Androulakis X Michelle, Guo Siyuan, Zhang Jiajia, Sico Jason, Warren Peter, Giakas Alec, Li Xiaoming, Peterlin B Lee, Mathew Roy, Reyes Deborah
Department of Neurology, Columbia VA Healthcare System, Columbia, SC, USA.
Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
J Pain Res. 2021 Aug 24;14:2629-2639. doi: 10.2147/JPR.S322432. eCollection 2021.
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.
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.
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)].
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.
对患有慢性疼痛的退伍军人进行大规模回顾性分析，以研究：（1）患有慢性头痛和其他慢性疼痛病症的退伍军人自杀未遂（SA）的年发病率；（2）与非头痛性慢性疼痛相比，患有慢性头痛的男性和女性以及患有慢性头痛并发创伤性脑损伤（TBI）的男性和女性的SA风险。
这项回顾性研究（N = 3,247,621）分析了2000年至2010年期间被诊断患有慢性头部、颈部、背部和其他慢性疼痛的患者的国家退伍军人事务健康管理数据。采用多变量泊松回归分析按性别分层的患有慢性头痛和慢性头痛并发TBI的退伍军人的SA相对风险。
在所有已确定的慢性疼痛病症类型中，患有慢性头痛的退伍军人每年的SA发病率最高（每10万人中329至491例）。在调整了人口统计学因素、TBI和精神疾病合并症后，与其他非头痛性慢性疼痛相比，慢性头痛与SA风险增加相关[男性RR（1.48），CI（1.37,1.59）；女性RR（1.64），CI（1.28,2.09）]。当慢性头痛与TBI合并时，风险进一步增加[男性RR（2.82），CI（2.60, 3.05）；女性RR（2.16，CI（1.67 - 2.78）]。
患有慢性头痛的退伍军人比患有其他慢性疼痛的退伍军人有更高的SA风险，患有慢性头痛女性比患有慢性头痛的男性风险更高。慢性头痛并发TBI进一步增加了这种风险，尤其是在男性中。我们的数据强调了在针对自杀预防措施时，识别患有TBI合并症的退伍军人中特定类型的慢性疼痛以及与SA相关的性别差异的重要性。
