A pt develops excessive worries, undue pessimism, poor appet

A 75-year-old woman is admitted to hospital for hip fracture following a fall while intoxicated. She develops excessive worries, undue pessimism, poor appetite, and early morning awakening. She is having difficulty with physiotherapy due to poor energy and excessive pain. She is treated with sertraline 150 mg daily to which she responded in the past. Which one of the following is most likely to increase her risk of suicide?

Early morning wakening
Excessive worrying
Abstinence from alcohol consumption
Poorly controlled pain
Female gender

Answer: Poorly controlled pain