The Experience of Pain is Strongly Associated With Poor Sleep Quality and Increased Risk for Suicide

Abstract

Objective

Effective suicide prevention is hindered by a limited understanding of the neurobiology leading to suicide. We aimed to examine the association between changes in the experience of pain and disturbances in sleep quantity and quality in patients with elevated risk for suicide.

Methods

Three groups of adult depressed individuals, including patients following a recent suicide attempt (n = 79), patients experiencing current suicidal ideation (n = 131), and patients experiencing depression but no suicidal ideation or behavior in at least 6 months (n = 51), were examined in a case-control study for sleep quantity and quality, physical and psychological pain, pressure pain threshold, suicidal ideation, and recent suicidal behavior.

Results

Sleep quality, physical and psychological pain were positively associated with suicidal ideation severity. In both cases in which sleep quality was added to a model with either physical or psychological pain, physical or psychological pain became more significantly associated with suicidal ideation severity. Pressure pain threshold was elevated in patients suffering from any type of insomnia. There was no significant association between pressure pain threshold and suicidal ideation severity.

Conclusions

The impact of these findings lies in the identification of both psychological and physical pain, and sleep quality as potential biological mechanisms underlying suicidal risk.

HIGHLIGHTS

• We assessed the association between pain and sleep quality in suicidal patients.

• Sleep quality, physical and psychological pain were associated with suicide risk.

• Pain perception may mediate the progression to suicidal behavior.

Keywords:

• Insomnia
• physical pain
• psychological pain
• sleep
• suicidal ideation
• suicide

ACKNOWLEDGMENT

We thank Dr. Christine DeLorenzo for her critical review of this manuscript.

DISCLOSURE STATEMENT

RC receives research funding from Neuronetics and Janssen Pharmaceuticals and belongs to Roche’s speaker’s bureau. All the other authors declare no conflict of interest. No funding source had any role in study design, in the collection, analysis, and interpretation of data, in the writing of the manuscript, and in the decision to submit the article for publication.

Additional information

Funding

This work was partially funded by the Clinician Scientist Program of the University Arkansas for Medical Sciences and by a grant numbered [P30 GM110702].

Notes on contributors

Ricardo Cáceda

Ricardo Cáceda, Department of Psychiatry, Stony Brook University, Stony Brook, New York, USA; Psychiatry Service, Northport Veteran Administration Medical Center, Northport, New York, USA.

Diane J. Kim

Diane J. Kim, Department of Psychiatry, Stony Brook University, Stony Brook, New York, USA.

Jessica M. Carbajal

Jessica M. Carbajal, Department of Psychiatry, Stony Brook University, Stony Brook, New York, USA.

Wei Hou

Wei Hou, Preventive Medicine Division, Stony Brook University, Stony Brook, New York, USA.