Outpatient Engagement May Lower Suicide Attempts in Patients With Fibromyalgia
Patients with fibromyalgia without documented suicidality spent more time annually with a physician, highlighting the importance of outpatient engagement in this patient population.
Risk factors for suicide attempts in patients with fibromyalgia include drug dependence and obesity, according to a study recently published in Arthritis Care & Research. Additionally, time spent between outpatients and providers has shown a positive correlation with protection against suicide.
This case-control study included 8879 participants with fibromyalgia. Within this group, there were 96 documented instances of suicidal ideation and 34 suicide attempts, with good external validity for both suicidal ideation (area under the receiver operating characteristic [AUC]=0.80) and attempts (AUC=0.82). Suicide attempt was associated with specific risk factors, including drug dependence (odds ratio [OR], 1.15; 95% CI, 1.12-1.18) and obesity (OR, 1.18; 95% CI, 1.10-1.27). Suicidal ideation was affected by polysomatic risk factors, including weakness (OR, 1.17; 95% CI, 1.15-1.19), dizziness (OR, 1.25; 95% CI, 1.22-1.28), and fatigue (OR, 1.29; 95% CI, 1.25-1.32). Time spent with providers in follow-up was significantly associated with suicide attempts and ideation. Individuals with fibromyalgia and no suicide attempts spent 40 times longer with providers annually, and those with no suicidal ideation spent 3.5 times longer with providers annually. This finding suggests that outpatient engagement should be pursued for those at risk.
This study included EHR data recorded between 1998 and 2017 and focused on individuals with fibromyalgia who met certain criteria on the Phenotype KnowledgeBase website. Sensitivity, calibration, specificity, and AUC were taken into consideration in evaluating model performance. L1-penalized regression was used to select risk factors. Time spent with providers was estimated by transforming the providers' billing codes to time spent in contact.
The study researchers concluded, “this is the first study to successfully apply machine learning to reliably detect suicidality in [fibromyalgia], identifying novel risk factors for suicidality and highlighting outpatient engagement as a protective factor against suicide.”
McKernan LC, Lenert MC, Crofford LJ, Walsh CG. Outpatient engagement lowers predicted risk of suicide attempts in fibromyalgia [published online September 7, 2018]. Arthritis Care Res (Hoboken). doi: 10.1002/acr.23748.