Refer Fibromyalgia Patients to Psychs to Reduce Suicides

Patients with fibromyalgia (FM) who attend regular office visits are less likely to self-harm or attempt suicide, according to new study results. 

“This is the first study to successfully apply machine learning to reliably detect suicidality in FM,” the researchers wrote.

Patients with FM are 10 times more likely to die by suicide compared with the general population. Therefore, the researchers sought to validate published models that predicted suicidal ideation and attempts, as well as identify risk and protective factors for suicidality, exclusively in patients with FM.

Model performance of FM cases with validated Phenotype KnowledgeBase criteria were measured by area under the receiver operating characteristic (AUC), sensitivity, specificity, and calibration plots. L1‐penalized regression with bootstrapping was used for identifying risk factors.

The researchers also conducted secondary utilization analyses to convert time‐based billing codes to equivalent minutes to assess face‐to‐face provider contact.

Overall, individuals who did not attempt suicide saw their doctor an average of 50 hours per year, whereas patients who self-harmed saw their doctor less than 1 hour per year.

A total of 34 known suicide attempts and 96 documented cases of suicidal ideation were reported. External validity appeared good for suicidal ideation (AUC, 0.80) and suicide attempts (AUC, 0.82) with exemplary calibration. 

Analyses identified fatigue (odds ratio [OR], 1.29), dizziness (OR, 1.25), and weakness (OR, 1.17) as risk factors specific to suicidal ideation. Risk factors specific to suicide attempt included obesity (OR, 1.18) and drug dependence (OR, 1.15).

“Per utilization analyses, those with FM and no suicidal ideation spent 3.5 [times] more time in follow‐up annually, and those without documented suicide attempts spent over 40 [times] more time face‐to‐face with providers annually,” the researchers wrote.

—Melinda Stevens

Reference:
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. https://doi.org/10.1002/acr.23748.