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Fibromyalgia patients with no documented suicide attempt spent far more hours in face-to-face meetings with providers than did those who made a suicide attempt over a 20-year period at a single academic medical center. The results, based on a machine-learning analysis of electronic health records, shed more light on the heavy burden of suicidality among patients with rheumatologic illnesses.
“People who didn’t have suicide attempts were present at the doctor 50 hours in a year, compared to less than an hour in a year for those who did attempt suicide. It’s a staggering difference,” said study author Lindsey McKernan, PhD, of the department of psychiatry and behavioral sciences at Vanderbilt University, Nashville, Tenn. What’s more, patients who did not have suicidal thoughts averaged about 6 office hours per year, compared with less than 2 hours for those with suicidal ideation (Arthritis Care Res. 2018 Sep 7. doi: 10.1002/acr.23748).
Fibromyalgia patients are at about ten times the risk of suicide as the general population, and rates of depression and anxiety are higher in patients with rheumatoid arthritis, ankylosing spondylitis, and psoriatic disease as well.
Still, mental health issues often go unaddressed. “Many times rheumatologists focus on the patient’s joints and their rheumatologic illness, and they don’t focus on their mental health, and as a result depression in a suicidal patient is, I think, more often missed in a rheumatologic practice than it should be,” said Rakesh Jain, MD, of the department of psychiatry at Texas Tech University, Odessa.
But that gap isn’t for lack of awareness, says Barton Wise, MD, of the departments of orthopedic surgery and internal medicine at the University of California, Davis. “In general, people recognize that depression is a major problem in their patients,” he said. He was the lead author of a study that found that rheumatologists often lack the time, confidence, and connections to properly address a patient’s mental health needs (J Clin Rheumatol. 2016 Sep;22[6]:307-11).
Together, the two studies underscore the pressing need for better mental health care among rheumatology patients. Such issues often take a back seat to a rheumatologist’s primary concern about joint and overall health, but studies have shown that mental health issues are tied to worse rheumatologic disease outcomes. “Addressing comorbid depression will just make the rheumatological outcome be better. So why not do it?” Dr. Jain said.
Screening is a key consideration, according to Dr. Jain, who recommends the Patient Health Questionnaire-9. But even when a problem arises, rheumatologists may lack the confidence to tackle mental health issues. This can be addressed through various resources, such as courses at professional meetings, but another challenge awaits. Rheumatologists may also be unsure of who should be responsible for handling mental health concerns. Even though the rheumatologist may see the patient more often than his or her other providers, “you often feel that you can’t manage everything,” Dr. Wise said.
One way to address that is to establish relationships with mental health providers who can receive referrals for patients who require it. In academic medical centers or other large institutions, relationships can be formalized, so that a patient could see a psychiatrist on the same day as the rheumatologist visit. He even suggests group sessions for patients with similar comorbidities, such as depression related to fibromyalgia or lupus.
Special challenges
Rheumatologic conditions are well documented to have heightened rates of suicide and mental health issues, and this may be related to some of the additional challenges such patients face. Many have chronic pain, which in itself is a risk factor for suicide.
Fibromyalgia can be particularly difficult because patients struggle to communicate about their condition with their clinician and even with loved ones. “Patients report feeling stigmatized and often struggle to communicate about what’s happening in their bodies. The pain can change location and intensity, and it doesn’t show up on medical tests,” Dr. McKernan said.
Another burden is that rheumatologic patients typically have high levels of inflammation, a characteristic that has been linked to lower responses to some antidepressants, according to Dr. Jain.
Antidepressants should still be considered for these patients, but they should be combined with other treatments or management techniques, he says. He emphasizes the importance of a low-inflammatory diet, exercise, and other lifestyle factors. He has also created the free Wild 5 Wellness program, which seeks to broadly improve wellness in patients with chronic pain and mental health challenges.
