Prevalence and correlates of suicidal ideation among patients with skin disease

Concerns have been raised about the potential of deliberate self-harm and suicide among patients with dermatologic conditions.

We sought to estimate the prevalence of suicidal ideation among patients with dermatologic conditions, and to identify demographic, clinical, and psychosocial correlates.

Two samples of outpatients with dermatologic conditions (N = 294) and inpatients (N = 172) completed the 12-item General Health Questionnaire, the Skindex-29, and the Patient Health Questionnaire.

Forty patients (8.6%) reported suicidal ideation during the previous 2 weeks. In univariate analysis, the presence of suicidal ideation was associated with female sex, inpatient status, presence of a depressive or anxiety disorder, and higher 12-item General Health Questionnaire and Skindex-29 scores. The size of the diagnostic groups allowed reasonable prevalence estimates only for psoriasis (10%) and acne (7.1%). In multivariate analysis, only emotional distress (12-item General Health Questionnaire) and impaired social functioning (Skindex-29) were independently associated with suicidal ideation.

We lacked an observer-rated evaluation of skin condition and could rely only on the Skindex-29 symptoms subscale as a measure of disease severity. In addition, the measurement of suicidal ideation was limited as a result of the use of only one question to assess it. Furthermore, the cross-sectional design prevented causal inferences.

Suicidal ideation is not rare among patients with dermatologic conditions. Assessing suicidality would be warranted in dermatologic practice among patients at particular risk such as women with high psychologic distress and impaired social functioning. The development of psychiatric consultation-liaison services is mandatory to provide effective treatment and careful follow-up of patients who are suicidal.