Suicide can be a difficult topic to talk about, a hard discussion to have publicly or privately. Even in news stories about people who have self-harmed, reporters and journalists rarely go into detail. Consequently, we now use euphemisms like ‘the death is not thought to be suspicious.’ We used to think that if we downplayed suicide, we could reduce the level of copy-cat events and the contagion effect. The jury is still out on whether this approach has worked, especially given the increase in social media.
Last Friday, 10 September, was World Suicide Prevention Day. Not only is it a time to raise awareness about suicide but also the reasons behind the statistics, including the link with chronic pain. Living with chronic pain takes a huge emotional toll. There is an established link between people living with chronic pain and living with mental health problems, particularly depression and anxiety.
Major depression is the most common mental health condition associated with chronic pain, with among 30-40% of people with a diagnosed mental health condition also presenting for treatment for chronic pain.
People living with chronic pain, may also be dealing with some of the major risk factors for suicide, including co-occurring anxiety and depression, anger, isolation, and sleep disturbances.
For some people, this includes suicidal ideation to escape the pain that they deal with on a daily basis. According to a Study conducted by the Australian Catholic University in 2014, around 50% of people living with chronic pain “seriously considered suicide” at one time or another.
A 2018 study, published in the journal Annals of Internal Medicine, analysed the presence of chronic pain in people who died by suicide. It included data from 2003 to 2014 on 123,181 people across 18 states in North America. Researchers found that 8.8 percent of cases included evidence of chronic pain. The most common conditions were back pain (22.6%), cancer (12.5%), and arthritis (7.9%), with most people having more than one condition.
Mental health problems affect an individual’s education opportunities and employment, relationships, stigma, and loss of quality of life. The similarities in prevalence and impact between mental health problems and chronic pain are striking, with many Australians currently living with chronic pain also experiencing similar impact on their opportunities and quality of life.
These figures come into sharp focus when we consider population groups who may be disproportionately impacted such as people serving in the Australian Defence forces and Veterans. When Painaustralia provided input into the first stage of the Royal Commission into Defence and Veteran’s Suicide in May this year, we pointed out that one of the factors associated with the higher suicide risk in veterans (between 2002–2017 the age-adjusted rate of suicide in ex-serving men was 18% higher than among Australian men) was chronic pain.
We know that chronic pain significantly contributes to poor mental health. We know that a significant number of veterans live with pain from injuries caused by improvised explosive devices and weapons that inflict severe impacts on heads, necks, spines, and limbs. Pain is also common in veterans who have experienced several injuries, and it is often accompanied by post-traumatic stress disorder (PTSD).
Feeling isolated, having catastrophic thoughts, and being in denial about having chronic pain are all emotional states and feelings that can potentially be counteracted with a multidisciplinary approach that combines medication, counselling, and physical therapy.
Whatever population group, we know that that ensuring access to information, support and best practice multidisciplinary care in the community is the key to improving the way we respond to chronic pain. For health professionals, access to quality pain management education and training as well as treatment options including, and beyond, medication is the best way to ensure that they provide the most effective care for people living with chronic pain.
Suicide is not always about poor mental health and does not always have a clear cause. The complexity and unique considerations in many cases make suicide prevention challenging. At the same time, we know there are population groups more at risk of suicide, which is why Painaustralia seeks to have the needs of people experiencing chronic pain factored into suicide prevention programs and services.
The fact is that if we can provide better chronic pain services where people feel valued and able to continue making a positive contribution in their lives, we will reduce the level of suicide in Australia. And that is something we should all be talking about.
Carol Bennett, CEO
Painaustralia has joined with Soldier On to highlight the disproportionate impact of chronic pain on veterans. Our joint fact sheet can be found here