• Ashli A Owen-Smith, Brian K Ahmedani, Ed Peterson, Gregory E Simon, Rebecca C Rossom, Frances L Lynch, Christine Y Lu, Beth E Waitzfelder, Arne Beck, Lynn L DeBar, Victoria Sanon, Yousef Maaz, Shehryar Khan, Lisa R Miller-Matero, Deepak Prabhakar, Cathy Frank, Christopher L Drake, and Jordan M Braciszewski.
• School of Public Health, Georgia State University, Atlanta, Georgia, U.S.A.
• Pain Pract. 2019 Apr 1; 19 (4): 382-389.

ImportanceFew 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.ObjectiveTo assess whether sleep disturbance mediates the relationship between NMCP and suicide death.DesignThis case-control study included 2,674 individuals who died by suicide between 2000 and 2013 (cases) and 267,400 matched individuals (controls).SettingEight Mental Health Research Network (MHRN)-affiliated healthcare systems.ParticipantsAll cases and matched controls were health plan members for at least 10 months during the year prior to the index date.Main Outcomes And MeasuresSociodemographic 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.ResultsAfter 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.Conclusions And RelevanceThere 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.© 2018 World Institute of Pain.

14 keywords...

hide…