Prevalence and correlates of suicidal ideation in SLE inpatients: Chinese experience

Abstract

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that affects multiple organs. Because of double damages of body and mind, SLE patients are in a potential risk of suicide. Many factors may contribute to the occurrence of suicide in SLE: socioeconomic factors, medical factors, mental health, family support and coping style. This study aims to investigate the prevalence and correlates of suicidal ideation in SLE inpatients in China in order to determine whether they had risk of suicide, and if so, what factors should be paid more attention to prevent suicide in wards. A total of 285 SLE patients were interviewed with questionnaires on suicidal ideation and socio-demographic characteristics, Beck Depression Inventory (BDI), Family APGAR and Trait Coping Style Questionnaire (TCSQ). Disease activity was assessed with SLE Disease Activity Index. The other medical information was collected from the patients' medical records. In total, 34.4% of SLE patients had current suicidal ideation. Significant individual risk factors for current suicidal ideation in SLE patients included having religious belief, heavy self-reported financial burdens, long duration of SLE, low level of family functioning and negative coping style. And in the presence of these risk factors, being separated, divorced or widowed, having premorbid suicidal ideation and depression were independent predictors of suicidal ideation. In summary, the rate of suicidal ideation in SLE patients in China is higher than that in other countries. Factors that contribute to risk of suicidal ideation include social and cultural domains and physical and psychological health. Although the association of suicidal ideation to religions and medical factors is still to be investigated, these findings may give some references to suicide prevention efforts for SLE patients in China.

Suicide and poverty in low-income and middle-income countries: a systematic review

“…67 These problems manifest in the inconsistency with which suicidal phenomena have been defined and measured in included studies. In some, for example, suicidal ideation is defined as 'thoughts of killing oneself' 43 while others define the same concept as 'a spectrum of self-destructive thoughts or ideas'. 39 Some studies focus on very particular kinds of non-fatal SIB (e.g.…”

“…All three studies focusing on completed suicide used bivariate analysis only, reporting one 51 positive, one 38 null, and one 62 unclear association. Amongst the four 32,43,50,53 studies on non-fatal SIB, one 43 showed positive and one 32 a null association using bivariate analyses. When multivariate analyses were performed, the results were similar with two studies reporting positive associations between non-fatal SIB and economic or financial problems.…”

“…We assessed 29 (78%) studies to be of high [30][31][32][33][34][35][36][37][38][39][40][41][42][43] or acceptable [44][45][46][47][48][49][50][51][52][53][54][55][56][57][58] quality (Table 3). Eight studies [59][60][61][62][63][64][65][66] were of low quality due to problems with risk of bias: performance, attrition and detection bias (interrupted-time series); selection bias, unclear case definitions, detection bias, lack of adjustment for confounding factors (case-control studies); detection bias, lack of adjustment for confounding factors (cross sectional and ecological studies).…”

“…50 A null association was shown between financial burden for managing the autoimmune disorder, lupus, and suicidal ideation in China. 43 …”

Depression in Autoimmune Diseases

“…In adults with SLE, suicidal ideation is common in up to one-third of patients with and without NPSLE, and is associated with higher disease activity, increased depression and anxiety severity and previous suicide attempts (Karassa et al, 2003;Mok et al, 2014;Xie et al, 2012).…”