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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,<ref>{{Cite journal | last = Schwartz-Lifshitz | first = Maya | author-link = | last2 = Zalsman | first2=Gil | author-link2 = | last3 = Giner | first3 = Lucas | author-link3 = | last4 = Oquendo | first4 = Maria A. | authorlink4 = | date = Dec 2012 | title = Can We Really Prevent Suicide?|url=http://link.springer.com/10.1007/s11920-012-0318-3|journal=Current Psychiatry Reports|language=en|volume=14|issue=6 | pages = 624–633|doi=10.1007/s11920-012-0318-3|issn=1523-3812|pmc = 3492539|pmid=22996297|access-date=|quote=|via=}}</ref> the stigma of suicide which may mask the official cause of death, and whether chronic pain is a presenting symptom.<ref>{{Cite journal | last = Hassett | first=Afton L. | author-link = | last2 = Aquino | first2 = Jordan K. | authorlink2 = | last3 = Ilgen | first3=Mark A. | authorlink3 = | date = Aug 2014 | title = The Risk of Suicide Mortality in Chronic Pain Patients|url=http://link.springer.com/10.1007/s11916-014-0436-1|journal=Current Pain and Headache Reports|language=en|volume=18|issue=8|pages=436|doi=10.1007/s11916-014-0436-1|issn=1531-3433|pmc=|pmid=|access-date=|quote=|via=}}</ref><ref name="Newton-John, 2014">{{Cite journal | last1 = Newton-John | first1 = TR | authorlink1 = | title = Negotiating the maze: risk factors for suicidal behavior in chronic pain patients| journal = Current Pain & Headache Reports | volume = 18 | issue = 9| page = 447 | date = 2014 | pmid = 25091131| url = https://pubmed.ncbi.nlm.nih.gov/25091131 | doi = 10.1007/s11916-014-0447-y}}</ref> Regardless, one question is much discussed among researchers, clinicians, and patients: that the incidence of suicide appears higher in patients with [[myalgic encephalomyelitis|ME]] and [[Chronic fatigue syndrome|CFS]] than that of the general population. ==Causes== The reasons cited for suicide risk in the [[myalgic encephalomyelitis|ME]] and [[Chronic fatigue syndrome|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.<ref name="Chu2016pres">{{Cite journal |url=http://iacfsme.org/PDFS/2016MayNesletter/Attachment-03-Dr-Lily-Chu-ME-CFS-and-suicide.aspx | date = May 2016 | last = Chu | first = Lily | authorlink = Lily Chu | title = Suicide and ME/CFS|work=IAME/CFS Newsletter|volume=9|issue=1|url-status=usurped}}</ref><ref name="Pederson2017">{{Cite journal | last = Pederson | first = Cathy L. | last2 = Gorman-Ezell | first2 = Kathleen | last3 = Hochstetler-Mayer | first3=Greta | date = 2017-08-01 | title = Invisible Illness Increases Risk of Suicidal Ideation: The Role of Social Workers in Preventing Suicide|url=https://academic.oup.com/hsw/article/42/3/183/3867907|journal=Health & Social Work|language=en|volume=42|issue=3|pages=183–186|doi=10.1093/hsw/hlx029|issn=0360-7283}}</ref> 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<ref name="Devendorf2018">{{Cite journal | last = Devendorf | first = AR | author-link = Andrew Devendorf | last2 = McManimen | first2 = SL | authorlink2 = Stephanie McManimen | last3 = Jason | first3 = LA | authorlink3 = Leonard Jason | date = 2018 | title=Suicidal ideation in non-depressed individuals: The effects of a chronic, misunderstood illness|url=https://www.ncbi.nlm.nih.gov/pubmed/29992837|journal=Journal of Health Psychology|volume=|pages=|doi=10.1177/1359105318785450|via=}}</ref> == Stigma == The [[Stigma and discrimination#stigma|stigma]] of living with a poorly understood chronic ilness may also be a factor.<ref name="Devendorf2018" /> Stigma can reduce social support and increase isolation, which are both factors linked to an increased suicide risk. ==Regional studies== ===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.