Pain Research, Informatics, Multimorbidities and Education Center, VA Connecticut Healthcare System, West Haven, CT, United States; Yale Center for Medical Informatics, Yale School of Medicine, New Haven, CT, United States; Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States.
VA Capital Healthcare Network (VISN 5) Mental Illness, Research, Education, and Clinical Center (MIRECC), Baltimore, MD, United States.
J Affect Disord. 2025 Jan 15;369:429-435. doi: 10.1016/j.jad.2024.10.028. Epub 2024 Oct 9.
High suicide rates are documented among persons with bipolar disorder diagnoses and pain diagnoses, but few studies have examined the association of pain with suicide mortality in individuals with comorbid pain and bipolar disorders. This study assessed the association of pain screening and pain severity with suicide mortality among veterans with comorbid bipolar and musculoskeletal disorder (MSD) diagnoses.
A retrospective cohort study was conducted on 168,021 patients within the Veterans Health Administration (VHA) who received an MSD diagnosis from 2000 to 2015 and had a bipolar disorder diagnosis. Pain severity, comorbidities, demographics, and suicide mortality were extracted from VHA databases. Poisson regression examined relative risk of suicide by the presence pain screening and pain severity ratings.
Pain was assessed in 72.73 % of veterans. Suicide risk was greater in those not assessed (0.98 % versus 0.77 % in assessed group). However, this result did not persist after adjusting for covariates (RR = 1.06). Among those assessed, higher suicide risk was associated with moderate (RR = 1.10), severe pain (RR = 1.06), and no pain (reference) relative to mild pain (RR = 0.99). Major depression, substance use disorders, and prescribed opioids and benzodiazepines increased risk.
Data were obtained from medical records; diagnoses were not confirmed via formal assessment, and no information was available on actual medication use or purpose. Over 25 % of the sample were missing pain severity ratings, which could have affected results.
Suicide risk factors among persons with bipolar disorder are complex and multifactorial. Providers should prioritize suicide prevention efforts following new onset or worsening pain.
有双相情感障碍诊断和疼痛诊断的人群自杀率很高，但很少有研究检查疼痛与患有共病疼痛和双相情感障碍的个体自杀死亡率之间的关系。本研究评估了疼痛筛查和疼痛严重程度与退伍军人共患双相情感障碍和肌肉骨骼疾病（MSD）诊断的自杀死亡率之间的关系。
对退伍军人事务部（VHA）数据库中 2000 年至 2015 年间接受 MSD 诊断且有双相情感障碍诊断的 168021 名患者进行了回顾性队列研究。从 VHA 数据库中提取疼痛严重程度、合并症、人口统计学和自杀死亡率。泊松回归检查了疼痛筛查和疼痛严重程度评分存在的情况下自杀的相对风险。
72.73%的退伍军人接受了疼痛评估。未接受评估的自杀风险更高（未评估组为 0.98%，评估组为 0.77%）。然而，在调整了协变量后，这一结果并未持续（RR=1.06）。在接受评估的人群中，与轻度疼痛（RR=0.99）相比，中度疼痛（RR=1.10）、重度疼痛（RR=1.06）和无疼痛（参考）与更高的自杀风险相关。重度抑郁症、物质使用障碍以及开处阿片类药物和苯二氮䓬类药物会增加风险。
数据来自病历；诊断未经正式评估确认，实际用药或用药目的信息不可用。超过 25%的样本缺失疼痛严重程度评分，这可能影响了结果。
双相情感障碍患者的自杀危险因素复杂且多因素。在出现新的疼痛或疼痛恶化时，提供者应优先考虑预防自杀。
