Suicidal Ideation and Self-Injury in Trigeminal Neuralgia

Nathan S Fishbein,1 Jafar Bakhshaie,2,3 Jonathan Greenberg2,3 1Psychology Department, Fordham University, Bronx, NY, USA; 2Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital, Boston, MA, USA; 3Harvard Medical School, Boston, MA, USACorrespondence: Jonathan Greenberg, Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital, Harvard Medical School, 1 Bowdoin Square, 6th Floor, Suite 648, Boston, MA, 02114, USA, Email [email protected]: Trigeminal neuralgia is commonly associated with emotional distress and unique challenges that may increase the risk of suicidality. Nevertheless, suicidality remains understudied in this population. This study reports rates and severity of suicidal ideation and self-injury and the association between suicidality, emotional distress, and pain intensity in a large sample of adults with trigeminal neuralgia and related neuralgias.Patients and Methods: We recruited 229 adults with trigeminal neuralgia and other related conditions to complete a cross-sectional survey assessing suicidal ideation, self-injury, and emotional distress. We analyzed rates and severity of suicidal ideation and self-injury. We performed independent samples t-tests to compare the severity of suicidality between respondents with high and low levels of anxiety, depression, and pain intensity.Results: Over a third (34.6%) of respondents reported at least some thoughts of suicide in the past 2 weeks, 27.6% reported thinking the world would be better off without them, 57.7% reported thinking about their own death, 14.0% reported thinking about hurting themselves, 2.6% reported hurting themselves purposefully, and 1.3% reported cutting or burning themselves. Over a third of respondents (39.1%) had elevated anxiety, and suicidality was more severe among those with elevated anxiety than among those without (n = 214, p < 0.001). Over a quarter of respondents (28.5%) had elevated depression, and suicidality was more severe among those with elevated depression than among those without (n = 213, p < 0.001). Almost two-thirds of respondents (62.9%) had elevated pain intensity, and suicidality was more severe among those with elevated pain intensity than among those without (n = 228, p < 0.001).Conclusion: Suicidality is an urgent yet under-addressed concern among adults with trigeminal neuralgia and is associated with high rates of anxiety, depression, and pain intensity in this population. We propose recommendations to enhance suicide screening and develop interventions to reduce suicide risk among those with chronic orofacial pain.Keywords: suicide, emotional distress, pain, anxiety, depression