Significant increase in self-harm attempts following ankylosing spondylitis diagnosis
The results of a population study presented today at the Annual European Congress of Rheumatology (EULAR 2018) demonstrate a significantly increased rate of self-harm attempts in inflammatory arthritis (IA), particularly following a diagnosis of Ankylosing Spondylitis (AS).
Results of the study showed that individuals with AS were almost twice as likely to self-harm as their comparators (adjusted hazard ratio of 1.59 (95% CI 1.16 to 2.21). Deliberate self-harm was also increased in individuals with rheumatoid arthritis (RA) but only before adjustment for baseline characteristics. The most frequent method of self-harm was poisoning (64% of attempts in AS, 81% in RA) or self-mutilation (36% in AS, 18% in RA).
"Our study is one of the first to document the risk of serious mental health outcomes following a RA or AS diagnosis and highlights the need for routine evaluation of self-harm behaviour as part of the management of patients," said Dr. Nigil Haroon, senior study author, University of Toronto.
Physical aspects of AS include pain, joint stiffness, and a gradual loss of spinal mobility, however, there is also considerable impact on mental health. Although a higher prevalence of psychiatric comorbidities, including depressive disorder, has been proven in patients with AS, until now there is limited data on the risk of serious mental health outcomes following diagnosis.
"This study is important because understanding the mechanisms that contribute to deliberate self-harm attempts will help tailor future preventative strategies to reduce morbidity associated with this serious mental health outcome," said Professor Thomas Dörner, Chairperson of the Abstract Selection Committee, EULAR.
The study evaluated population-based cohorts of RA (N=53,240) and AS (N=13,964), each matched 1:4 by age, sex, and calendar year (at diagnosis) with non-IA comparator cohorts in Ontario, Canada. Individuals with a history of mental illness or prior episode of deliberate self-harm were excluded. The outcome was a first emergency room presentation for deliberate self-harm, subsequent to RA or AS diagnosis, between April 1, 2002 and March 31, 2016. Hazard ratios were adjusted for demographic, clinical and health service utilisation variables.
This study suggests there is a link between inflammatory arthritis and the development of serious mental health consequences. These findings highlight the need for routine evaluation of self-harm behaviour as part of the management of chronic inflammatory arthritis. Understanding the mechanisms contributing to deliberate self-harm attempts will help inform risk-reduction strategies among individuals living with inflammatory arthritis.