Physician response
The results of the study on fibromyalgia patients suggests another avenue toward improving mental health. The researchers examined data on 8,879 patients with fibromyalgia, using data collected between 1998 and 2017. There were 34 suicide attempts and 96 cases of suicidal ideation. A machine-learning algorithm spat out some factors associated with heightened suicide risk, such as fatigue, dizziness, and weakness, as well as obesity and drug dependence.
But it also generated some associations that weren’t obviously related, such as receiving a flu shot or taking vitamin supplements. “There were a lot of things associated with routine medical care in the patients who didn’t have thoughts about suicide and didn’t attempt suicide. So we looked at how much time people spent with their doctor. I think we might have found an important signal that requires further investigation in bigger samples, and also in other populations. If we can look at people who are at risk [of suicide] but who aren’t engaged with their doctors, that gives us a potential avenue to do something about it, where we can get them connected with a provider, or reconnected if they’ve fallen off, or give them a call to see how they’re doing,” Dr. McKernan said.
In fact, the research suggests that such an effort alone might be enough to reduce suicidality, since patient-provider contact appears to be so important.
“I know in the past that physicians have expressed feeling frustrated – like they don’t have some sort of [mental health] intervention to provide patients who have fibromyalgia. This might show that continuing to see the patient, to stay engaged, may have intrinsic benefit that serves almost like an intervention in itself,” Dr. McKernan said.
Dr. McKernan, Dr. Jain, and Dr. Wise had no financial conflicts of interest.
Fibromyalgia patients with no documented suicide attempt spent far more hours in face-to-face meetings with providers than did those who made a suicide attempt over a 20-year period at a single academic medical center. The results, based on a machine-learning analysis of electronic health records, shed more light on the heavy burden of suicidality among patients with rheumatologic illnesses.
“People who didn’t have suicide attempts were present at the doctor 50 hours in a year, compared to less than an hour in a year for those who did attempt suicide. It’s a staggering difference,” said study author Lindsey McKernan, PhD, of the department of psychiatry and behavioral sciences at Vanderbilt University, Nashville, Tenn. What’s more, patients who did not have suicidal thoughts averaged about 6 office hours per year, compared with less than 2 hours for those with suicidal ideation (Arthritis Care Res. 2018 Sep 7. doi: 10.1002/acr.23748).
Fibromyalgia patients are at about ten times the risk of suicide as the general population, and rates of depression and anxiety are higher in patients with rheumatoid arthritis, ankylosing spondylitis, and psoriatic disease as well.
Still, mental health issues often go unaddressed. “Many times rheumatologists focus on the patient’s joints and their rheumatologic illness, and they don’t focus on their mental health, and as a result depression in a suicidal patient is, I think, more often missed in a rheumatologic practice than it should be,” said Rakesh Jain, MD, of the department of psychiatry at Texas Tech University, Odessa.
But that gap isn’t for lack of awareness, says Barton Wise, MD, of the departments of orthopedic surgery and internal medicine at the University of California, Davis. “In general, people recognize that depression is a major problem in their patients,” he said. He was the lead author of a study that found that rheumatologists often lack the time, confidence, and connections to properly address a patient’s mental health needs (J Clin Rheumatol. 2016 Sep;22[6]:307-11).
Together, the two studies underscore the pressing need for better mental health care among rheumatology patients. Such issues often take a back seat to a rheumatologist’s primary concern about joint and overall health, but studies have shown that mental health issues are tied to worse rheumatologic disease outcomes. “Addressing comorbid depression will just make the rheumatological outcome be better. So why not do it?” Dr. Jain said.
Screening is a key consideration, according to Dr. Jain, who recommends the Patient Health Questionnaire-9. But even when a problem arises, rheumatologists may lack the confidence to tackle mental health issues. This can be addressed through various resources, such as courses at professional meetings, but another challenge awaits. Rheumatologists may also be unsure of who should be responsible for handling mental health concerns. Even though the rheumatologist may see the patient more often than his or her other providers, “you often feel that you can’t manage everything,” Dr. Wise said.
