Physical pain and suicide-related outcomes across the lifespan: systematic review and meta-analysis

Abstract

Suicide is a complex and multifactorial phenomenon, with increasing evidence highlighting the link between physical pain and suicidal thoughts and behaviors. This meta-analysis examines suicide-related outcomes among individuals with and without physical pain. We searched PubMed, PsycINFO, and Cochrane databases, including 91 studies in the review and 88 in the meta-analysis. Data were analyzed using Comprehensive Meta-Analysis software (version 3.7). The findings revealed that people experiencing physical pain were significantly more likely to have suicide-related outcomes than those without pain. The strongest associations were found for lifetime death wish (OR = 2.10), current suicidal ideation (OR = 1.93), and lifetime suicide attempts (OR = 1.94). Among adolescents, self-harm was notably higher among those with pain, while adults showed a higher risk of lifetime suicide attempts and suicide death. In older adults, suicidal ideation and suicide attempts were more strongly linked to pain. Females had higher odds of suicidal ideation compared to males. Specific painful conditions, like fibromyalgia, abdominal pain, and migraines, were also linked to increased suicide risk. Limitations include high heterogeneity and lack of data on some suicide-related outcomes. Pain is a significant risk factor for suicidality across all ages and in specific populations, as conceptualized by ideation-to-action framework suicide models.

Keywords: Adolescents; Adults; Meta-analysis; Older adults; Pain; Suicide.