Introduction
Recent research suggests that physical pain may be an important risk factor for suicidality in adolescents. The aims of this study were: to estimate the association between physical symptoms of pain in 11-year-olds and the risk of suicidal ideation and suicide attempts during the teenage years up to age 18; and to assess whether depression mediates the relationship between pain and suicidality.
Methods
Data analyses were conducted on the Danish National Birth Cohort (DNBC), utilizing sub-data collections from the 11-year follow-up (DNBC-11) and 18-year follow-up (DNBC-18). Exposure was defined at age 11 as reporting pain weekly in the head, stomach, neck or back. Suicidality was assessed by self-reported suicidal ideation or suicide attempts from the DNBC-18, and information on hospital-registered suicide attempts. Multinomial logistic regressions, adjusted for relevant covariates and incorporating sampling weights to account for selection bias, were employed. Causal mediation analysis was utilized to investigate depression as a mediator between pain and suicidality.
Results
Among the 28,465 included individuals 12.6% reported frequent pain (head, stomach, back or neck pain). Increased risks of both suicidal ideation and suicide attempt were observed for those with weekly pain compared to all other categories. Pain was longitudinally associated with an increased risk of suicide attempt; back or neck pain [relative risk ratio (RRR) = 4.2, 95% confidence interval (Cl): = 3.2-5.3], stomach aches (RRR = 3.2 95% CI =2.5-4.1), and headache (RRR = 2.8, 95% CI =2.3-3.5). Additionally, a significant association was observed with suicidal ideation for each pain site; however, the risk estimates were slightly lower. Adolescents reporting three pain sites had a notably higher risk of suicide attempt (RRR = 6.4, 95% CI =3.9-10.4) compared to those not reporting any weekly pain. Associations between pain and suicidality remained statistically significant after adjusting for mental health variables. Mediation analysis revealed that depression mediated around 10% of the associations between the three distinct pain sites and suicidality.
Conclusion
Adolescents experiencing frequent pain had an elevated risk of suicidal ideation and suicide attempt compared to those without such pain. This paper emphasizes the importance of directing suicide prevention programs toward children and adolescents reporting frequent pain.