Objectives Suicide is one of the most devastating complications of chronic medical illnesses, including rheumatological disorders. We studied the absolute incidence of suicide and its standardized incidence ratio (SIR) in six rheumatic diseases in Hong Kong as compared to the general population.
Methods Patients with the diagnostic codes of systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PSA), systemic vasculitides (SV) and systemic sclerosis (SSc) registered in 37 public hospitals between 1999 and 2010 were identified from the hospital registry database. Patients who died of suicidal attempts within the same period were also retrieved. The SIRs were calculated by comparing the suicidal rate of patients with each disease with that of the general population, adjusted for age, with the 95% confidence intervals obtained by the exact Poisson method.
Results In 2010, data on 10996 RA, 6296 SLE, 3034 AS, 2108 SV, 1192 PSA and 569 SSc patients were available in our registry. Between 1999 and 2010, 25 patients with these diseases committed suicide and died (15 SLE, 5 RA, 3 AS, 1 PSA, 1 SV and 0 SSc patients). There were 19 women and 6 men. The mean age of these patients at the time of suicidal acts was 48.8±16.3 years (range 21-89) and the mean duration of the underlying diseases was 90±105 months. The methods of suicide were: jump from height (60%), overdose of medications (20%); hanging or strangulation (8%); drowning (4%); and uncertain method (8%). Of patients who committed suicide by overdose of medications, two were SLE patients who died of overdosage of hydroxychloroquine. Four of these patients (16%) committed suicide within the first year of diagnosis of their rheumatic diseases and 5 (20%) had recent disease flares. Nine patients (36%) had concomitant psychiatric symptoms (3 depression, 2 schizophrenia, 1 delusional disorder, 1 anxiety disorder, 1 dementia and 1 compulsive obsessive disorder). Three patients (12%) had previous history of suicidal attempt. One patient had history of substance and alcohol abuse but none had a reported family history of suicide. Nine patients (36%) suffered from chronic pain. Five patients were single, 2 were widowed and 1 was divorced. Seven patients (28%) were unemployed at the time of suicide, and 4 (16%) were solely dependent on government financial assistance for living. Among the 15 SLE deaths, 2 patients had active neuropsychiatric lupus at the time of suicidal act. The incidence of suicide per 100,000 patients was 31.6 for SLE, 17.1 for AS, 16.7 for PSA, 7.5 for SV and 6.9 for RA. The age-adjusted SIRs in female patients were 3.13 (95%CI [1.75-5.16]) in SLE, 2.72 (95%CI [0.07-15.2] in AS and 0.34 (95%CI [0.07-1.00]) in RA. The age-adjusted SIRs in male patients were 0.59 (95%CI [0.07-2.14]) in AS, 0.50 (95%CI [0.06-1.82]) in RA, 1.29 (95%CI [0.03-7.21]) in PSA and 0.82 (95%CI [0.02-4.56]) in SV.
Conclusions Among the rheumatic diseases studied, only female patients with SLE have significantly increased relative risk of suicide by 2-fold as compared to the general population. Concomitant psychiatric symptoms, chronic pain, lack of social support, previous suicidal attempts and financial difficulty are contributing factors in patients with chronic rheumatological disorders.
Disclosure of Interest None Declared
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.