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Abstract
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OBJECTIVE: We assessed the longitudinal association of suicide attempts by moderate to severe pain and insomnia prior to and following the initiation of pain services among veterans.
METHODS: A cohort of 221,817 veterans initiating pain care was divided into four subgroups: (a) no/mild pain+no insomnia (LowPain-NoINS), (b) no/mild pain Pain+insomnia (LowPain-INS), (c) moderate/severe pain+no insomnia (HighPain-NoINS), and (d) moderate/severe pain+insomnia (HighPain-INS). Data on diagnoses, pain severity, demographics, medications, and suicide attempts were extracted from Veterans Health Administration datasets.
RESULTS: Overall, there were 2,227 (1.0%) suicide attempts prior to initiating pain services and 1,655 (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 following the initiation of pain services relative to all subgroups (vs. LowPain-NoINS: HR = 1.44, 95%CI = 1.21-1.72; vs. LowPain-INS: HR = 1.71, 95%CI = 1.23-2.38; vs. 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 both moderate/severe pain and insomnia [also] had higher odds of attempting suicide in the year prior to initiating pain services compared to all subgroups (vs. LowPain-NoINS: HR = 1.75, 95%CI = 1.50-2.05; vs. LowPain-INS: HR = 1.41, 95%CI = 1.09-1.82; vs. HighPain-NoINS: HR = 1.21, 95%CI = 1.07-1.37).
CONCLUSIONS: 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.
Language: en |