Suicidal ideation in non-depressed individuals: The effects of a chronic, misunderstood illness, Devendorf et al, 2018

Indigophoton · Jul 11, 2018

Abstract
Chronic illness is a risk factor for suicide but is often explained with depression. Research has shown an increased suicide rate in patients with myalgic encephalomyelitis and chronic fatigue syndrome, but specific risk factors have been unexplored. We qualitatively analyzed responses from 29 patients who endorsed suicidal ideation but did not meet depression criteria. Two themes were developed: (1) feeling trapped and (2) loss of self, loss of others, stigma and conflict. Myalgic encephalomyelitis and chronic fatigue syndrome caused patients severe disability, restructured their lives, and inflicted serious pain. Participants emphasized that they were not depressed, but felt trapped by the lack of treatments available.
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This study attempts to understand factors, other than a psychiatric dis-order, that contribute to suicidal thoughts in patients with myalgic encephalomyelitis (ME) and chronic fatigue syndrome (CFS).
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Of the 551 patients
(McManimen et al., 2018), 7 percent endorsed
SI [suicidal ideation] but did not meet depression criteria.
Our qualitative findings illustrate how the
ceaseless burden of ME and CFS contributes to
SI. ME and CFS caused this sample severe dis-
ability, restructured their lives, and inflicted
serious pain, which aligns with our hypotheses
and other qualitative studies (Anderson et al.,
2012). Participants emphasized that they were
not depressed—they desired to participate in
life—but they felt trapped by their hopeless cir-
cumstances. This feeling was produced by
unsatisfying interactions with healthcare pro-
viders, feeling powerless, and a lack of treat-
ment. Participants encountered stigma and
blame, misunderstanding, and unwarranted
advice about treatments, where patients felt the
need to educate others about their illness. These
social detriments and isolating circumstances,
which are common for patients, exacerbated
feelings of hopelessness.
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http://journals.sagepub.com/doi/10.1177/1359105318785450

Full paper available here, http://sci-hub.tw/10.1177/1359105318785450

Kalliope · Jul 12, 2018

https://twitter.com/user/status/1017349045310935040

Tom Kindlon · Aug 4, 2018

https://twitter.com/user/status/1025865069412925441

Tom Kindlon · Aug 5, 2018

https://twitter.com/user/status/1025892823806160899

Alvin · Aug 5, 2018

I wish i could say its surprising or irrational, patients were suffering greatly and see no other option to end their pain except suicide. This is more rational then many politicians could ever hope to approximate, yet they are paid big bucks when they screw their constituents while patients of this devastating disease are typically tortured by the professionals who are supposed to help them...

Dolphin · Aug 5, 2018

One study with over 36,000 participants found that chronic pain conditions increase the risk for suicidal ideation (SI) and suicidal behavior, while controlling for mental disorders and comorbidity (Ratcliffe et al., 2008).
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Dolphin · Aug 5, 2018

Several factors other than depression may increase the suicide risk in ME and CFS. Patients experience a considerable decline from pre-illness states in multiple facets of life. ME and CFS decrease quality of life (Hvidberg et al., 2015), socially isolate patients, facilitate unsupportive social interactions (Ware, 1999), and cause significant work, disability, and financial losses (Taylor and Kielhofner, 2005). While the prognostic outlook for children is more optimistic (Beverley, 2005), adult recovery rates are low, which may exacerbate these factors.
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Dolphin · Aug 5, 2018

These circumstances surrounding ME and CFS are likely to increase feelings of hopelessness, entrapment, and SI [suicidal ideation] (Liu and Miller, 2014). Indeed, Jiménez-Ortiz (2015) found that lack of adequate medical care, delegitimizing interactions with physicians, financial instability, and dependence on family members for help with daily tasks were associated with an increased risk of suicide in patients.
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Dolphin · Aug 5, 2018

It should be emphasized that hopelessness, which is often conflated with depression, can be a distinct predictor of suicide (Breitbart et al., 2000).
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Tom Kindlon · Aug 5, 2018

It should be emphasized that hopelessness, which is often conflated with depression, can be a distinct predictor of suicide (Breitbart et al., 2000).
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I think one of the many benefits of more biomedical research is that it gives people hope that there might be improvements. It's one of the things that helps me to keep going and to not consider suicide.

Dolphin · Aug 6, 2018

There's a supplementary file:

Table 2: Themes of suicidal ideation in non-depressed patients with ME and CFS
Theme and Subthemes
Representative Quote

http://journals.sagepub.com/doi/sup...ppl_file/Supplementary_Material_B_Table_2.pdf
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Tom Kindlon · Aug 6, 2018

https://twitter.com/user/status/1026248415519363074

Dolphin · Aug 7, 2018

Resources mentioned included support systems, finances, a job, and a physician who understands ME and CFS. Participants felt hope, validation, and compassion when there were support systems present to help with daily living activities. A supportive loved one, for instance, saves a patient valuable resting time:

I am one of the lucky few whose ME/CFS has never been in question by any family member, friend or employer. It hasn’t stopped my disease from making me bedbound … but it has allowed me to cope with such a loss of life without getting depressed. I can’t imagine how devastating it would be, especially if your family questioned the validity of your illness. (P28)

Lacking a caregiver and financial resources made it difficult for patients to cope, since patients had to then exert energy to work themselves, causing physical consequences.
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Dolphin · Aug 7, 2018

Many lacked access to helpful physicians, which is overviewed in the following subtheme. For those who had positive healthcare experiences, having a knowledgeable physician provided hope, encouragement, and relief. Physician house calls were welcomed and meaningful to developing the patient–doctor relationship. Finding these helpful physicians took years of shuffling through “ignorant” doctors.
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Tom Kindlon · Aug 7, 2018

https://twitter.com/user/status/1026900675022794754

Tom Kindlon · Aug 9, 2018

https://twitter.com/user/status/1027342442469761024

Tom Kindlon · Aug 9, 2018

https://twitter.com/user/status/1027343816360161280

Tom Kindlon · Aug 9, 2018

https://twitter.com/user/status/1027344968971628545

Tom Kindlon · Aug 9, 2018

Probably the whole of the results section could be quoted. It does summarise a lot of the difficulties people with the illness have so it itself is a bit depressing

Tom Kindlon · Aug 9, 2018

If the last three extracts look familiar, that's because I initially posted them to the wrong thread!

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