Research may help identify patients at high risk
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. Rheumatoid arthritis, the most prevalent chronic inflammatory musculoskeletal disease, has been associated with several negative psychological outcomes, including depression.
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.
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, 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...
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