Risk of self-harm and non-fatal suicide attempts, and completed suicide in patients with psoriasis – a population-based cohort study

Abstract

Background

Psoriasis is a common inflammatory skin disease, and inflammation may affect suicidal behavior. Current data on the incidence and risk of suicidal behavior in patients with psoriasis are scarce.

Objective

We investigated the association between psoriasis and the risk of self-harm and suicide attempts, and suicides, respectively.

Methods

All Danish patients aged ≥18 years with mild or severe psoriasis (cases) from January 1, 1997 to December 31, 2011 were matched on age, sex, and calendar time 1:5 with healthy controls. The outcome was a diagnosis of self-harm or non-fatal suicide attempt, or completed suicide, respectively. Incidence rates per 10,000 person-years were calculated, and incidence rate ratios (IRRs) were estimated by Poisson regression models.

Results

The study cohort comprised 408,663 individuals, including 57,502 and 11,009 patients with mild and severe psoriasis, respectively. A total of 280 cases of self-harm or suicide attempts, and 574 suicides, respectively, occurred during follow up. There was no increased risk of self-harm or suicide attempts in patients with mild psoriasis (IRR 1.01, 95% CI 0.17-2.01), but this risk was significantly increased in severe psoriasis (IRR 1.69, 95% CI 1.00-2.84). There was no increased risk of suicides in mild (IRR 1.05, 95% CI 0.84-1.32), or severe psoriasis (IRR 0.78, 95% CI 0.45-1.36), respectively. Similar results were found when suicides were confirmed by official forensic investigations, and when psoriasis was compared with atopic dermatitis.

Conclusions

We found limited evidence to suggest an increased risk of self-harm and non-fatal suicide attempts in psoriasis patients and, importantly, after adjustment for psoriatic arthritis this risk was no longer significantly increased. The risk of completed suicide was also not increased, regardless of psoriasis severity.

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