One way to address that is to establish relationships with mental health providers who can receive referrals for patients who require it. In academic medical centers or other large institutions, relationships can be formalized, so that a patient could see a psychiatrist on the same day as the rheumatologist visit. He even suggests group sessions for patients with similar comorbidities, such as depression related to fibromyalgia or lupus.
Special challenges
Rheumatologic conditions are well documented to have heightened rates of suicide and mental health issues, and this may be related to some of the additional challenges such patients face. Many have chronic pain, which in itself is a risk factor for suicide.
Fibromyalgia can be particularly difficult because patients struggle to communicate about their condition with their clinician and even with loved ones. “Patients report feeling stigmatized and often struggle to communicate about what’s happening in their bodies. The pain can change location and intensity, and it doesn’t show up on medical tests,” Dr. McKernan said.
Another burden is that rheumatologic patients typically have high levels of inflammation, a characteristic that has been linked to lower responses to some antidepressants, according to Dr. Jain.
Antidepressants should still be considered for these patients, but they should be combined with other treatments or management techniques, he says. He emphasizes the importance of a low-inflammatory diet, exercise, and other lifestyle factors. He has also created the free Wild 5 Wellness program, which seeks to broadly improve wellness in patients with chronic pain and mental health challenges.
Physician response
The results of the study on fibromyalgia patients suggests another avenue toward improving mental health. The researchers examined data on 8,879 patients with fibromyalgia, using data collected between 1998 and 2017. There were 34 suicide attempts and 96 cases of suicidal ideation. A machine-learning algorithm spat out some factors associated with heightened suicide risk, such as fatigue, dizziness, and weakness, as well as obesity and drug dependence.
But it also generated some associations that weren’t obviously related, such as receiving a flu shot or taking vitamin supplements. “There were a lot of things associated with routine medical care in the patients who didn’t have thoughts about suicide and didn’t attempt suicide. So we looked at how much time people spent with their doctor. I think we might have found an important signal that requires further investigation in bigger samples, and also in other populations. If we can look at people who are at risk [of suicide] but who aren’t engaged with their doctors, that gives us a potential avenue to do something about it, where we can get them connected with a provider, or reconnected if they’ve fallen off, or give them a call to see how they’re doing,” Dr. McKernan said.
In fact, the research suggests that such an effort alone might be enough to reduce suicidality, since patient-provider contact appears to be so important.
“I know in the past that physicians have expressed feeling frustrated – like they don’t have some sort of [mental health] intervention to provide patients who have fibromyalgia. This might show that continuing to see the patient, to stay engaged, may have intrinsic benefit that serves almost like an intervention in itself,” Dr. McKernan said.
Dr. McKernan, Dr. Jain, and Dr. Wise had no financial conflicts of interest.
Fibromyalgia patients with no documented suicide attempt spent far more hours in face-to-face meetings with providers than did those who made a suicide attempt over a 20-year period at a single academic medical center. The results, based on a machine-learning analysis of electronic health records, shed more light on the heavy burden of suicidality among patients with rheumatologic illnesses.
“People who didn’t have suicide attempts were present at the doctor 50 hours in a year, compared to less than an hour in a year for those who did attempt suicide. It’s a staggering difference,” said study author Lindsey McKernan, PhD, of the department of psychiatry and behavioral sciences at Vanderbilt University, Nashville, Tenn. What’s more, patients who did not have suicidal thoughts averaged about 6 office hours per year, compared with less than 2 hours for those with suicidal ideation (Arthritis Care Res. 2018 Sep 7. doi: 10.1002/acr.23748).
Fibromyalgia patients are at about ten times the risk of suicide as the general population, and rates of depression and anxiety are higher in patients with rheumatoid arthritis, ankylosing spondylitis, and psoriatic disease as well.
Still, mental health issues often go unaddressed. “Many times rheumatologists focus on the patient’s joints and their rheumatologic illness, and they don’t focus on their mental health, and as a result depression in a suicidal patient is, I think, more often missed in a rheumatologic practice than it should be,” said Rakesh Jain, MD, of the department of psychiatry at Texas Tech University, Odessa.
