediated model.

CONCLUSIONS AND RELEVANCE: There is a need for clinicians to screen for both sleep disturbance and suicidal ideation in NMCP patients and for health systems to implement more widespread behavioral treatments that address comorbid sleep problems and NMCP. This article is protected by copyright. All rights reserved.

This article is protected by copyright. All rights reserved.

Language: en

Keywords

Chronic pain; Sleep; Suicide