Fibromyalgia patients who regularly see their doctors are much less likely to attempt suicide compared to patients who rarely visit the doctor, according to a new study at Vanderbilt University Medical Center.
Fibromyalgia is a chronic condition characterized by widespread pain with associated fatigue, sleep and mood issues. Although it can occur in anyone, the disorder is most prevalent in women (75 to 90 percent of patients). The condition has also been linked to exposure to interpersonal trauma.
And research has shown that fibromyalgia patients are 10 times more likely to die by suicide than the general population.
The findings, published in the journal Arthritis Care & Research, show that fibromyalgia patients who did not attempt suicide were at the doctor an average of 50 hours per year versus less than one hour per year for those who self-harmed.
In addition, receiving mental health care was found to be particularly preventive of suicide attempts — not a single patient in the study who was receiving mental health services attempted suicide.
“Fifty hours versus one hour — that’s a staggering difference,” said lead author Lindsey McKernan, Ph.D., assistant professor of Psychiatry & Behavioral Sciences, Physical Medicine & Rehabilitation.
“They might have been at one appointment in a year and this disorder, fibromyalgia, takes a lot to manage. It takes a lot of engagement.”
This study is the first to successfully use machine learning to reliably detect suicide risk in these individuals and also to explain that risk in clinically meaningful ways, according to senior author Colin Walsh, M.D., M.A., assistant professor of Biomedical Informatics.
“The study suggests a possible path for intervention,” Walsh said. “Perhaps we can connect those individuals to an outpatient provider, or providers, to improve their care and reduce their suicide risk. We also might see patients at-risk establish meaningful relationships with providers whom they can contact in times of crisis.”
The study looked at electronic health record (EHR) data collected from 1998-2017. This included 8,879 individuals with fibromyalgia; among this group there were 34 known suicide attempts and 96 documented cases of suicidal thoughts. Using this data, the researchers looked for factors that increased and decreased risk of suicide in fibromyalgia patients.
On average, study patients who reported suicidal thoughts at some point spent only 1.7 hours in clinic per person per year while those who did not present with suicidal thoughts were in clinic 5.9 hours per person per year.
The difference was far more significant for patients with suicide attempts: less than one hour per year in clinic for attempters versus over 50 hours per year on average for non-attempters.
The researchers found that risk factors specific to suicidal thoughts included complaints such as fatigue, dizziness and weakness. Risk factors specific to suicide attempts included obesity and drug dependence.
“It’s not just about risk factors; it is about what keeps people from hurting themselves, protective factors,” McKernan said. “If you really break it down the people who were having suicidal thoughts weren’t going into the doctor as much. I think about the people who might be falling through the cracks. Chronic pain in and of itself is very isolating over time.”
McKernan noted that part of living with and managing fibromyalgia is participating in many types of care. These can include physical therapy, working with a psychologist or mental health provider, engaging in exercise and self-management in addition to seeing a primary care provider and rheumatologist.
“We looked at thousands of people in this study and not one who received mental health services of some kind went on to attempt suicide,” she said.