Suicide Attempts in US Veterans with Chronic Headache Disorders: A 10-Year Retrospective Cohort Study

Abstract

Objectives A large-scale retrospective analysis of veterans with chronic pain was conducted to examine (1) the annual incidence of suicide attempts (SA) in veterans with chronic headache and other chronic pain conditions, and (2) the risk of SA in men and women with chronic headache and chronic headache concurrent with traumatic brain injury (TBI) as compared to non-headache chronic pain. Methods This retrospective study (N=3,247,621) analyzed National Veterans Affair Health Administrative data of patients diagnosed with chronic head, neck, back and other chronic pain from 2000 to 2010. Multivariable Poisson regression was used to explore the relative risks of SA in veterans with chronic headache and chronic headache concurrent with TBI as stratified by sex. Results Veterans with chronic headaches had the highest annual incidence of SA (329 to 491 per 100,000) each year among all identified types of chronic pain conditions. Compared to other non-headache chronic pain, chronic headache is associated with increased risk of SA [men RR (1.48), CI (1.37,1.59); women RR (1.64), CI (1.28,2.09)], after adjusting for demographic factors, TBI, and psychiatric comorbidities. The risk increased further when chronic headache is comorbid with TBI [men RR (2.82), CI (2.60, 3.05); women RR (2.16, CI (1.67–2.78)]. Conclusion Veterans with chronic headache have a higher risk of SA than those with other chronic pain and women with chronic headache are at a higher risk than men with chronic headache. Chronic headache concurrent with TBI further heightened this risk, especially in men. Our data underscore the importance of identifying specific types of chronic pain in veterans with comorbid TBI and sex disparity associated with SA when targeting suicide prevention measures.

Testing the Decision Support Tool for Responsible Pain Management for Headache and Facial Pain Diagnosis with Opioid-Risk-Stratified Treatment

“…The 9-item Patient Health Questionnaire (PHQ) is activated if the patient responds to either of two questions in the history (“Little pleasure in doing things”; “Feeling down, depressed, or hopeless”) with “More than half the days” or worse [ 42 ]. Suicide risk: The National Institute of Mental Health’s 4-item ASQ (Ask Suicide Screening Questions) scale is activated after a non-negative response to the PHQ question “Thoughts that you would be better off dead, or of hurting yourself.” Chronic pain is an important risk factor for suicide [ 43 ]: chronic headache posed higher suicide risk than other chronic pain types in a 10-year veterans’ retrospective study [ 44 ]. …”

“…Suicide risk: The National Institute of Mental Health’s 4-item ASQ (Ask Suicide Screening Questions) scale is activated after a non-negative response to the PHQ question “Thoughts that you would be better off dead, or of hurting yourself.” Chronic pain is an important risk factor for suicide [ 43 ]: chronic headache posed higher suicide risk than other chronic pain types in a 10-year veterans’ retrospective study [ 44 ].…”

Risks of suicide in migraine, non-migraine headache, back, and neck pain: a systematic review and meta-analysis

“…In 2020, the suicide rate for Veterans was 57.3% greater than for non-Veteran U.S. adults when adjusted for demographic differences ( 9 ). Traumatic brain injury (TBI), PTSD, and depression are significant risk factors for chronic headache in Veterans ( 10 ). Veterans with chronic headache, especially those with comorbid TBI, PTSD, and depression, are at increased risk for suicidal behavior ( 10 , 11 ).…”

“…Traumatic brain injury (TBI), PTSD, and depression are significant risk factors for chronic headache in Veterans ( 10 ). Veterans with chronic headache, especially those with comorbid TBI, PTSD, and depression, are at increased risk for suicidal behavior ( 10 , 11 ). As such, there is a need to better understand the relationship between suicidality and head, neck, and back pain, and establishing interdisciplinary collaboration when caring for Veterans with migraine, which often go undiagnosed or not coded ( 12 ).…”

Delivery of a Mental Health Intervention for Chronic Pain Through an Artificial Intelligence–Enabled App (Wysa): Protocol for a Prospective Pilot Study

“…Moreover, patients experiencing from pain-related depression and anxiety are also likely to have worse outcomes from chronic pain [ 15 , 16 ]. Numerous studies have also suggested that individuals living with chronic pain are 2 to 3 times more susceptible to suicidal ideation and suicidal behaviors [ 17 - 19 ].…”