Chronic pain and psychological distress as mediators of suicidality in rheumatic disorders: a systematic review

Background: Rheumatic disorders are correlated with substantial psychiatric burden. However, few studies have assessed the link between rheumatic disorders and suicide burden. Objectives: To evaluate by systematic review the prevalence of suicide and suicide mortality in rheumatic conditions, and the factors that mediate this relationship. To our knowledge, this is the first review to investigate the prevalence and the correlates of suicidality in these disorders. Methods: A two-pronged literature search was performed, coupling the mandatory term ‘suicid*’ with rheumatology-specific terms such as ‘rheumatoid arthritis’ and ‘fibromyalgia’. Databases searched included PubMed, Scopus, Embase and CINAHL, with an end date of 25 April 2021. Two independent reviewers performed abstract and full-text screening. Findings: Suicidal ideation and mortality were significantly elevated in rheumatoid arthritis, osteoarthritis, fibromyalgia and systemic lupus erythematosus. Chronic pain, psychological distress and low quality of life were positive modulators of the relationship between rheumatic disorders and suicide burden. Conclusion: Rheumatic diseases are associated with elevated suicidality and suicide mortality. However, there is sparse evidence supporting interventions that directly target suicidality in this vulnerable cohort. In addition to medical disease management, clinicians should consider the risk factors contributing to suicidality in this population, with an emphasis on psychiatric screening and allied health linkage. ; No Full Text