Rheumatological conditions as risk factors for self-harm. A retrospective cohort study
Prevention of self-harm, as a key risk factor for suicide, is an international public health priority. The WHO recommends that clinicians should assess the potential for self-harm in high-risk patients e.g. those with chronic pain and depression. The risk of self-harm across individual rheumatological conditions (associated with chronic pain and depression) has not previously been examined.
We conducted a retrospective cohort study using data from the UK Clinical Practice Research Datalink (CPRD). Patients with a Read code for osteoarthritis, osteoporosis, fibromyalgia, rheumatoid arthritis (RA) or ankylosing spondylitis (AS) were identified between 01/01/1990–31/12/2016 and matched to controls of the same gender and within the same 10-year age category. Incident self-harm was identified by Read code after diagnosis of the rheumatological condition. Hazard ratios (HR) were obtained from Cox-regression models to examine the risk of self-harm in each rheumatological condition compared to their matched controls. Analysis was initially unadjusted and then adjusted for age, gender, body mass index, smoking, alcohol, anxiety and depression.
Over the 16-year time-period, there were 720,762 osteoarthritis, 126,316 osteoporosis, 26,572 fibromyalgia, 55,678 RA and 24,181 AS patients. Adjusted HRs (95%CI) of self-harm for each rheumatological condition compared to matched controls were as follows; osteoarthritis 1.2 (1.1-1.2); osteoporosis 1.5 (1.3-1.6); fibromyalgia 2.0 (1.6-2.4); RA 1.3 (1.1-1.6); AS 1.0 (0.8-1.3).
Patients with rheumatological conditions in primary care, particularly fibromyalgia are at greater risk of self-harm compared to matched controls, except for those with AS. Clinicians need to be aware of the potential for self-harm in patients consulting with these conditions.