Fibromyalgia (FM) patients who spend more time in follow-up visits with their healthcare providers are less likely to attempt suicide or have suicidal thoughts, a large retrospective study suggests.
The study also identified fatigue, dizziness, weakness, obesity, and drug dependence as risk factors that elevate suicidal tendencies in these patients.
The report, “Outpatient Engagement Lowers Predicted Risk of Suicide Attempts in Fibromyalgia,” was published in the journal Arthritis Care & Research.
Diseases associated with chronic pain raise the risk of suicide. This is particularly worrisome in the case of fibromyalgia, whose patients have about a 10 times higher risk of death from suicide than the general population, and about three times more at risk than other chronic pain patients.
Few and conflicting data are available about which risk factors contribute to such high suicide tendencies. Moreover, the relative contribution of pain severity versus the presence of psychiatric disorders is still under debate.
“Existing evidence notes general risk factors for suicide do not always translate to chronic pain populations, and that pain sub-populations may have different risk factors for suicidality and need to be studied separately to enhance prevention efforts,” researchers stated in the study.
The study’s goal was to validate how good a recently published machine learning model for predicting suicide attempt risk was at anticipating these tendencies, specifically in the context of fibromyalgia, and to identify factors that increase or reduce the risk of suicide among these patients.
Researchers tested the performance of the predictive model using a large database of clinical electronic health records (EHR). Data was retrieved from a repository at Vanderbilt University Medical Center (VUMC), which includes clinical data collected for 20 years from more than 2.8 million individuals.
Records from a total of 8,879 fibromyalgia patients were included. All patients had made at least three visits to the hospital over the past six months. There were 34 known suicide attempts (0.4%) and 96 cases (1.1%) of reported suicidal thoughts (ideation).
The validity tests revealed that the model was able to predict with good discrimination both suicidal ideas and attempts among fibromyalgia patients. However, its precision in identifying the correct number of patients with these inclinations was poor.
Additional analysis identified fatigue, dizziness, weakness, serious and persistent mental illness, and longer hospital stays as factors linked with a higher likelihood of suicide-related thoughts.
Drug dependence, like cocaine dependence, obesity, mental illness like recurrent depression with psychosis, and longer hospitalizations were risk factors significantly associated with greater chances of attempting suicide.
On the contrary, the longer patients spent in follow-up visits at VUMC, the less likely they were to think about or attempt suicide. Those without suicidal thoughts spent three times more in follow-up visits per year, and those who did not attempt suicide had spent over 40 times more time with their outpatient healthcare providers (primary care, medical specialty, and mental health clinics).
This analysis suggests that fibromyalgia has unique profiles of suicide risk, with factors additional to the ones relevant for the general population and individuals with chronic pain.
Specifically, fatigue, dizziness and weakness appear to be uniquely linked with suicide risk in fibromyalgia patients, while frequent engagement and face-to-face contact with healthcare providers is a distinctly protective factor.
“Given our findings that outpatient engagement of any type including mental health engagement may attenuate risk of suicide attempt in those with suicidal ideation, we suggest connection to mental health resources such as cognitive-behavioral therapy for FM patients with suicidal ideation to enhance outpatient engagement and provider connection,” the researchers concluded.