Demoralization predicts suicidality in patients with cluster headache
Brian B Koo1,2,3,4, Ahmed Bayoumi5, Abdalla Albanna5
1Department of Neurology, Yale University School of Medicine (SOM), PO Box 208018, New Haven, CT, 06520-8018, USA. brian.koo@yale.edu.
The Journal of Headache and Pain
|April 21, 2021
Summary
Cluster headache (CH) patients exhibit significantly higher rates of suicidal ideation and suicide risk compared to controls. Demoralization, not depression, is a key factor associated with suicidal ideation in CH.
Area of Science:
- Neurology
- Psychiatry
- Epidemiology
Background:
- Cluster headache (CH) is a debilitating neurological disorder characterized by severe unilateral retro-orbital pain, often leading to disability and psychological distress.
- Existing literature suggests a link between CH and suicidality, but empirical data on the prevalence of suicidal ideation and suicide risk, considering factors like depression and demoralization, remains limited.
Purpose of the Study:
- To investigate the prevalence of suicidal ideation and assess suicide risk in individuals with cluster headache (CH).
- To compare the rates of suicidal ideation and suicide risk between CH patients and a matched control group without CH.
- To explore the association between suicidal ideation in CH patients and psychological factors such as depression and demoralization.
Main Methods:
- An observational case-control study involving 100 CH patients and 135 matched controls recruited via community and patient group advertisements.
- CH diagnosis was confirmed using the International Classification of Headache Disorders, 3rd edition criteria.
- Lifetime suicidal ideation and suicide risk were assessed using validated scales (Suicidal Behavior Questionnaire-revised, Columbia Suicide Severity Rating Scale), alongside measures for depression and demoralization.
Main Results:
- CH patients reported significantly higher lifetime active suicidal ideation (47.0% vs. 26.7%) and high suicide risk (38.0% vs. 18.5%) compared to controls.
- A history of depression (67.0% vs. 32.6%) and demoralization (28.0% vs. 15.6%) were also more prevalent in CH patients.
- The odds of lifetime suicidal ideation were doubled in CH patients, even after adjusting for depression and demoralization; suicidal ideation was specifically linked to demoralization (OR 6.66) rather than depression (OR 1.89).
Conclusions:
- Lifetime suicidal ideation and high suicide risk are common among individuals suffering from cluster headache.
- The likelihood of suicidal ideation in CH patients is significantly influenced by the presence of demoralization.
- These findings underscore the importance of screening for and addressing suicidal ideation and demoralization in CH management.
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