Eczema patients at 36% higher risk of suicide attempts, study finds

Evelyn Lewin

17/12/2018 12:06:00 PM

A systematic review and meta-analysis finds association between eczema and suicidality.

Researches suggest that dermatology providers monitor for suicidality and make appropriate referrals to mental health professionals.
Researches suggest that dermatology providers monitor for suicidality and make appropriate referrals to mental health professionals.

Patients with atopic dermatitis are at ‘significantly greater risk’ of suicidal ideation and suicide attempts, according to a new systematic review and meta-analysis in The Journal of the American Medical Association (JAMA).
The research, ‘Association between atopic dermatitis and suicidality’, found that patients with eczema are 44% more likely to exhibit suicidal ideation and 36% more likely to attempt suicide compared with patients without the condition.
The analysis identified 15 studies with a total of 4,770,767 participants. Of those, over 300,000 had eczema and over 4.4 million people did not.
Two of the studies investigated the prevalence of completed suicides, with one finding a higher risk of completed suicides in patients with eczema compared to the control group, and the other finding no significant difference in either group.
The authors noted that the observed increased risk of suicidality may relate to the physical and psychosocial burden of the disease, with patients with uncontrolled disease experiencing debilitating symptoms of pruritis, burning and skin pain.
Sleep loss due to pruiritis also increased the risk of suicidality.
However, the researchers noted that other factors may have contributed to this increased risk. For instance, they found that young girls with eczema were more likely to report greater dissatisfaction with appearance and low self-esteem than young boys, which can contribute to the risk of suicidality seen specifically in female paediatric patients with this condition.
On a physiological level, eczema is associated with an increase in proinflammatory cytokines, which the authors state ‘may have a role in the pathogenesis of suicidality’ in patients with eczema.
‘Higher levels of proinflammatory cytokines in the central nervous system may alter serotonin metabolism, thereby disrupting the balance of neurotransmitters in the brain,’ they wrote.
The discussion noted that treatments targeting cytokines, such as interleukin 4 and interleukin 13, have been shown to decrease symptoms of depression and anxiety in patients with eczema. 
Due to these findings, the authors state it is important for dermatology providers to be aware of and monitor for the increased risk of suicidality, and make appropriate referrals to mental health professionals.
Research from 2013 published in Clinics in Dermatology found that patients with eczema scored significantly higher than healthy controls on measures of depression and anxiety symptoms. Severe eczema was also reported to have a greater impact than severe psoriasis on subjective health status.
Furthermore, a matched case-control study in BMJ Open found that patients with persistent eczema have a modestly increased subsequent increased risk of death from suicide, but this was not independent of overall mental health and that the absolute risk was low.
According to Allergy & Anaphylaxis Australia, one in three children and over one million Australians have eczema.
Lifeline reports that the overall suicide rate in 2015 was 12.6 per 100,000 in Australia.

dermatology eczema skin issues suicide

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