There is an association between suicidality and physical health problems such as  chronic pain ,  traumatic brain injury ,  cancer,  kidney failure (requiring hemodialysis ), HIV , and systemic lupus erythematosus .  The diagnosis of cancer approximately doubles the subsequent risk of suicide.  The prevalence of increased suicidality persisted after adjusting for depressive illness and alcohol abuse. In people with more than one medical condition the risk was particularly high. In Japan, health problems are listed as the primary justification for suicide.