Suicidal Behavior in Patients with Chronic Pain: A Systematic Review and Meta-Analysis

OBJECTIVES: Chronic pain has been severely impaired an individual's daily activity and quality of life. Also, chronic pain may contribute to suicidal behaviors by leading to some mechanisms including pain-related catastrophizing. This review aimed to investigate the prevalence and associated factors of suicidal behaviors including suicidal ideation and suicide attempt or its complete, in with chronic pain.

METHODS: By comprehensive searches in five databases, observational studies published up to up to October 4, 2022, investigating the prevalence of suicidal behavior in chronic pain patients were included. The methodological quality of the included studies was assessed using the Strengthening the Reporting of Observational studies in Epidemiology statement. By using the command ‘metaprop’ was used in STATA/MP 16, a meta-analysis was conducted to quantify the prevalence of suicidal behavior in chronic pain patients. Factors explaining the association between chronic pain and suicidal behavior identified through regression analysis were also investigated.

RESULTS: Total 19 studies were included (N = 3,312,343). The pooled lifetime prevalence of suicidal ideation and suicide attempt was 28.90% (95% CI: 17.95%, 41.26%) and 10.83% (5.72%, 17.30%), respectively, in a mixed sample. Also, the pooled prevalence of past 2-week suicidal ideation was 25.87% (18.09% to 34.50%) in this sample. The methodological quality of the included studies was generally poor, and the use of validated suicidal behavior assessment tools were lacking. Potential protective factors against suicidal behavior in chronic pain patients included pain coping and self-efficacy, older age, certain race/ethnicity groups, and marriage.

CONCLUSIONS: This review demonstrated the high prevalence of suicidal behavior in chronic pain patients. Around 1 in 4 chronic pain patients had suicidal ideation within the last 2 weeks. However, there was considerable heterogeneity in the pooled prevalence of suicidal behavior in this population.