People with painful rheumatic conditions at higher risk of self-harm

Written by Dr James Prior, Senior Research Associate in Epidemiology, James.Prior@lstmed.ac.uk.

People with fibromyalgia, rheumatoid arthritis, and osteoarthritis are at increased risk of harming themselves. The risk appears highest for those with fibromyalgia, who in new research, were twice as likely to self-harm as people without the condition.

Prevention of self-harm, a key risk factor for suicide, is an international public health priority. Long-term pain can increase the risk of self-harm, and the World Health Organization recommends that healthcare professionals consider the potential for self‐harm in patient groups with chronic pain and depression – which includes many people with rheumatic conditions.

In this new study, researchers gathered data from the Clinical Practice Research Datalink (CPRD), the largest primary care dataset in the UK. They included adults recorded as having fibromyalgia, rheumatoid arthritis, osteoarthritis, or ankylosing spondylitis between 1990 and 2016. Most people with fibromyalgia, rheumatoid arthritis and osteoarthritis were women (86%, 60% and 67%, respectively). The researchers looked to see if the individuals were recorded as harming themselves in the years following their diagnosis.

The research team identified the same number of people without one of these four rheumatic conditions to use as a comparison group. They adjusted results for other factors which could increase self-harm, including depression, alcohol consumption and deprivation.

The study found that people with fibromyalgia, rheumatoid arthritis, and osteoarthritis are at increased risk of harming themselves.

• The incidence of self‐harm was highest in people with fibromyalgia, who were twice as likely to harm themselves as those without the condition.
• People with rheumatoid arthritis were 1½ times more likely to self-harm.
• Unlike the other conditions, with osteoarthritis, people’s risk of self-harm varied according to the time since diagnosis. Those who had had the condition for between one to ten years had a slightly increased risk of harming themselves but those who had had the condition for less than one year or more than ten years were not at increased risk.
• No link was found between ankylosing spondylitis and self‐harm.
• Neither age nor sex appeared to have an effect on the risk of self-harm.

This study also found that the level of self-harm in people with these rheumatic conditions has remained unchanged over this 16-year time-period. The research team suggests that GPs, rheumatologists, and allied health professionals should be more alert to distress in patients, particularly those with fibromyalgia and rheumatoid arthritis and ask about mood.

Where distress is identified, then the risk of self-harm should be explored, and appropriate support should be offered by the clinician, and with referral to psychological therapies.

NICE guidelines on self-harm:
https://www.nice.org.uk/guidance/cg16/resources/selfharm-shortterm-treatment-and-management-189900253

NIHR evidence alert:
https://evidence.nihr.ac.uk/alert/painful-rheumatic-conditions-linked-to-self-harm/