Background/Purpose: To study the incidence of suicidal ideation in patients with SLE and its relationship with anxiety/depression score, disease activity and organ damage

Methods: Consecutive patients who fulfilled the ACR criteria for SLE were recruited for a questionnaire study on suicidal ideation, which was assessed by (1) 3 standard questions on suicidal thoughts and suicidal plans in the past 1 month; and (2) the validated Chinese version of the Beck Scale for Suicidal Ideation (BSSI) for suicidal intention: 19 questions (each scores 0-2, final score is the summation of the scores of the 19 questions (0-38 points; higher score more suicidal intention).  History of suicidal attempts and self assessment of suicidal tendency was also included in this tool.  Anxiety and depressive symptoms were assessed simultaneously by the Hospital Anxiety and Depression (HAD) scale (0-21 points for each of depression and anxiety).  Disease activity of SLE was assessed by SLEDAI and physicians’ global assessment (PGA), whereas organ damage since SLE diagnosis was assessed by the ACR SLICC damage index (SDI).  The BSSI score was correlated with the demographic and clinical features of the participants, HAD, SLEDAI and SDI score.  Linear regression models were established to study the independent factors associated with suicidal intention.

Results: 319 SLE patients were studied (300 women; mean age at SLE onset was 30.2±12.2 years; disease duration 9.0±7.0 years).  43 (13%) patients had clinically active SLE (SLEDAI >=5). 106 (33%) patients had organ damage (SDI >=1).  29 (9%) patients had suicidal thoughts and 4 (1%) patients had suicidal thoughts together with solid plans within 1 month of study.  39 (12%) patients had previous suicidal thoughts / attempts whereas 18 (6%) had documented suicidal attempts. The mean BSSI score was 1.37±3.62 points (0-24).  Compared to those without suicidal thoughts within 1 month of study, patients with suicidal thoughts had significantly higher BSSI scores (6.0±6.1 vs 0.89±2.9 points; p<0.001), HAD-anxiety (13.1±5.2 vs 5.70±4.2; p<0.001) and HAD-depression (12.4±4.3 vs 4.50±3.9; p<0.001) scores.  Linear regression analysis revealed that the total BSSI scores (suicidal intention) correlated significantly with HAD-depression (Beta 0.52; p<0.001), HAD-anxiety (Beta 0.47; p<0.001), age (Beta 0.15; p=0.009), male sex (Beta -0.13; p=0.02), previous suicidal attempts (Beta 0.17; p=0.003) and SDI score (Beta 0.21; p<0.001) but not with SLEDAI (Beta 0.05; p=0.44).  In a multivariate regression model, only HAD-depression score (Beta 0.30; p<0.001), HAD-anxiety score (Beta 0.28; p<0.001), age (Beta 0.12; p=0.02) and SDI damage score (Beta 0.11; p=0.03) correlated positively and significantly with the total BSSI score.

Conclusion: In this cross-sectional study, suicidal ideation in the preceding month occurred in 9% of patients with SLE, whereas previous suicidal thoughts / attempts were present in 12% of participants.  The suicidal intention was stronger in older patients, men, and those with more organ damage, anxiety or depressive symptoms.  Suicidal intention did not correlate with disease activity.  Further study on the contribution of socioeconomic factors to suicidal ideation in SLE patients is in progress.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/suicidal-ideation-in-patients-with-systemic-lupus-erythematosus-incidence-and-relationship-with-anxietydepression-score-disease-activity-and-organ-damage/