Recently, an article in “JAMA Psychiatry” presented data from over five million patients in the Veterans Administration health care system that associated back pain, migraine, and other types of chronic pain without a known physical cause with an increased risk of suicide. Interestingly, no such link was found between suicide and arthritis, neuropathic pain and non-migraine headaches. For many, this came as no surprise, as there may be more frustration and a sense of hopelessness in patients suffering from conditions such as fibromyalgia and chronic fatigue syndrome; there is still much debate as to what exactly is being treated, and how best to treat. In contrast, there are anti-inflammatory therapies and, if needed, eventually surgery for certain types of arthritis.
Of course, it is not an easy step to extrapolate these findings to the general population. There are many horrors that combat veterans have experienced, which could contribute to a chronic pain state. And I certainly would not put everyone with chronic pain on suicide watch.
However, there may another method of predicting suicide risk that is more objective.
A recent online report in “Molecular Psychiatry” described an observational study of bipolar patients, and found that those patients who experienced a dramatic shift from absent suicidal thinking to strong suicidal ideation also had marked increase in RNA biomarkers, including SAT 1 (spermidine/spermine N1-acetyltransferase 1). Similar findings were noted in a longitudinal study of patients with schizophrenia and schizoaffective disorder: High blood levels of these biomarkers were associated with future hospitalizations for suicidal attempts or ideation, in addition to hospitalizations that had occurred even before the patients’ blood was tested. In other words, the biomarkers studied may not be elevated only during the acute period of heightened suicide risk, but may be markers of long-term risk.
The strongest signal associated with suicidal thoughts was SAT 1. In fact, in the suicide victims who had been tested, elevated levels of SAT 1 were found in every patient. Of interest, particularly in the context of the recent publicity linking omega-3 to prostate cancer, the omega-3 docosahexaenoic acid (DHA) signaling pathway appears to play a role in the manifestation of these biomarkers: low omega-3 levels have been correlated with increased suicidality.
SAT 1 and 18 other biomarkers described in the study have been found to change in expression by omega-3 treatment in animal studies. Of course, more research needs to be done before any recommendations can be directed to humans regarding use of omega-3 supplementation for the prevention of suicide.
No therapist, family doctor, or family member wants to lose a patient to suicide. Suicide is that self-inflicted wound that can cause horrible collateral damage to those who knew and loved the victim, adding more victims in its wake. Accurately assessing risk, and assessing it in a manner that protects the rights of the patient, remains a challenge for health care providers and friends and family members. While it is difficult to deal with the uncertainty of the suicidal potential, at least there is research being undertaken that might result in new tools that will allow for the prevention of deaths that otherwise might have occurred.
The results from a needle stick just might allow us a leg up on the seemingly inevitable one of these days.