Risk and Predisposing Factors for Suicide Attempts in Patients with Migraine and Status Migrainosus: A Nationwide Population-Based Study.

Tomor Harnod,Chia-Hung Kao,Cheng-Li Lin

doi:10.3390/jcm7090269

Abstract

Objective: To investigate the risk and risk factors for suicide attempt by patients with regular migraines (RM) and status migrainosus (SM) in Taiwan. Methods: We analyzed a subset of the National Health Insurance Research Database of Taiwan and enrolled patients (≥20 years old) who had ever received a diagnosis of RM or SM between 2000 and 2012 in the RM and SM cohort. The SM cohort included 13,605 patients, the RM cohort had 21,485 patients, and the comparison cohort contained approximately four times that many patients. We calculated the adjusted hazard ratios and 95% confidence intervals (CI) for suicide attempts after adjusting for age, sex, monthly income, urbanization level, occupation, and comorbidities. Results: The SM cohort had a 1.81-fold risk of attempting suicide (95% CI = 1.14–2.89) compared to the comparison cohort. Other factors that predispose patients with SM to attempt suicide include the following: female sex, relatively young age (<50 years old), and low monthly income (<15,000 New Taiwan Dollars, approximately equivalent to 495 US Dollars). Additionally, the risk of attempting suicide only increased in patients who had been diagnosed with SM for longer than five years. Conclusion: SM is associated with a higher risk for suicide attempt in migraineurs in Taiwan. This finding is important to clinicians and government officials seeking to prevent patients from attempting suicide in Taiwan and other similar East Asian countries.

Highlights

A migraine is the most frequently diagnosed type of headache at neurological clinics across Asian developing countries, accounting for 66.6% of all headache services [1]
The Kaplan-Meier graph shows that the cumulative incidence of suicide attempts was higher for the status migrainosus (SM) cohort than the comparison cohort throughout the 12-year follow-up period (p = 0.01 for the log-rank test) (Figure 1A)
We noted that the cumulative incidences of suicide attempts were not significantly different between the regular migraines (RM) and comparison cohorts (Figure 1B, log-rank test: p = 0.14)

Summary

Introduction

A migraine is the most frequently diagnosed type of headache at neurological clinics across Asian developing countries, accounting for 66.6% of all headache services (range: 50.9–85.8%) [1]. Numerous epidemiological studies conducted in Western developed countries during the past two decades have found that migraines affect approximately 20% of the general population [2,3]. We discovered that most of the previous studies of suicidal behaviors exhibited by the patients were investigated in patients with general or regular migraines (RM), and did not focus on patients with a treatment-resistant or status migrainosus (SM) condition. Patients with SM have more disability than patients with a classic, general migraine and may require specific pharmacological and psychological strategies to reduce the burden of the disease [9,10]. Further investigation is required to compare the correlated risks of suicide attempts in patients with RM and SM to elucidate future treatment strategies among these specific ones

Methods

Results

Discussion

Conclusion