Pain and suicidality during adolescence: a Danish National Cohort Study

Pain has been suggested as an important risk factor for suicidality in adolescents. We examined the association between pain at age 11 years and suicidality until age 18 years. Second, we assessed whether psychiatric diagnoses might mediate this association. We used data from the Danish National Birth Cohort's 11-year follow-up (DNBC-11) and 18-year follow-up (DNBC-18). Self-reported head, stomach, neck, and back pain at age 11 years were examined as exposures. Outcomes were formed from data on self-reported suicidal ideation and suicide attempts from the DNBC-18 and hospital-recorded suicide attempts by age 18 years. We used multinomial logistic regressions and mediation analyses, adjusting for covariates and incorporating sampling weights. Among 28,465 eleven-year-olds, 13.5% reported any frequent pain, which was associated with increased risks of suicidal ideation (adjusted relative risk ratio [aRRR] = 1.6, 95% confidence interval [CI]: 1.5-1.7) and suicide attempts (aRRR = 2.4, 95% CI: 2.0-2.8). Individuals who had reported 3 or more pain sites at age 11 years had a higher risk of suicide attempt (aRRR = 6.4, 95% CI: 3.9-10.4) compared with those with no frequent pain. Pain-related functional interference and recurrent pain were associated with significantly elevated risks of suicidal ideation and suicide attempts. Affective and anxiety/stress-related disorders diagnosed between age 11 and 18 years significantly mediated the association between frequent pain and suicidal ideation (14%-16%), as well as between frequent pain and suicide attempts (37%-48%). Frequent pain is a common concern in 11-year-olds in Denmark and prospectively associated with an increased risk of suicidality by age 18 years. Suicide preventive strategies may consider targeting youth with frequent pain.