A Population-Based Analysis of the National Violent Death Reporting System: Characterizing Suicide Decedents with Cancer and Chronic Pain

Abstract

Suicide is among the leading causes of death in the United States, and individuals with a history of cancer face a 26% higher suicide risk compared to the general population. Chronic pain, a common and debilitating symptom affecting 30–50% of cancer patients undergoing active treatment, has been independently associated with elevated suicide risk. However, the extent to which chronic pain modifies suicide risk within cancer populations remains understudied. This study examined the contribution of chronic pain to suicide mortality among individuals with a history of cancer using data from the National Violent Death Reporting System Restricted Access Database (NVDRS-RAD) for the years 2003–2022.A cancer-specific dataset was constructed by applying keyword-based text analysis to law enforcement and coroner/medical examiner narratives, yielding a cohort of 11,625 suicide decedents with a confirmed cancer history. Decedents were classified by chronic pain status based on explicit narrative documentation of chronic pain or persistent pain management. Descriptive statistics and chi-squared tests were used to characterize and compare demographics, suicidality indicators, mental health history, mechanism of death, and toxicology findings across pain and no-pain groups. Propensity score matching was used to control for confounding in comparisons between groups.Of the cohort, 30% (n=3,458) had documented chronic pain at the time of death. Compared to those without pain, decedents with chronic pain were older, more likely to have expressed prior suicidal ideation (26% vs. 18%), left a suicide note (34% vs. 30%), and disclosed intent to an intimate partner (31% vs. 24%). The pain group also showed higher prevalence of opiates (17% vs. 11%) and benzodiazepines (7.2% vs. 5.4%) detected at autopsy. Mental health diagnoses and method of suicide were broadly similar across groups. These findings suggest that chronic pain is associated with greater expression of suicidal intent prior to death among cancer patients. After propensity score matching, chronic pain was associated with lower odds of alcohol detection and higher odds of opiate presence, consistent with pain management practices. These findings highlight that chronic pain may operate as an independent suicide risk factor in cancer patients, and that suicide risk stemming from chronic pain may be communicated before an attempt, underscoring the need to integrate universal pain screening, suicide risk assessment, and suicide prevention interventions in oncology settings.