Demoralization predicts suicidality in patients with cluster headache

Abstract

Objective To determine the frequency of suicidal ideation and assess suicide risk in cluster headache (CH) patients compared to matched controls without CH in this observational case-control study. Background CH is characterized by recurrent intolerable attacks of unilateral retro-orbital pain, which can cause disability, depression, and desperation. CH has been linked to suicide since its early descriptions by B.T. Horton; however, there is relatively little empiric data showing the association between suicidality and CH, especially in the context of other psychological phenomena, such as depression and demoralization. Methods CH and control participants were recruited through community and CH patient group advertisements. CH diagnosis was confirmed using the International Classification of Headache Disorders, 3rd edition diagnostic criteria for CH. Lifetime suicidal ideation and suicide risk were assessed using the Suicidal Behavior Questionnaire-revised and the Columbia Suicide Severity Rating Scale. The Brief Lifetime Depression Scale evaluated lifetime depression. Demoralization was assessed using the Diagnostic Criteria for use in Psychosomatic Research – Demoralization and the Kissane Demoralization Scale. Forward stepwise logistic regression determined the odds of suicidal ideation. Results One hundred CH and 135 control participants were comparable for age, sex, race, income, and marital status. Significantly more CH than control participants had lifetime active suicidal ideation (47.0% vs. 26.7%; p = 0.001), high suicide risk (38.0% vs. 18.5%; p = 0.0009), lifetime depression history (67.0%% vs. 32.6%; p < 0.00001), and demoralization (28.0% vs. 15.6%; p = 0.02). The odds of lifetime suicidal ideation were higher in those with CH (odds [95% confidence interval]; 2.04 [1.08,3.85]), even after accounting for depression and demoralization. In CH, suicidal ideation was associated with demoralization (6.66 [1.56,28.49]) but not depression (1.89 [0.66,5.46]). Conclusions Lifetime suicidal ideation and high suicide risk are prevalent in CH sufferers, and its likelihood is dependent on the presence of demoralization.

Mental state of demoralisation across diverse clinical settings: A systematic review, meta-analysis and proposal for its use as a ‘specifier’ in mental illness

“…Suicidal ideation was significantly associated with demoralisation in seven studies reporting on 2712 participants (Bobevski et al, 2018; Costanza et al, 2020a; Elfil et al, 2020; Fang et al, 2014; Koo et al, 2021; Nanni et al, 2018; Xu et al, 2019). Additionally, demoralisation was found to have a greater or separate influence on suicidal ideation than depression (Costanza et al, 2020a; Fang et al, 2014; Koo et al, 2021; Vehling et al, 2017) and other psychiatric disorders such as adjustment disorder (Vehling et al, 2017). Patients with depression and demoralisation were also identified to have an increased level of suicidal ideation above the effect of depression alone (Fang et al, 2014).…”

“…Heterogeneity: Battaglia et al, 2020Murri et al, 2020bBerardelli et al, 2021Costanza et al, 2020aGrassi et al, 2020Hsu et al, 2021Koo et al, 2021Sadeghpour et al, 2020Van Tongeren et al, 2021Zhu et al, 202116.98] [36.58;40.42] [32.89;40.59] [58.89;63.31] [37.07;41.13] [24.21;30.71] [24.44;32.16] [33.24;39.26] [36.80;45.00] [ 8.50;14.10] 10.0% 10.1% 9.9% 10.1% 10.1% 10.0% 9.9% 10.0% 9.9% 10.0%…”

The economic and personal burden of cluster headache: a controlled cross-sectional study

“…Self-rated health is an important predictor and strongly associated with increased mortality [ 21 ]. CH have been associated with an increased suicidality [ 22 ] and an unhealthy lifestyle increasing the risk of cardiovascular diseases [ 14 ]. The combined increased mortality risk should be taken serious by physicians treating CH patients.…”

Diagnostic Delay and Its Predictors in Cluster Headache

“…Finally, suicidal idea was not assessed by the well-validated tool like the Columbia-Suicide Severity Rating Scale. Further studies need to use such tool for the analysis of suicidal ideation ( 31 ).…”