School of Public Health, Georgia State University, Atlanta, Georgia, U.S.A.
Kaiser Permanente Georgia, Center for Research and Evaluation, Atlanta, Georgia.
Pain Pract. 2019 Apr;19(4):382-389. doi: 10.1111/papr.12750. Epub 2019 Jan 18.
Few studies have examined the relationship between nonmalignant 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.
To assess whether sleep disturbance mediates the relationship between NMCP and suicide death.
This case-control study included 2,674 individuals who died by suicide between 2000 and 2013 (cases) and 267,400 matched individuals (controls).
Eight Mental Health Research Network (MHRN)-affiliated healthcare systems.
All cases and matched controls were health plan members for at least 10 months during the year prior to the index date.
Sociodemographic data and diagnosis codes for NMCP and sleep disorders were extracted from the MHRN's Virtual Data Warehouse. Suicide mortality was identified using International Statistical Classification of Diseases and Related Health Problems (ICD)-10 codes from official government mortality records matched to health system records.
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 nonsignificant direct effect of NMCP on suicide death provide support for a fully mediated model.
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.
很少有研究探讨非恶性慢性疼痛（NMCP）与自杀死亡之间的关系，更少有研究专门探讨睡眠障碍在 NMCP 与自杀死亡之间的关联中可能起什么作用。
评估睡眠障碍是否在 NMCP 与自杀死亡之间的关系中起中介作用。
这项病例对照研究纳入了 2000 年至 2013 年间自杀死亡的 2674 名个体（病例）和 267400 名匹配个体（对照）。
八个心理健康研究网络（MHRN）附属医疗系统。
所有病例和匹配对照在指数日期前的一年中至少有 10 个月是健康计划成员。
从 MHRN 的虚拟数据仓库中提取了 NMCP 和睡眠障碍的社会人口统计学数据和诊断代码。自杀死亡率通过官方政府死亡率记录与健康系统记录匹配来确定，使用国际疾病分类和相关健康问题（ICD-10）代码。
在考虑了协变量后，NMCP 与睡眠障碍之间存在显著关系；被诊断为 NMCP 的人更有可能随后出现睡眠障碍。同样，睡眠障碍与自杀死亡显著相关。最后，NMCP 通过睡眠障碍对自杀死亡的间接效应显著，而 NMCP 对自杀死亡的直接效应不显著，这为完全中介模型提供了支持。
临床医生需要在 NMCP 患者中筛查睡眠障碍和自杀意念，健康系统需要实施更广泛的行为治疗，以解决共病睡眠问题和 NMCP。
