Suicide prevention in rheumatology: Engagement is key


Special challenges

Rheumatologic conditions are well documented to have heightened rates of suicide and mental health issues, and this may be related to some of the additional challenges such patients face. Many have chronic pain, which in itself is a risk factor for suicide.

Fibromyalgia can be particularly difficult because patients struggle to communicate about their condition with their clinician and even with loved ones. “Patients report feeling stigmatized and often struggle to communicate about what’s happening in their bodies. The pain can change location and intensity, and it doesn’t show up on medical tests,” Dr. McKernan said.

Another burden is that rheumatologic patients typically have high levels of inflammation, a characteristic that has been linked to lower responses to some antidepressants, according to Dr. Jain.

Antidepressants should still be considered for these patients, but they should be combined with other treatments or management techniques, he says. He emphasizes the importance of a low-inflammatory diet, exercise, and other lifestyle factors. He has also created the free Wild 5 Wellness program, which seeks to broadly improve wellness in patients with chronic pain and mental health challenges.

Physician response

The results of the study on fibromyalgia patients suggests another avenue toward improving mental health. The researchers examined data on 8,879 patients with fibromyalgia, using data collected between 1998 and 2017. There were 34 suicide attempts and 96 cases of suicidal ideation. A machine-learning algorithm spat out some factors associated with heightened suicide risk, such as fatigue, dizziness, and weakness, as well as obesity and drug dependence.

But it also generated some associations that weren’t obviously related, such as receiving a flu shot or taking vitamin supplements. “There were a lot of things associated with routine medical care in the patients who didn’t have thoughts about suicide and didn’t attempt suicide. So we looked at how much time people spent with their doctor. I think we might have found an important signal that requires further investigation in bigger samples, and also in other populations. If we can look at people who are at risk [of suicide] but who aren’t engaged with their doctors, that gives us a potential avenue to do something about it, where we can get them connected with a provider, or reconnected if they’ve fallen off, or give them a call to see how they’re doing,” Dr. McKernan said.

In fact, the research suggests that such an effort alone might be enough to reduce suicidality, since patient-provider contact appears to be so important.

“I know in the past that physicians have expressed feeling frustrated – like they don’t have some sort of [mental health] intervention to provide patients who have fibromyalgia. This might show that continuing to see the patient, to stay engaged, may have intrinsic benefit that serves almost like an intervention in itself,” Dr. McKernan said.

Dr. McKernan, Dr. Jain, and Dr. Wise had no financial conflicts of interest.

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