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Rheumatic Conditions as Risk Factors for Self‐Harm: A Retrospective Cohort Study
Author(s) -
Prior James A.,
Paskins Zoe,
Whittle Rebecca,
AbdulSultan Alyshah,
ChewGraham Carolyn A.,
Muller Sara,
Bajpai Ram,
Shepherd Tom A.,
Sumathipala Athula,
Mallen Christian D.
Publication year - 2021
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.24345
Subject(s) - medicine , ankylosing spondylitis , fibromyalgia , rheumatoid arthritis , hazard ratio , osteoarthritis , cohort , retrospective cohort study , incidence (geometry) , confidence interval , proportional hazards model , cohort study , rate ratio , physical therapy , pathology , physics , alternative medicine , optics
Objective To examine the risk of self‐harm in rheumatic conditions. Methods We conducted a retrospective cohort study using data from the Clinical Practice Research Datalink. Patients with ankylosing spondylitis, fibromyalgia, osteoarthritis, or rheumatoid arthritis were identified from 1990 to 2016 and matched to patients without these conditions. Incident self‐harm was defined by medical record codes following a rheumatic diagnosis. Incidence rates (per 10,000 person‐years) were reported for each condition, both overall and year‐on‐year (2000–2016). Cox regression analysis determined risk (hazard ratio [HR] and 95% confidence interval [95% CI]) of self‐harm for each rheumatic cohort compared to the matched unexposed cohort. Initial crude analysis was subsequently adjusted and stratified by age and sex. Due to nonproportionality over time, osteoarthritis was also stratified by disease duration (<1 year, ≥1 to <5 years, ≥5 to <10 years, and ≥10 years). Results The incidence of self‐harm was highest in patients with fibromyalgia (HR 25.12 [95% CI 22.45–28.11] per 10,000 person‐years) and lowest for osteoarthritis (HR 6.48 [95% CI 6.20 – 6.76]). There was a crude association with each rheumatic condition and self‐harm, except for ankylosing spondylitis. Although attenuated, these associations remained after adjustment for fibromyalgia (HR 2.06 [95% CI 1.60–2.65]), rheumatoid arthritis (HR 1.59 [95% CI 1.20–2.11]), and osteoarthritis (1 to <5 years HR 1.12 [95% CI 1.01–1.24]; ≥5 to <10 years HR 1.35 [95% CI 1.18 – 1.54]). Age and sex were weak effect modifiers for these associations. Conclusion Primary care patients with fibromyalgia, osteoarthritis, or rheumatoid arthritis (but not ankylosing spondylitis) are at increased risk of self‐harm compared to people without these rheumatic conditions. Clinicians need to be aware of the potential for self‐harm in patients with rheumatic conditions (particularly fibromyalgia), explore mood and risk with them, and offer appropriate support and management.