<ref name="McManimen, 2016" /> ===United Kingdom=== A 2016 study by Roberts, et al. examined the mortality rates via electronic clinical records of 2147 people with [[chronic fatigue syndrome]] (as per the [[Oxford definition|Oxford case definition]]) over a seven year period who presented to a specialist clinic that serves London and the south of England.<ref name="Roberts, 2016">{{Cite journal | last1 = Roberts | first1 = Emmert | authorlink1 = | last2 = Wessely | first2 = Simon | authorlink2 = Simon Wessely | last3 = Chalder | first3 = Trudie | authorlink3 = Trudie Chalder | last4 = Chang | first4 = Chin-Kuo | authorlink4 = | last5 = Hotopf | first5 = Matthew | authorlink5 = Matthew Hotopf | title = 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 | url = https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)01223-4/fulltext | journal = The Lancet | volume = 387 | issue = 10028 | page = 1638 - 1643 | date = 2016 | pmid = 26873808| doi = 10.1016/S0140-6736(15)01223-4}}</ref> :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.<ref name="Roberts, 2016" /> Kapur and Webb, from the Centre for Suicide Prevention at the University of Manchester, UK commented on the 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."<ref name="Kapur, 2016" /> 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.<ref>{{Cite web |url = https://jcoynester.wordpress.com/2016/02/16/bad-stats-non-sequitur-conclusions-in-lancet-chronic-fatigue-syndromesuicide-study/| title = Bad stats, non sequitur conclusions in Lancet chronic fatigue syndrome/suicide study by Dr. James Coyne | authorlink = James Coyne|first = James C. |last =Coyne | date = 2016-02-16}}</ref> ===Spain=== A 2015 doctoral thesis from [[Spain]] found an increased risk of suicidal ideation in [[ME/CFS]] patients, 12.74% compared to 2.3% in the general Spanish population. This study is believed to be the first that pointed to external factors, such as [[Medical neglect and abuse#medical_neglect|inadequate medical treatment]] and loss of job and relationships, instead of [[depression]] as the reason for suicidal ideation.<ref>{{Citation|lay-url=https://afectadasporlosrecortessanitarios.wordpress.com/2016/05/11/risk-of-suicide-due-to-neglect-amongst-pwme/|trans-title=Risk of Suicide due to Neglect Amongst PWME | website = Plataforma de Afectadas por los Recortes Sanitarios - La PARS|language=es-ES|access-date=2020-07-27 |url=https://web.archive.org/web/20170517091502id_/http://uvadoc.uva.es:80/bitstream/10324/13868/1/Tesis705-150928.pdf | last= Jiménez-Ortiz | first = JJ| title = Depresión y desesperanza en personas enfermas de Encefalomielitis Miálgica/ Síndrome de Fatiga Crónica: Factores de riesgo y de protection| publisher=Universidad de Valladolid | date = 2015}}</ref><ref name="McManimen, 2016" /> ==Lost to suicide == Some of the people with [[ME/CFS]] known have died by suicide are: *[[Robert Courtney]], a citizen scientist who frequently commented on research including the [[PACE trial]] and the [[Cochrane]] review of exercise therapy for CFS<ref>{{Cite web | title = A Tribute To ‘Bob’ – Robert Courtney, ME Activist, Fundraiser, Researcher, And Friend | date = March 19, 2018 | url = https://www.meaction.net/2018/03/19/a-tribute-to-robert-courtney/}}</ref> *[[Lynn Gilderdale]], whose mother Kay was prosecuted for assisting Lynn's suicide<ref name="bbc">{{Cite news | url=http://news.bbc.co.uk/2/hi/uk_news/england/sussex/8479211.stm | title = Mother cleared in ME death trial | date = 2010 | access-date=2018-08-16|language=en-GB}}</ref><ref name="book">{{Cite book | title=One Last Goodbye: Sometimes only a mother's love can help end the pain|url=https://www.amazon.com/One-Last-Goodbye-Sometimes-mothers/dp/0091939143|publisher=Ebury Press | date = 2011-04-14|isbn=9780091939144|language=English | first = Kay | last = Gilderdale| year = |location=|pages=}}</ref> *[[Anne Örtegren]], a well-known Swedish ME activist and fundraiser<ref name="Anne-HR1">{{Cite web | date = Jan 10, 2018|website =[[Health Rising]]|url=https://www.healthrising.org/authors/anne-ortegen/ | title = Farewell: A Last Post from Anne Örtegren}}</ref> ==Quotes== *2016 - "Ultimately the best way to prevent suicide in ME/CFS will be to find effective disease-modifying [[:Portal:Treatments|treatments]] or cures for it," by Dr. [[Lily Chu]]<ref name="Chu2016pres" /> ==Notable studies== *2014, Negotiating the maze: risk factors for suicidal behavior in chronic pain patients - [https://pubmed.ncbi.nlm.nih.gov/25091131 (Abstract)] *2016, [http://www.tandfonline.com/doi/abs/10.1080/21641846.2016.1236588?journalCode=rftg20 Mortality in patients with myalgic encephalomyelitis and chronic fatigue syndrome]<ref name="McManimen, 2016"> {{Cite journal | last1 = McManimen | first1 = Stephanie L. | authorlink1 = Stephanie McManimen | last2 = Devendorf | first2 = Andrew R. | authorlink2 = | last3 = Brown | first3 = Abigail A. | authorlink3 = Abigail Brown | last4 = Moore | first4 = Billie C. | authorlink4 = | last5 = Moore | first5 = James H. | authorlink5 = | last6 = Jason | first6 = Leonard A. | authorlink6 = Leonard Jason | url = https://doi.org/10.1080%2F21641846.2016.1236588 | title = Mortality in patients with myalgic encephalomyelitis and chronic fatigue syndrome| journal = Fatigue: Biomedicine, Health & Behavior | volume = 4 | issue = 4 | page = 195-207 | date = 2016 | doi =10.1080/21641846.2016.1236588}}</ref> - [http://www.tandfonline.com/doi/abs/10.1080/21641846.2016.1236588?journalCode=rftg20 (Abstract)] *2016, [http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)00270-1/fulltext Suicide risk in people with chronic fatigue syndrome]<ref name="Kapur, 2016">{{Cite journal | last = Kapur | first = Nav | author-link = | last2 = Webb | first2 = Roger | author-link2 = | date = Apr 2016 | title = Suicide risk in people with chronic fatigue syndrome|url=https://doi.org/10.1016/S0140-6736(16)00270-1|journal=The Lancet|volume=387|issue=10028|pages=1596–1597|doi=10.1016/s0140-6736(16)00270-1|issn=0140-6736|pmc=|pmid=|quote=|via=}}</ref> - [http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)00270-1/fulltext (Full text)] *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<ref name="Roberts, 2016" /> - [https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)01223-4/fulltext (Full text)] *2017, [https://academic.oup.com/hsw/article-abstract/doi/10.1093/hsw/hlx029/3867907/Invisible-Illness-Increases-Risk-of-Suicidal Invisible Illness Increases Risk of Suicidal Ideation: The Role of Social Workers in Preventing Suicide]<ref name="Pederson2017" /> - [https://academic.oup.com/hsw/article-abstract/doi/10.1093/hsw/hlx029/3867907/Invisible-Illness-Increases-Risk-of-Suicidal (Full text)] *2018, The Importance of Screening for Suicide Risk in Chronic Invisible Illness<ref name="Pederson, 2018">{{Citation | last1 = Pederson | first1 = Cathy L. | authorlink1 = | title = The Importance of Screening for Suicide Risk in Chronic Invisible Illness| journal = J Health Sci Educ | volume = 2 | issue = 4 | page = 1-5 | date = 2018| url = https://www.researchgate.net/profile/Cathy_Pederson/publication/325976771_The_Importance_of_Screening_for_Suicide_Risk_in_Chronic_Invisible_Illness/links/5b318096aca2720785e83871/The-Importance-of-Screening-for-Suicide-Risk-in-Chronic-Invisible-Illness.pdf |pmid =}}</ref> - [https://www.researchgate.net/profile/Cathy_Pederson/publication/325976771_The_Importance_of_Screening_for_Suicide_Risk_in_Chronic_Invisible_Illness/links/5b318096aca2720785e83871/The-Importance-of-Screening-for-Suicide-Risk-in-Chronic-Invisible-Illness.pdf (Full Text)] *2018, Suicidal ideation in non-depressed individuals: The effects of a chronic, misunderstood illness<ref name="Devendorf2018" /> - [https://www.ncbi.nlm.nih.gov/pubmed/29992837 (Abstract)] *2018, Outpatient Engagement Lowers Predicted Risk of Suicide Attempts in Fibromyalgia<ref>{{Cite journal | last = McKernan | first = Lindsey C | last2 = Lenert | first2 = Matthew C | last3 = Crofford | first3 = Leslie J | last4 = Walsh | first4 = Colin G | date = 2018-09-07 | title = Outpatient Engagement Lowers Predicted Risk of Suicide Attempts in Fibromyalgia|url=https://onlinelibrary.wiley.com/doi/abs/10.1002/acr.23748|journal=Arthritis Care & Research|language=en|doi=10.1002/acr.23748|issn=2151-464X}}</ref> - [https://onlinelibrary.wiley.com/doi/abs/10.1002/acr.23748 (Full text)] *2021, Association between chronic fatigue syndrome and suicidality among survivors of Middle East respiratory syndrome over a 2-year follow-up period<ref>{{Cite journal | last = Ahn | first = So-Hyun | author-link = | last2 = Kim | first2 = Jeong Lan | authorlink2 = | last3 = Kim | first3 = Jang Rae | authorlink3 = | last4 = Lee | first4 = So Hee | authorlink4 = | last5 = Yim | first5 = Hyeon Woo | authorlink5 = | last6 = Jeong | first6 = Hyunsuk | authorlink6 = | last7 = Chae | first7 = Jeong-Ho | last8 = Park | first8 = Hye Yoon | last9 = Lee | first9 = Jung Jae | date = May 2021 | title = Association between chronic fatigue syndrome and suicidality among survivors of Middle East respiratory syndrome over a 2-year follow-up period | url =https://linkinghub.elsevier.com/retrieve/pii/S0022395621000960|journal=Journal of Psychiatric Research|language=en|volume=137|issue=|pages=1–6|doi=10.1016/j.jpsychires.2021.02.029|pmc = 7888998|pmid=33631632|access-date=|quote=|via=}}</ref> - [https://www.sciencedirect.com/science/article/pii/S0022395621000960 (Full text)] *2021, Identifying and Managing Suicidality in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome<ref name="Chu2021">{{Cite journal | last = Chu | first = Lily | authorlink = Lily Chu | last2 = Elliott | first2 = Meghan | authorlink2 = | last3 = Stein | first3=Eleanor | author-link3 = Eleanor Stein | last4 = Jason | first4 = Leonard A. | authorlink4 = Leonard Jason | date = 2021-05-25 | title = Identifying and Managing Suicidality in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8227525/|journal=Healthcare|volume=9|issue=6 | pages = 629|doi=10.3390/healthcare9060629|issn=2227-9032|pmc=8227525|pmid=34070367|access-date=|quote=|via=}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8227525/ (Full text)] == See also == * [[Epidemiology of myalgic encephalomyelitis and chronic fatigue syndrome]] * [[Causes of death]] * [[Medical neglect and abuse]] * [[Stigma and discrimination]] * [[Ethical issues]] * [[Depression]] * [[Mental health]] ==Learn more== *2011, [http://phoenixrising.me/archives/12027 Suicide in ME/CFS and Fibromyalgia], by [[Cort Johnson]] in [[Phoenix Rising]] *2016, [https://jcoynester.wordpress.com/2016/02/16/bad-stats-non-sequitur-conclusions-in-lancet-chronic-fatigue-syndromesuicide-study/ Bad stats, non sequitur conclusions in Lancet chronic fatigue syndrome/suicide study by Dr.] [[James Coyne|James C. Coyne]] *2016, [http://iacfsme.org/PDFS/2016MayNesletter/Attachment-03-Dr-Lily-Chu-ME-CFS-and-suicide.aspx Suicide and ME/CFS], by Lily Chu, MD, MSHS for the [[International Association for Chronic Fatigue Syndrome/Myalgic Encephalomyelitis]] *2016, [https://batemanhornecenter.org/increased-suicide-risk/ New Paper Cites Increased Risk of Suicide in CFS], by Leigh Reynolds in [[Bateman Horne Center]] newsletter ==References== {{Reflist}} [[Category:Core topics]]
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