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Chronic Pain Conditions and Suicidal Ideation and Suicide Attempts: An Epidemiologic Perspective

Ratcliffe, Gregory E. BSc*; Enns, Murray W. MD, FRCPC* †; Belik, Shay-Lee BSc (Hons)* †; Sareen, Jitender MD, FRCPC* †

doi: 10.1097/AJP.0b013e31815ca2a3
Original Articles

Objectives Investigations of the association between chronic pain conditions and suicidal ideation (SI) and suicide attempts (SA) have rarely taken the effect of mental disorders into account and have been limited by nonrepresentative samples. The present study used a large population-based sample to investigate the association between chronic pain conditions and SI and SA.

Methods Data were from the Canadian Community Health Survey Cycle 1.2 public use file conducted by Statistics Canada from 2001 to 2002 (N=36,984; response rate 77%). Respondents were asked if they had been diagnosed with the following painful conditions: migraine, back problems, arthritis, and fibromyalgia. Respondents were assessed for past 12-month SI and SA. The Composite International Diagnostic Interview was used to assess Diagnostic and Statistical Manual of Mental Disorders-IV.

Results After adjusting for sociodemographics, Axis I mental disorders and comorbidity (3 or more mental disorders), the presence of 1 or more chronic pain conditions was associated with both SI and SA. Among respondents with a mental disorder, comorbidity with 1 or more chronic pain conditions was also associated with SI and SA. In models adjusting for other painful conditions, migraine had the strongest link with SI and SA.

Discussion This is the first study to demonstrate the association between several chronic pain conditions and SI and SA while adjusting for mental disorders in a nationally representative sample. Moreover, this study demonstrates that among individuals with a mental disorder, having a chronic pain condition significantly increased the association with SI and SA.

*Department of Psychiatry

Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada

Preparation of this article was supported by (1) a CIHR New Investigator grant awarded to Dr Sareen, (2) a CIHR Canada Graduate Scholarship—Master's Award awarded to Ms Belik, and (3) a Western Regional Training Centre studentship funded by Canadian Health Services Research Foundation, Alberta Heritage Foundation for Medical Research, and CIHR awarded to Ms Belik.

Reprints: Jitender Sareen, MD, FRCPC, PZ430-771 Bannatyne Avenue, Winnipeg, MB, Canada R3E 3N4 (e-mail:

Received for publication February 14, 2007; revised September 17, 2007; accepted September 28, 2007

© 2008 Lippincott Williams & Wilkins, Inc.