Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Division of Dermatology, Department of Medicine, Women's College Hospital, Toronto, Ontario, Canada.
BMJ Open. 2018 Nov 25;8(11):e023776. doi: 10.1136/bmjopen-2018-023776.
To assess the association of eczema with a patient's subsequent risk of death from suicide. We hypothesised that persistent eczema would be associated with an increased risk for death from suicide.
Double matched case-control study.
General population of Ontario, Canada.
Patients 15-55 years old. We identified cases of suicide from coroners' reports between 1 January 1994 and 31 December 2014 and matched 1:2 with alive controls based on age, sex and socioeconomic status.
The primary predictor was a history of persistent eczema, defined as five or more physician visits for the diagnosis over the preceding 5 years.
Logistic regression to estimate the association between eczema and death from suicide.
We identified 18 441 cases of suicide matched to 36 882 controls over the 21-year accrual period. Persistent eczema occurred in 174 (0.94%) suicide cases and 285 (0.77%) controls yielding a 22% increased risk of suicide associated with persistent eczema (OR 1.22, 95% CI 1.01 to 1.48, p=0.037). In mediation analyses, this association was largely explained through major suicide risk factors. Two-thirds of patients with eczema who died from suicide had visited a physician in the month before their death and one in eight had visited for eczema in the month before their death. Among patients who died by suicide, jumping and poisoning were relatively more frequent mechanisms among patients with eczema.
Patients with persistent eczema have a modestly increased subsequent risk of death from suicide, but this is not independent of overall mental health and the absolute risk is low. Physicians caring for these patients have opportunities to intervene for suicide prevention.
评估湿疹与患者自杀死亡风险之间的关联。我们假设持续性湿疹与自杀死亡风险增加相关。
双匹配病例对照研究。
加拿大安大略省的一般人群。
年龄在 15-55 岁的患者。我们从 1994 年 1 月 1 日至 2014 年 12 月 31 日的验尸报告中确定了自杀病例，并根据年龄、性别和社会经济地位与 1:2 的活着对照进行了匹配。
主要预测因素是持续性湿疹病史，定义为过去 5 年内五次或以上因该诊断就诊。
使用逻辑回归来估计湿疹与自杀死亡之间的关联。
在 21 年的累积期内，我们确定了 18441 例自杀病例，与 36882 例对照相匹配。持续性湿疹在 174 例（0.94%）自杀病例和 285 例（0.77%）对照中发生，与持续性湿疹相关的自杀风险增加 22%（比值比 1.22，95%置信区间 1.01 至 1.48，p=0.037）。在中介分析中，这种关联主要通过主要自杀风险因素来解释。三分之二死于自杀的湿疹患者在死亡前一个月曾就诊过医生，八分之一的患者在死亡前一个月曾因湿疹就诊。在死于自杀的患者中，与湿疹相关的自杀患者中，跳楼和中毒是相对更常见的自杀机制。
持续性湿疹患者随后自杀死亡的风险略有增加，但这与整体心理健康状况无关，绝对风险较低。照顾这些患者的医生有机会进行自杀预防干预。
