Suicidal Ideation and Suicide Attempts in the Elderly Associated with Opioid Use and Pain Sensitivity

terviews focused on sociodemographic characteristics and mental status examination were conducted along with a general health questionnaire, including medical history and medication use. Analgesics were classified according to the World Health Organization (WHO) Anatomical Therapeutic Chemical (ATC) classification system. We considered opioid and nonopioid analgesic use at T5 and T6. A structured questionnaire on chronic physical pain was administered at T6 ( n = 568). Binary and multinomial logistic regression models were used to assess whether the 3 groups were different with regard to analgesic consumption and physical pain after adjustment for sociodemographic and clinical variables found to be different between the groups ( p ≤ 0.05). A generalized linear model was used to compare the impact of pain symptoms on the quality of life between the groups using the same covariates, with the addiction of opioid consumption. The significance threshold was adjusted using false discovery rate (FDR) ( q ≤ 0.02). The main sociodemographic and clinical characteristics of our sample of SI/SA were consistent with previous findings. In particular, concerning sociodemographic features, SI/SA had a higher rate of women than HC ( p < 0.0001) but it was not different from AC ( p = 0.28). Moreover, SI/SA had a higher mean age than HC ( p = 0.02). Finally, SI/SA lived more often alone in comparison to both AC ( p = 0.005) and HC ( p < 0.0001). Concerning clinical features, SI/SA reported a higher frequency of head trauma in comparison to both AC ( p = 0.04) and HC ( p = 0.03). They reported a higher rate of current depressive symptoms ( p < 0.0001), a higher rate of lifetime history of anxiety disorders ( p = 0.02), and higher rates of current antidepressant ( p < 0.0001) and anxiolytic use ( p = 0.002) in comparison to AC. Finally, SI/SA reported a higher number of fractures in comparison to HC ( p = 0.001) and poorer subjective health in comparison to both AC and HC (both p < 0.0001). The proportion of subjects taking analgesics was 37.6% in SI/ SA, 30.2% in AC, and 21.6% in HC. A higher rate of analgesic consumption in SI/SA versus HC was reported ( p < 0.0001). For nonopioid drugs, proportions were 21.8% in SI/SA, 18.5% in AC, and 15.5% in HC; for opioid drugs, they were 15.7% in SI/SA, 11.7% in AC, and 6.1% in HC. Also comparing nonopioid and opioid drug consumption, a difference between SI/SA and HC was found ( p < 0.0001). In logistic regression model 1 ( Table 1 ), SI/SA were more prone to use analgesics in comparison to HC. However, when we removed cancer cases as potential confounders for opioid consumption, the difference was no longer significant. In multinomial logistic regression ( Table 1 , model 2B), when we compared opioid users to analgesic nonusers, SI/SA were more prone to use opioids than HC (SI/SA: odds ratio (OR) = 2.78 [95% confidence interval (CI) = 1.40–5.53], p = 0.003). Interestingly, the comparison between AC and HC was not significant after FDR. The results were similar after the exclusion of cancer cases. The most commonly prescribed medications in the United States (US) are currently opioid analgesics, because of their capacity to relieve acute pain, even if their efficacy for chronic noncancer pain is questionable. The recent dramatic increase in opioid prescribing and their inappropriate use has led to an epidemic of opioid addictions, often generalizing to other substance use disorders and overdose deaths. In the US, the suicide death rate with opioid overdose increased from 2.2% in 1999 to 4.4% in 2010 [1] . Suicides by opioid overdose are frequently found in patients with chronic pain [2] . Additionally, chronic pain is associated with elevated rates of suicidal thoughts and behaviors [3] . We recently reported increased opioid consumption in elderly people with a past history of suicide attempt [4] . So, we hypothesized that people having a history of suicidal thoughts and behaviors would be more prone to consume opioids, probably to get relief from pain, than subjects without such a history. In addition, we hypothesized a higher rate of chronic physical pain in these individuals. Our aim was to investigate differences in terms of analgesic consumption and physical pain between (1) subjects with suicidal ideation during follow-up or with a lifetime history of suicide attempt (SI/SA) ( n = 229), (2) affective controls (AC) ( n = 384), i.e., subjects with a lifetime history of major depression Mini-International Neuropsychiatric Interview (MINI) or high depressive symptoms (Center for Epidemiological Studies-Depression, CES-D >16) during the study but without SI/SA, and (3) healthy controls (HC) ( n = 245), i.e., having neither SI/SA nor major depression, and having low depressive symptoms and no psychotropic medication use during the study. These 3 groups (total n = 858) were selected from an existing prospective general population elderly study (ESPRIT, n = 2,132) [5] (full manuscript available on request). Subjects were evaluated at 7 time points: from baseline (T0: 1999–2001) until time point 6 (T6: 2011–2012). Standardized inReceived: February 18, 2017 Accepted after revision: May 30, 2017 Published online: November 3, 2017