But that gap isn’t for lack of awareness, says Barton Wise, MD, of the departments of orthopedic surgery and internal medicine at the University of California, Davis. “In general, people recognize that depression is a major problem in their patients,” he said. He was the lead author of a study that found that rheumatologists often lack the time, confidence, and connections to properly address a patient’s mental health needs (J Clin Rheumatol. 2016 Sep;22[6]:307-11).
Together, the two studies underscore the pressing need for better mental health care among rheumatology patients. Such issues often take a back seat to a rheumatologist’s primary concern about joint and overall health, but studies have shown that mental health issues are tied to worse rheumatologic disease outcomes. “Addressing comorbid depression will just make the rheumatological outcome be better. So why not do it?” Dr. Jain said.
Screening is a key consideration, according to Dr. Jain, who recommends the Patient Health Questionnaire-9. But even when a problem arises, rheumatologists may lack the confidence to tackle mental health issues. This can be addressed through various resources, such as courses at professional meetings, but another challenge awaits. Rheumatologists may also be unsure of who should be responsible for handling mental health concerns. Even though the rheumatologist may see the patient more often than his or her other providers, “you often feel that you can’t manage everything,” Dr. Wise said.
One way to address that is to establish relationships with mental health providers who can receive referrals for patients who require it. In academic medical centers or other large institutions, relationships can be formalized, so that a patient could see a psychiatrist on the same day as the rheumatologist visit. He even suggests group sessions for patients with similar comorbidities, such as depression related to fibromyalgia or lupus.
Special challenges
Rheumatologic conditions are well documented to have heightened rates of suicide and mental health issues, and this may be related to some of the additional challenges such patients face. Many have chronic pain, which in itself is a risk factor for suicide.
Fibromyalgia can be particularly difficult because patients struggle to communicate about their condition with their clinician and even with loved ones. “Patients report feeling stigmatized and often struggle to communicate about what’s happening in their bodies. The pain can change location and intensity, and it doesn’t show up on medical tests,” Dr. McKernan said.
Another burden is that rheumatologic patients typically have high levels of inflammation, a characteristic that has been linked to lower responses to some antidepressants, according to Dr. Jain.
Antidepressants should still be considered for these patients, but they should be combined with other treatments or management techniques, he says. He emphasizes the importance of a low-inflammatory diet, exercise, and other lifestyle factors. He has also created the free Wild 5 Wellness program, which seeks to broadly improve wellness in patients with chronic pain and mental health challenges.
Physician response
The results of the study on fibromyalgia patients suggests another avenue toward improving mental health. The researchers examined data on 8,879 patients with fibromyalgia, using data collected between 1998 and 2017. There were 34 suicide attempts and 96 cases of suicidal ideation. A machine-learning algorithm spat out some factors associated with heightened suicide risk, such as fatigue, dizziness, and weakness, as well as obesity and drug dependence.
But it also generated some associations that weren’t obviously related, such as receiving a flu shot or taking vitamin supplements. “There were a lot of things associated with routine medical care in the patients who didn’t have thoughts about suicide and didn’t attempt suicide. So we looked at how much time people spent with their doctor. I think we might have found an important signal that requires further investigation in bigger samples, and also in other populations. If we can look at people who are at risk [of suicide] but who aren’t engaged with their doctors, that gives us a potential avenue to do something about it, where we can get them connected with a provider, or reconnected if they’ve fallen off, or give them a call to see how they’re doing,” Dr. McKernan said.
In fact, the research suggests that such an effort alone might be enough to reduce suicidality, since patient-provider contact appears to be so important.
“I know in the past that physicians have expressed feeling frustrated – like they don’t have some sort of [mental health] intervention to provide patients who have fibromyalgia. This might show that continuing to see the patient, to stay engaged, may have intrinsic benefit that serves almost like an intervention in itself,” Dr. McKernan said.
Dr. McKernan, Dr. Jain, and Dr. Wise had no financial conflicts of interest.