An Increased Risk of Suicide across Medical Conditions – Including Migraine

A new analysis considers 31 medical conditions, including neurological conditions like migraine. The elevated suicide risk in almost all of them increased with more severe disability.

A new study from researchers at Denmark’s Aarhus University is reporting a disturbing commonality across a range of medical conditions: An increased risk of suicide.

After analyzing health, mortality, and demographic data from more than 6.6 million people residing in Denmark between the years 2000 and 2020, the investigators discovered that having a medical condition elevated the risk of suicide across all of the 31 conditions considered in the study except for endocrine disorders.

While the risk was highest for gastrointestinal conditions, cancer, and hematological conditions, neurological conditions – including migraine – also conferred an increased risk.

Further, suicide risk was higher in people who experienced significant disability burden from their condition. Yet being hospitalized for depression, anxiety, or other mental disorders did not add to suicide risk.

“This is an important study and something that we must remain vigilant for as healthcare professionals,” said Dawn Buse, Albert Einstein College of Medicine, New York, US, in an email to Migraine Science Collaborative.

“The findings on migraine and suicidality in the study align with broader literature showing that, sadly, individuals with migraine are at an elevated risk of suicide,” according to Buse, a clinical psychologist and headache researcher who was not involved with the new work.

The study appeared in the December 2024 issue of JAMA Psychiatry.

A comprehensive data source
Suicide remains a daunting public health problem. According to the Centers for Disease Control and Prevention (CDC), suicide rates increased by 36% between 2000 and 2022, and the World Health Organization estimates that more than 700,000 individuals will die by their own hand each year around the globe.

Many factors contribute to suicide, and it makes sense that having a chronic medical condition may be one of those factors, according to Elizabeth Seng, a psychologist and migraine researcher at Yeshiva University, New York, US, who was not involved with the current study.

“In some ways, it isn’t a surprise that having a chronic illness would worsen the suicide risk for people,” she told MSC during an interview. “We know that risk factors for death by suicide include feeling like you have no hope, which you might feel if your physical health is in decline. Chronic illness can be an acute financial stressor, and financial problems have been linked to suicide risk, too.”

Thanks to Denmark’s national health and social registries, the country has longitudinal data on each person living in the country. That includes demographic information, medical diagnoses, admissions to inpatient psychiatric facilities, drug prescriptions, immigration status, cause of death, and more.

For the current study, researchers led by psychiatrist Søren Østergaard (who declined to be interviewed for this article) mined this unique and expansive data set to look at the links among 31 distinct medical conditions, nested within 9 categories, to determine whether they increased risk for suicide. Migraine was included in the category for neurological conditions. The team also looked at whether a prior mental health disorder requiring a psychiatric inpatient hospital stay further elevated the risk.

“This group was able to exploit the wonderful data they have in Denmark to answer a question that we haven’t been able to look at that carefully before,” according to Theo Vos, an epidemiologist from the University of Washington’s Institute for Health Metrics and Evaluation, Seattle, US.

“They have information on healthcare encounters for the whole population. And because each citizen has a unique identifier, they can link it to the country’s mortality register in order to do an analysis of different medical conditions and deaths that were classified as suicide,” said Vos, who also was not involved with the new work.

Consistent findings across medical conditions
The study included in its analysis more than 6.5 million people (roughly evenly split between males and females) living in Denmark between January 1, 2000, and December 31, 2020. Nearly 13,000 individuals died by suicide during that time.

The study would determine incidence rate ratios (IRRs), calculated by dividing the incidence rate of suicide amongst those with a particular medical condition by the incidence rate of suicide amongst those without that condition.

The researchers found that having a medical condition increased the risk of dying by suicide for all medical conditions included in the study except for endocrine disorders. Suicide risk was highest for those with gastrointestinal conditions (an IRR of 1.7), cancer (an IRR, of 1.5), and hematological conditions (an IRR of 1.5).

