Suicidal thoughts are common in SLE

By Lorraine L. Janeczko

NEW YORK (Reuters Health) - Suicidal thoughts are common in patients with systemic lupus erythematosus (SLE) and are more intense in patients with depressive symptoms, recent life events, cardiovascular damage and previous suicide attempts, according to researchers from Hong Kong.

In addition to treating the physical disease, physicians should identify patients with suicidal thoughts early to help them reduce their risk of suicide, and they should provide psychological counseling and prompt referral to psychiatrists or clinical psychologists when needed, the researchers said in a report online December 20 in Rheumatology.

High-risk patients, including those with more severe organ damage, recent adverse life events and a previous history of attempted suicide, should be screened for psychiatric symptoms and suicidal thoughts during clinical consultations, and they should be encouraged to join self-help groups to enhance their sense of social support, the authors wrote.

"Doctors should certainly be asking their patients about it - and taking it seriously," said Dr. David A Isenberg, academic director of rheumatology in the School of Life and Medical Sciences of the University College London in the United Kingdom, in an email to Reuters Health.

"The best way to support these patients is, first, to get them to admit and discuss the problem. Support from family, friends and trained professionals, including psychiatrists, may also be helpful," said Dr. Isenberg, who was not involved in the study.

Lead author Dr. Chi Chiu Mok of Tuen Mun Hospital and colleagues recruited 367 consecutive patients who fulfilled four or more American College of Rheumatology criteria for SLE.

The researchers assessed the patients' suicidal thoughts during the preceding month by three direct questions and they assessed the intensity of suicidal ideation by the validated Beck Scale for Suicidal Ideation (BSSI).

Of the 367 SLE patients studied, 96% were women, the mean age was 40.2 years, and the mean disease duration was 9.3 years. Overall, 67 (18.3%) patients had clinically active SLE and 137 (37.3%) had organ damage.

Forty-four patients (12%) had suicidal thoughts. These patients, compared with those without suicidal ideation, had significantly higher mean Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) scores in the preceding year (5.1 vs 2.9, p<0.001).

They also had higher scores on the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI; 1.4 vs 0.6, p<0.001), and higher Hospital Anxiety and Depression Scale (HADS) scores for depression (11.2 vs 4.4, p<0.001) and anxiety (12.2 vs 5.6, p<0.001).

Patients with suicidal thoughts were more likely to be unemployed (p=0.02), have a history of psychiatric disorders (p=0.03) and previous suicide attempts (p=0.02), and to have had major life events in the preceding month (p=0.006).

With linear regression, the BSSI score correlated significantly with the HADS-depression score (p=0.001), previous suicide attempts (p=0.03), major life events (p= 0.01) and cardiovascular SDI score (p<0.001).

Dr. Fotini B. Karassa, lecturer of rheumatology at the University of Ioannina, Greece, said in an email that "vigilance is crucial since depressive symptoms are present in up to 39% of lupus patients. Early detection of depression, psychological counseling and prompt referral to psychiatrists are all essential for a favorable outcome."

Dr. Karassa, who was not involved in the study, agreed with the authors that patients should be encouraged to join self-help groups to enhance their sense of social support.

"Clinicians should be aware of the importance of the psychosocial factors that coping with life-threatening and unpredictable illness such as SLE, creates," she said.

Dr. Isenberg wrote in an email that the suggested link to damage and to cardiovascular disease in particular is novel, but that other findings, including links to disease activity, unemployment and previous depression or suicide attempts had been reported previously.

He questioned the lack of a matched control population, saying that it weakens the study because we don't know the rate of depression or suicide in an equivalent "healthy" group.

"The problem with trying to understand the cause of depression (and anxiety) in SLE is knowing whether it is a genuine manifestation of SLE involving the brain or simply a reflection of a young/youngish group of people who would expect to be healthy, discovering the they have a potentially life threatening disease which will last for years and often require major medication (with many side effect risks) to control it," he said.

"Suicidal ideation does NOT always lead to suicide. In 30 years of looking after over 650 SLE patients in the United Kingdom, only three of my patients have committed suicide, though doubtless many more have considered it," he said.

The corresponding author did not respond to requests for comments.

SOURCE: http://bit.ly/19DxFrE

Rheumatology 2013.

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