Risk factors for suicidal ideation in a chronic illness 2022 Elliott and Jason

Abstract

Suicide is an urgent concern for people with chronic illnesses, particularly for those with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Prior work has examined suicide risk in this illness, but few studies have examined specific risk factors. This study uses binary logistic regression to identify physical, social, and demographic risk and protective factors for suicidal ideation in ME/CFS (N = 559). The results indicate sleep-related symptoms, stigma, disability status, physical functioning, and marital status as risk factors for suicidal ideation in this group. These findings highlight the importance of education, de-stigmatization, and the search for effective disease-modifying treatments for ME/CFS.

Paywall, https://www.tandfonline.com/doi/full/10.1080/07481187.2022.2132551

 

Unfortunately, I can only read the abstract, but if they didn't they really should have looked at whether having doctors or family who believe you're actually sick has an effect. I bet it does.

 

Having a supportive doctor and family goes a long way.

Also, governments providing proper financial supports so that pwchronic illnesses can live a dignified life and not have to worry on top of being ill.

 

Friends and family, if they haven't already come across the stigmatizing propaganda regarding ME, very quickly pick up on this when one of their own is diagnosed with ME. From there the disbelief, lack of support and isolation begin.

Medicine and governments play a notable role in this isolation and lack of support, that may lead some pwME to suicide.

 

I'm lucky to have had a different experience with family. They believe me. My mom even reads about ME from biomedical sources.

 

I think when someone is diagnosed may play a part in whether those close to the pwME are supportive. If the diagnosis was made decades ago, when the BPS model was most strong, then support was maybe more limited.

Now that some government departments are on board, at least on the face of it, and there is a bit more research, this might engender more support.

It would be interesting to see what percentage of pwME have friends and family support. Although interpreting "support" can be subjective, both from the provider's and the recipient's points of view.

 

I doubt that they considered direct chemical responses. Niacin made me strongly suicidal. I believe the mechanism involved quinolinic acid, which is known to induce suicidal ideation.

 

As far as results go, they just have this:

 

Stigma is a major factor, increasing risk of suicidal ideation by roughly 4 times. No surprise there.

Receiving disability benefits increases the risk of suicidal ideation? That's strange. Is it because people on disability have worse functioning, maybe more social isolation?

Their conclusion about physical functioning is weird. I don't know what methods they used, but the confidence interval is extremely narrow compared to the others. It's also not a meaningful difference. (Statistically significant doesn't mean clinically significant.)

 

I would imagine it's because of things like:

Decreased income.
Financial insecurity.
Enforced poverty.
Poor housing and homelessness.
Having to fight to maintain benefits.
Fear of being thrown off of benefits.
Not being allowed to marry as it will decrease benefits.
Grief from material losses.
Inability to have things and pursue interests that are now unaffordable.

Edited to add: Stigma to being on benefits.

 

Receiving disability benefits implies more severe ME and, as noted by @Laurie P, precariousness and financial instability.

 

So much for all that secondary gain...

 

indeed. I'd also add that in uk the system is byond hostile, going through the process of regular reassessment (which is like being cross examined in court accused of a crime you havent committed), has provoked ideation in me, regardless of being ill etc.

 

...when cognitively impaired and likely in a state of PEM.

No one seems to have mentioned the single biggest risk factor, the thing that all pwME considering suicide have in common;

They are all alive, obviously the risk of suicidal ideation drops considerably, for that person, if this was not the case. Every single successful suicide reduces the scale of the problem, so the way these things are typically measured, could be counted as a 'success'.

Hypothetical.

Really bad therapist;

Last week I had 12 people who expressed suicidal thoughts to me. I listened and advised, and this week only 2 people expressed suicidal thoughts.

I'm a great therapist.

(the other 10 people were successful in their aim)

 

As morbid as it sounds, you're right. We need to consider survivorship bias when looking at suicidal thoughts in pwME. Otherwise, we might get some absurd results, depending on the rate of actual suicide.

 

Leonard Jason and colleagues have previously published an article on the risk factors for suicide among 64 people with ME, 17 of whom had taken their lives. The data of the deceased patients were collected from their relatives. https://www.s4me.info/threads/death...igue-syndrome-2020-johnson-jason-et-al.15494/

 

Based on what I have read and heard out of desperate pwME (and LC) over the years, I find only one factor, everything else is derived from it: lack of hope.

It's one thing to have a disease with support and the knowledge that people are at least trying to help, even if it's not much. But knowing that the very people whose job it is to do something instead are committed to making sure this never happens, hold those patients in contempt because of their illness, all hope is lost. Almost every interaction with the healthcare system is a reminder of how committed they are to keep this disaster going.

From LC forums every time desperate people voice their hopelessness, replies are always in the form that with time, most recover, so they have to hold on to that hope, to chance, basically. It's all chance, no one is affecting things, let alone improving them. Hope that medicine can help, now or in the future, is already long over.

So the cause and solution are obvious: medical neglect, and its end. I don't think any single factor matters a fraction as much as chance here: how ill someone is, how long it lasts, their financial and familial situation. It's all chance, random, mostly by the complete absence of the only professionals allowed to do anything. That's all consequence of negligence.

It's always the lack of hope that gets people. That's technically easy to deal with, except the way out is essentially blocked by politics and culture, as it goes through acknowledging that medicine itself played the main role in this despair. Nothing kills hope faster and more thoroughly than the damned psychosomatic ideology that choked all life out of this issue. None of this had to happen. None of it.

 

This

 

Agree unequivocally. No plausible pathway to improvement is the main source of my despondency. When you look at the landscape and assess who is working on solving this condition, the view is rather desolate.

The metabolic trap, the itaconoate shunt, neuroinflammation from Younger and VanElzakker, etc. At some point these hypotheses have to produce actionable intelligence or be consigned to the ash heap.

Apologies for the morose outlook. It’s been a difficult few days here.

 

Yes, we ask ourselves "After all those doctors saying "Sorry, can't help you.", and looking at the pile of pill/supplement bottles that didn't help, is there any hope in the foreseeable future?" If you've had a string of days that were nothing but suffering, the questions arises: "Is there any point in waking up for another day of that?" I think I was quite lucky to have had several temporary remissions, which convinced me that this disease was reversible; it could quite simply be 'shut off'. That gave me hope that I could find another way of triggering that switch and keeping it in the off position.

The random factors are important though. A particularly irritating response from a doctor, or some household hassle, or some other such factor could push the patient into deciding not to deal with life anymore. Having gotten "Sorry, can't help you." from several calls to suicide prevention services, I wonder how many suicides they actually caused by that response.