With regard to migraine, the overall IRR was 1.2 (1.1 for males and 1.3 for females), which Buse characterized as a moderate elevation that is consistent with findings from previous studies of suicide risk in people with migraine. The IRR of 1.2 means that the incidence rate of suicide was 1.2 times as high in those with migraine as the rate among those without migraine.

Adjusting for socioeconomic position and immigrant status had little effect on suicide risk in people with medical conditions.

However, perhaps surprisingly at first glance, being previously hospitalized for a mental health disorder did not significantly alter the risk of suicide. Seng pointed to one possible reason behind that finding.

“Thinking about death, dying, and killing yourself is common, especially in severe mood disorders. Those kinds of thought patterns are even in the diagnostic criteria for mood disorders,” she explained. “But we’ve learned there’s a certain impulsivity to the act of suicide. There’s strong evidence to suggest if you can intervene with people in the moment, they will lose the intent to do themselves harm. It’s a very timebound phenomenon. The fact that the patients here were hospitalized and got help may explain why there isn’t a stronger association.”

Along similar lines, Vos said, “Many mental disorders, particularly common ones like depression and anxiety, just don’t get picked up in the health system. Many people just don’t seek care for those,” he said. “There could be a significant percentage of cases, maybe even more than 40%, of these kinds of mental illnesses that simply aren’t included in the analysis, so the association looks weaker than it is.”

The analysis also demonstrated that risk of suicide was most elevated in the six months after diagnosis of a medical condition, including for migraine. There was also a dose-response association, where higher disability (quantified using Global Burden of Disease Study data) conferred a higher risk of suicide. Vos said he would expect that.

“It makes sense. The more severe the condition, the bigger the burden of living with the disease, and the higher risk of suicide,” he said.

Looking at the migraine data specifically, Buse said that the combination of migraine and a prior mental disorder did raise suicide risk to an IRR of nearly 1.4, overall, with a greater risk for females living with migraine.

“This study emphasizes the importance of assessing and monitoring psychological comorbidities and symptomology among people with migraine,” she told MSC. “Prior mental disorders significantly amplify suicide risk, so thoroughly treating both diseases and referring for treatment as appropriate is important.”

Next steps
Seng called the work an “excellent” study with rigorous results, but she would like to see additional analysis in the future to tease out potential interactions between other variables and suicide risk.

“We know that risk of death by suicide changes over time by gender,” she said. “If there’s one thing I’d like to see, since so many of these diseases do vary by time and gender, is a closer look at potential interactions. That would require more data about symptoms at specific times. I hope the investigators continue to analyze the data and provide that color for us. An assessment of current and past substance abuse is also missing from this study, and since substance abuse is another strong predictor of suicide-related behavior, it would be interesting to see its effect.”

In the meantime, Buse hopes that healthcare providers, particularly headache specialists, understand the suicide risk that migraine confers and do what is necessary to monitor and reduce it.

“[These results underscore] the importance of closely monitoring the mental health of patients with migraine, particularly during the initial months following diagnosis when the risk is highest,” she said. “Early mental health interventions, such as screening for depression, anxiety, and other psychiatric conditions should be a priority to help mitigate this risk.”

Seng agreed. She added that there are screens like the Columbia-Suicide Severity Rating Scale that are readily available for doctors to use with patients. And, even having a poster in the office that advertises 988, the Suicide & Crisis Lifeline, can be beneficial.

“The most important thing we can do, as providers, to help people with suicidal intent is to help put space between their impulses and an access to means,” she said. “By asking people about suicidal thoughts and giving them the ability to talk about where they may be struggling, you can be part of that space. It’s not overstating it to say that you could save someone’s life.”

Kayt Sukel is a freelance writer based outside of Houston, Texas.

If you are having thoughts of suicide, call or text 988 to reach the 988 Suicide & Crisis Lifeline. For those who live outside of the US, visit the International Association for Suicide Prevention to find a helpline.

Image credit: 123RF Stock Photo.

Reference
Risk of suicide across medical conditions and the role of prior mental disorder.
Østergaard et al.
JAMA Psychiatry. 2024 Dec 1;81(12):1198-1206.