Systematic review finds an association between suicidal behavior and depression in psoriatic arthritis patients

The burden of autoimmune disease extends beyond physical symptoms. It includes factors such as anxiety, stigma, and their impact on well-being, which can adversely affect the quality of life of affected subjects. Studies have shown that individuals with psoriatic arthritis (PsA) experience poor health-related quality of life compared to the general population, with a higher prevalence of mental health disorders, including depression, observed in PsA patients. A recent study published in Seminars in Arthritis and Rheumatism found an association between suicidal behavior in PsA patients and depression and other psychiatric comorbidities. 

Dr. Parperis and his team conducted a systematic review and genetic linkage disequilibrium analysis to evaluate the risk factors and the prevalence of suicidal behavior in PsA patients. Out of 48 articles, 6 met the eligibility criteria, and the results showed that 0.57% of the 122,160 PsA patients included in the study exhibited suicidal behavior. Additionally, among 13,899 PsA patients, 0.53% reported suicidal ideation, and 0.9% had attempted suicide. The study identified specific single nucleotide polymorphisms associated with both PsA and depression at the chromosomal region 6p21.1, which contains the HLA genes for classes I, II, and III.  

In a 2016 qualitative study conducted in the UK, it was found that patients with PsA frequently expressed suicidal thoughts and concerns about the rapid progression of their condition during semi-structured individual interviews. Approximately 24 patients in the sample reported experiencing suicidal ideation and mentioned hiding their distress due to feeling ignored or having their needs minimized by others. 

Another study conducted in 2017 indicated that the rates of depression and suicidality in PsA and axial spondyloarthritis (axSpA) were comparable to those observed in psoriasis. However, difficulties arose in comparing research and diseases due to the lack of standardized assessment methods and definitions for depression and suicidality. Additionally, there was a lack of reported data for non-radiographic-axSpA (nr-axSpA), unlike ankylosing spondylitis, which has no gender preponderance. It is important to understand the proportional occurrence of ankylosing spondylitis versus nr-axSpA, as women tend to experience depression more frequently than men among psoriasis patients. 

It is crucial for clinicians to be aware of the prevalence of suicidal behavior among PsA axSpA patients in order to identify and prevent suicide attempts. Additionally, increasing knowledge about the impact of depression and suicidality in these patient populations can help healthcare providers better address these concerns and provide appropriate support. 

References  

  1. Parperis K, Kyriakou A, Voskarides K, Koliou E, Evangelou M, Chatzittofis A. Insights into Suicidal Behavior Among Psoriatic Arthritis Patients: a Systematic Review and a Genetic Linkage Disequilibrium Analysis. InSeminars in Arthritis and Rheumatism 2023 Jun 29 (p. 152241). WB Saunders.   
  2. Chisholm A, Pearce CJ, Chinoy H, Warren RB, Bundy C. Distress, misperceptions, poor coping and suicidal ideation in psoriatic arthritis: a qualitative study. Rheumatology. 2016 Jun 1;55(6):1047-52.  
  3. Sheahan A, Suruki R, Taylor PC, Sloan VS. AB1155 Depression and suicidality are common in psoriatic arthritis and axial spondyloarthritis, and rates are comparable to those in psoriasis. Annals of the Rheumatic Diseases 2017;76:1459.  

 

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