Chronic Pain Among Suicide Decedents, 2003 to 2014: Findings From the National Violent Death Reporting System

Abstract

Background: More than 25 million adults in the United States have chronic pain. Chronic pain has been associated with suicidality, but previous studies primarily examined nonfatal suicidal behaviors rather than suicide deaths associated with chronic pain or the characteristics of such deaths.

Objective: To estimate the prevalence of chronic pain among suicide decedents in a large multistate sample and to characterize suicide decedents with and without chronic pain.

Design: Retrospective analysis of National Violent Death Reporting System (NVDRS) data. The NVDRS links death certificate, coroner or medical examiner, and law enforcement data collected by investigators, who often interview informants who knew the decedent to gather information on precipitating circumstances surrounding the suicide. Information is abstracted by using standard coding guidance developed by the Centers for Disease Control and Prevention.

Setting: 18 states participating in the NVDRS.

Participants: Suicide decedents with and without chronic pain who died during 1 January 2003 to 31 December 2014.

Measurements: Demographic characteristics, mechanism of death, toxicology results, precipitating circumstances (mental health, substance use, interpersonal problems, life stressors), and suicide planning and intent.

Results: Of 123 181 suicide decedents included in the study, 10 789 (8.8%) had evidence of chronic pain, and the percentage increased from 7.4% in 2003 to 10.2% in 2014. More than half (53.6%) of suicide decedents with chronic pain died of firearm-related injuries and 16.2% by opioid overdose.

Limitation: The results probably underrepresent the true percentage of suicide decedents who had chronic pain, given the nature of the data and how they were captured.

Conclusion: Chronic pain may be an important contributor to suicide. Access to quality, comprehensive pain care and adherence to clinical guidelines may help improve pain management and patient safety.

Primary funding source: None.

Figure 1.

Case selection process for suicide decedents with chronic pain. NVDRS = National Violent Death Reporting System. * Circumstance variable indicating that the decedent was having physical health problems (e.g., chronic pain, terminal disease, debilitating condition) that seem to have contributed to the death.

Figure 2.

Percentage of suicide decedents with chronic pain aged 10 years or older, by year, in 18 states—NVDRS, 2003–2014. The solid line indicates the percentage of suicide decedents with chronic pain (all mechanisms). The dashed line shows the percentage of suicide decedents with chronic pain who died by opioid overdose, among all suicides (n = 123 181) during 2003 to 2014. NVDRS = National Violent Death Reporting System.