Suicide rheumatoid arthritis

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

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Rheumatoid arthritis, the most prevalent chronic inflammatory musculoskeletal disease, has been associated with several adverse psychological states, including depression.

More than 10% of patients with chronic rheumatoid arthritis have had suicidal ideas! Suicides in persons suffering from rheumatoid arthritis.

M. Timonen1,2,, K. Viilo1, H. Hakko1, T. Särkioja3, M. Ylikulju1, V. B. Meyer-Rochow4,5, E. Väisänen1 and P. Räsänen1

Objective. To assess the demographic and psychosocial profiles of patients with rheumatoid arthritis (RA) who committed suicide. Two control groups were used: osteoarthritis (OA) and suicide victims with neither RA nor OA.

Method. A study based on a prospective, 13-yr follow-up database with linkage to national hospital discharge registers of all suicides (1296 males, 289 females) committed during the years 1988–2000 in the province of Oulu situated in northern Finland.

Results. Females were significantly over-represented among RA patients who committed suicide (52.6% RA women vs 17.3% women with neither RA nor OA). Comorbid depressive disorders preceded suicides in 90% of the female RA patients. Before their suicide, 50% of the female RA patients (vs 11% of the male RA patients) had experienced at least one suicide attempt. The method of suicide was violent in 90% of the RA females. RA males were less often depressive, but committed suicide after experiencing shorter periods of RA and fewer admissions than females.

Conclusion. Attempted suicides and especially depression in female RA patients should be taken more seriously into account than previously in clinical work so that the most appropriate psychiatric treatment can be provided for such patients.

Suicidal ideation in patients with rheumatoid arthritis - Letter to the Editor

British Medical Journal, Nov 18, 2000 by Gareth J Treharne, Antonia C Lyons, George D Kitas, Tara Collinge, Ajit Shah

EDITOR--The finding of Carson et al--that depression associated with progressive physical (neurological) illness may lead to suicidal ideation--has important clinical implications and may be generalisable.[1] Rheumatoid arthritis, the most prevalent chronic inflammatory musculoskeletal disease,[2] has been associated with several negative psychological outcomes, including depression.[3]

Our ongoing studies indicate that almost 11% of hospital outpatients with rheumatoid arthritis (13 out of 123; 95% confidence interval 5% to 16%) experience suicidal ideation, as detected by the Nottingham health profile.[4]

At first glance, patients with longstanding disease (of more than four years' duration) seem more likely to report suicidal ideation (12%) than those with early rheumatoid arthritis (of less than two years' duration) (7%). Sex may also play a part, with 14% of female patients reporting suicidal ideation compared with only 3% of male patients. However, clinical depression detected by the hospital anxiety and depression scale,[5] is the most important factor; 30% of those reporting depression also experience suicidal ideation, a significantly higher proportion than the 7% seen in those who are not depressed ([chi square] = 9.54, P [is less than] 0.01).

This is confirmed by binary logistic regression of suicidal ideation, used to examine simultaneously the predictive value of age, sex, duration of rheumatoid arthritis, clinical anxiety, and depression. In this analysis only the presence of clinical depression was predictive of suicidal ideation (odds ratio 4.47, P [is less than] 0.05).

These findings support the suggestion by Carson et al that mental health assessment of physically ill patients should form part of routine clinical evaluation, particularly in chronic illness. Further research may help identify a demographic, physical and psychosocial profile that could predict patients at high risk of developing suicidal ideation.

[1] Carson Al, Best S, Warlow C, Sharpe M. Suicidal ideation among outpatients at general neurology clinics: prospective study. BMJ 2000;320:1311-2. (13 May.)
[2] Newman SP, Fitzpatrick R, Revenson TA, Skevington S, Williams G. Understanding rheumatoid arthritis. London: Routledge, 1996.
[3] Pincus T Grittith J, Pearce S, Isenberg D. Prevalence of self-reported depression in patients with rheumatoid arthritis. Br J Rheumatology 1996;35:879-83.
[4] Hunt SM, McEwan J, McKenna S. Measuring health status. New Hampshire: Croom Helm, 1986.
[5] Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983;67:361-70.

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