Suicide

Statistics about suicide among patients with myalgic encephalomyelitis (ME) and chronic fatigue syndrome (CFS) remain widely disparate, possibly because of regional differences in suicide rates in general, as well as the use of different case definitions between epidemiological studies. Some case definitions may capture someone with a depressive disorder instead of ME/CFS and some may exclude a ME/CFS patient because they have a secondary psychiatric disorder. Other factors to consider are the regional and personal support systems available, the stigma of suicide which may mask the official cause of death, and whether chronic pain is a presenting symptom. Regardless, one question is much discussed among researchers, clinicians, and patients: that the incidence of suicide appears higher in patients with ME and CFS than that of the general population.

Causes
The reasons cited for suicide risk in the ME and CFS populations are similar to those in other chronic illness populations: poor quality of life coupled with hopelessness for relief; loss of employment, finances, and/or relationships; chronic pain; secondary depression; and comorbid mental illness and/or physical illnesses. In a qualitative study of patients with ME/CFS with suicidal ideation, Devendorf et al. (2018) found the following contributing factors to suicide in non-depressed people with chronic illness:
 * having or lacking resources (79%)
 * social interactions with a lack of understanding (72%)
 * systemic healthcare issues related to treatment of ME/CFS (66%)
 * losing a sense of self due to ME/CFS (59%)
 * illness-induced distress (48%)
 * and other factors

Stigma
The stigma of living with a poorly understood chronic ilness may also be a factor. Stigma can reduce social support and increase isolation, which are both factors linked to an increased suicide risk.

United States
A 2016 study by the Center for Community Research, DePaul University, compared the mortality in patients with myalgic encephalomyelitis and chronic fatigue syndrome to the mortality rates of the general population in the United States. Four categories for death were examined in detail: all causes combined, suicide, cardiovascular-related and cancer. In this study sample of 56 patients, the most frequent cause of death, as reported by caregivers, was suicide, occurring among 26.8% of patients. When examining suicide rates they found the suicide rate was higher in male ME/CFS patients than females (53.33% male and 46.67% female), which was the only cause of death in this study to display this pattern. Although the mean age of death in individuals with ME and CFS is at a younger age compared to the overall population, only the rate of all causes combined and cardiovascular-related mortality reached statistical significance.

United Kingdom
A 2016 study by Robert, et al, examined the mortality rates via electronic clinical records of 2147 people with chronic fatigue syndrome (as per the Oxford case definition) over a seven year period who presented to a specialist clinic that serves London and the south of England. The researchers found no significant statistical difference in mortality rate for all-cause mortality or cancer-specific mortality in patients with chronic fatigue syndrome compared with the general population in England and Wales when matched for age and gender. The one category for which a significant increase existed was in suicide-specific mortality. The researchers, also, found an increased risk of completed suicide in patients with chronic fatigue syndrome when compared with a population control. In total, five people died from suicide during the 7-year period. Kapur and Webb, from the Centre for Suicide Prevention at the University of Manchester, UK commented on the Roberts, et al, study: "Based on the suicide rate in the general population of England and Wales, the expected number would have been less than one death by suicide. In other words, suicide risk was increased almost seven-fold."

Because of the statistic analysis used, this study is criticized by Dr. James Coyne, an ardent critic of the statistical analysis of the PACE trial. Please note that several of the researchers who authored this study, authored the PACE trial study.

Spain
A 2015 Spanish study founded an increased risk of suicide in ME/CFS patients, 12.75% compared to 2.3% in the general Spanish population. This study is believed to be the first that pointed to external factors, such as, inadequate medical treatment and loss of job and relationships, instead of depression as the motivation for suicide.

Quotes

 * 2016 - "Ultimately the best way to prevent suicide in ME/CFS will be to find effective disease-modifying treatments or cures for it," by Dr. Lily Chu

Notable studies

 * 2016, Mortality in patients with myalgic encephalomyelitis and chronic fatigue syndrome
 * 2016, Suicide risk in people with chronic fatigue syndrome
 * 2016, Mortality of people with chronic fatigue syndrome: a retrospective cohort study in England and Wales from the South London and Maudsley NHS Foundation Trust Biomedical Research Centre (SLaM BRC) Clinical Record Interactive Search (CRIS) Register
 * 2017, Invisible Illness Increases Risk of Suicidal Ideation: The Role of Social Workers in Preventing Suicide, by Cathy L. Pederson, Kathleen Gorman-Ezell, Greta Hochstetler-Mayer
 * 2018, The Importance of Screening for Suicide Risk in Chronic Invisible Illness - (Full Text)
 * 2018, Suicidal ideation in non-depressed individuals: The effects of a chronic, misunderstood illness (Abstract)
 * 2018, Outpatient Engagement Lowers Predicted Risk of Suicide Attempts in Fibromyalgia
 * 2021, Association between chronic fatigue syndrome and suicidality among survivors of Middle East respiratory syndrome over a 2-year follow-up period - (Full text)


 * 2021, Identifying and Managing Suicidality in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (Full text)

Learn more

 * 2011, Suicide in ME/CFS and Fibromyalgia, by Cort Johnson in Phoenix Rising
 * 2016, Bad stats, non sequitur conclusions in Lancet chronic fatigue syndrome/suicide study by Dr. James C. Coyne
 * 2016, Suicide and ME/CFS, by Lily Chu, MD, MSHS for the International Association for Chronic Fatigue Syndrome/Myalgic Encephalomyelitis
 * 2016, New Paper Cites Increased Risk of Suicide in CFS, by Leigh Reynolds in Bateman Horne Center newsletter