Pain as a risk factor for suicidal behavior in older adults: A systematic review

Objective: The objective of this systematic review was to examine whether pain is a risk factor for suicidal behavior (suicide ideation, suicide attempts or suicide) in older adults. Material and methods: An extensive search was conducted on the following databases: MEDLINE, ISI Web of Knowledge, Scopus and PsycARTICLES. Search terms used were pain, suicid* and elderly. Studies that assessed the relation between pain and suicidal behavior among people aged >= 60 years were included. Two reviewers independently screened the abstracts and applied selection criteria in the full-text of all included articles. Results: Results from 38 original research articles were included and reviewed. Moderate/severe pain increased the risk of suicide ideation from OR = 1.13 (95 %CI = 1.02-1.25) to OR = 2.7 (95 %CI = 1.1-7.0). The influence in suicide attempts ranged between OR = 1.92 (95 %CI 1.17-3.15) and 3.63-fold for extreme pain; and one article reported that the risk of a successful suicide was 4.07-fold higher in pain suffering patients. In most studies, this relation was maintained, even after controlling for other risk factors. Arthritis, back/neck problems and headaches were associated with higher risks of suicidal behavior. Pain was also a stronger predictor for suicide in men (OR = 9.9; 95 %CI = 6.0-16.4) than in women (OR = 3.3; 95 %CI = 1.4-7.7). Conclusion: Our results suggest the existence of a relationship between pain and suicidal behavior in older adults. This information may be extremely relevant to inform suicide prevention strategies.